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Comparison between Weight-for-Height Z-Score and Mid Upper Arm Circumference to Diagnose Children with Acute

Praveen Kumar1, Vasundhara Bijalwan2, Narendra Patil2

  • 1Department of Pediatrics, Kalawati Saran Children's Hospital Associated Lady Hardinge Medical College, New Delhi, India.

Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine
|October 9, 2018
PubMed

Insights

In India, weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC) identify different children with acute malnutrition. Only about a quarter of cases meet both criteria, with MUAC better for younger children and females.

Area of Science:

  • Public Health
  • Pediatric Nutrition
  • Anthropometry

Background:

  • The World Health Organization (WHO) recommends weight-for-height Z-score (WHZ) or mid-upper arm circumference (MUAC) for diagnosing acute malnutrition in children.
  • WHZ and MUAC identify distinct groups of children, with varying overlap in prevalence across different countries.

Purpose of the Study:

  • To assess the degree of overlap and agreement between WHZ and MUAC for diagnosing acute malnutrition in Indian children.
  • To understand the implications of using different anthropometric criteria for case identification.

Main Methods:

  • Analysis of data from five nutrition surveys in India using the Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology.
  • Inclusion of 2127 children aged 6-59 months, with anthropometric indices calculated using emergency nutrition assessment software and analyzed in Epi-Info.

Main Results:

  • WHZ identified 96% of global acute malnutrition (GAM) and 95.1% of severe acute malnutrition (SAM) cases, while MUAC identified 28.4% (GAM) and 30% (SAM).
  • The overlap between WHZ and MUAC criteria was low, at 24.5% for GAM and 25.2% for SAM.
  • MUAC demonstrated higher sensitivity in identifying acute malnutrition among children aged 6-23 months and females.

Conclusions:

  • Approximately one-fourth of GAM and SAM cases were identified by both WHZ and MUAC criteria.
  • MUAC identified a smaller proportion of SAM cases in India compared to other countries.
  • MUAC identified more females and younger children, a group at higher mortality risk, potentially leading to a significantly smaller caseload requiring intervention compared to WHZ.
Abstract

Keywords:
Global acute malnutritionmid-upper arm circumferencesevere acute malnutritionweight-for-height Z-score

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