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Published on: June 20, 2020
Weight estimation for children aged 6 to 59 months in limited-resource settings: A proposal for a tape using height
Mark E Ralston1, Mark A Myatt2
1Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
Insights
A new tool accurately estimates child weight using height and mid-upper arm circumference (MUAC) in low-resource settings. This simple method aids healthcare providers in assessing malnutrition where scales are unavailable.
Area of Science:
- Pediatric Nutrition
- Global Health
- Biostatistics
Background:
- Limited-resource settings face challenges in accurately assessing child weight, crucial for identifying severe acute malnutrition.
- Existing weight estimation tools may lack reliability in these contexts, where under-five mortality is high.
Purpose of the Study:
- To evaluate the accuracy and precision of a height and mid-upper arm circumference (MUAC) based weight estimation tool.
- To validate the tool's performance in children aged six months to five years in low-to-middle income countries.
Main Methods:
- Utilized data from 2,434 nutritional surveys across 51 low-to-middle income countries (1992-2017).
- Included over 1.8 million children (6-59 months) meeting specific anthropometric criteria.
- Employed a regression model using height and MUAC to estimate weight, analyzing accuracy and precision metrics.
Main Results:
- The height and MUAC model demonstrated accuracy and precision in weight estimation.
- Overall mean percentage difference (MPD) was +0.67% with a standard deviation (SD) of 9.95%.
- Proportions of estimates within ±10% (PW10) and ±20% (PW20) were 68.31% and 94.73%, respectively.
Conclusions:
- An updated model using height and MUAC is accurate and precise for estimating child weight in diverse low-resource settings.
- A proposed height-based weight estimation tape, stratified by MUAC classes, offers a practical solution for limited-resource environments.
Importance:
A simple, reliable tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available to healthcare professionals including first-response providers.
Objective:
To test the accuracy and precision of an existing weight estimation tool based on patient height and mid-upper arm circumference (MUAC) in children between six months and five years of age in low-to-middle income countries.
Design:
Data were collected in 2,434 nutritional surveys during 1992-2017 using a modified Expanded Program of Immunization two-stage cluster design.
Setting:
Locations in 51 low-to-middle income countries with high prevalence of acute and chronic malnutrition.
Participants:
Of 1,848,979 children enrolled in the surveys, a total of 1,800,322 children met inclusion criteria (age 6-59 months; weight ≤ 25 kg; MUAC 80-200 mm) and exclusion criterion (bilateral pitting edema and biologically implausible measurements based on WHO flagging criteria).
Exposures:
Weight was estimated by a regression procedure using database height and MUAC.
Main Outcomes And Measures:
Mean percentage difference between true and estimated weight (MPD), proportion of estimates accurate to within ± 10% and ± 20% of true weight (PW10 and PW20), weighted Kappa statistic, and Bland-Altman bias (bias) were reported as measures of tool accuracy. Standard deviation (SD) of the MPD and Bland-Altman 95% limits of agreement (LOA) were reported as measures of tool precision.
Results:
The height model fitted for MUAC classes was accurate and precise. MPD was +0.67% (SD = 9.95%); PW10/PW20 were 68.31% (95% CI 68.24%, 68.38%)/94.73% (95% CI 94.69%, 94.76%); and bias (LOA) were +0.06 kg (-1.97 kg; +2.10 kg). For MUAC < 115 mm, PW10/PW20 were 63.91% (95% CI 63.42%, 64.40%)/90.72% (95% CI 90.42%, 91.01%); and bias (LOA) were +0.14 kg (-1.29 kg; +1.56 kg). For 115 mm ≤ MUAC < 125 mm, PW10/PW20 were 76.27% (95% CI 76.03%, 76.51%)/96.36% (95% CI 96.25%, 96.46%); and bias (LOA) were +0.06 kg (-1.20 kg; +1.33 kg). For MUAC > 125 mm, PW10/PW20 were 69.93% (95% CI 69.86%, 70.00%)/95.27% (95% CI 95.24%, 95.30%); and bias (LOA) were +0.05 kg (-2.04 kg; +2.13 kg).
Conclusions And Relevance:
An updated model estimating weight from height and MUAC in a large database of children aged 6 to 59 months across a wide range of low-to-middle income countries with high prevalence of acute and chronic malnutrition was confirmed to be accurate and precise. A height-based weight estimation tape stratified according to MUAC classes is proposed for children aged 6-59 months in limited-resource settings.
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