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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Mid-upper arm circumference only protocol in Pakistan: missed opportunities for children suffering from severe acute
Benjamin Guesdon1, Meena Iqbal Faruqi1, Muhammad Ilyas Siddiqui2
1Action Contre la Faim - France, 102 rue de Paris, 93100Montreuil, France.
Insights
Using mid-upper arm circumference (MUAC) alone for severe acute malnutrition (SAM) missed many children needing care. This approach led to underdiagnosis and inadequate treatment, highlighting the need for improved identification methods.
Area of Science:
- Public Health
- Pediatrics
- Nutrition Science
Background:
- Severe acute malnutrition (SAM) poses a significant threat to child survival globally.
- Mid-upper arm circumference (MUAC) is widely used for SAM screening, but its sole application may have limitations.
- Weight-for-height Z-score (WHZ) is another key indicator for assessing child malnutrition.
Purpose of the Study:
- To investigate missed treatment opportunities in severe acute malnutrition (SAM) programs relying solely on mid-upper arm circumference (MUAC).
- To compare MUAC-based identification with weight-for-height Z-score (WHZ) in children with SAM.
- To explore parental perceptions of SAM treatment protocols.
Main Methods:
- A cross-sectional study was conducted in Tando Allah Yar District, Sindh, Pakistan.
- Quantitative data included MUAC and WHZ assessments for screened and treated children (n=17,277).
- Qualitative data were gathered through interviews with parents of children receiving SAM treatment (n=41).
Main Results:
- A substantial proportion of SAM cases identified by MUAC alone also met 'WHZ-only' criteria for malnutrition (up to 93.9% in older children).
- Over 25% of children discharged as recovered from SAM were still severely wasted based on WHZ.
- Parents generally viewed the treatment positively but suggested expanding eligibility criteria.
Conclusions:
- Relying exclusively on MUAC for SAM management (referral, admission, discharge) leads to significant missed opportunities for identifying and treating malnourished children.
- Integrating WHZ alongside MUAC may improve the accuracy and coverage of SAM interventions.
- Programmatic adjustments are needed to ensure all children requiring care for severe acute malnutrition receive timely and adequate support.
Objective:
We investigated the missed treatment opportunities affecting programmes using mid-upper arm circumference (MUAC) as the sole anthropometric criterion for identification and monitoring of children suffering from severe acute malnutrition (SAM).
Design:
Alongside MUAC, we assessed weight-for-height Z-score (WHZ) in children screened and treated according to the national MUAC only protocol in Pakistan. Besides, we collected parents' perceptions regarding the treatment received by their children through qualitative interviews.
Setting:
Data were collected from October to December 2021 in Tando Allah Yar District, Sindh.
Subjects:
All children screened in the health facilities (n 8818) and all those discharged as recovered (n 686), throughout the district, contributed to the study. All children screened in the community in the catchment areas of five selected health facilities also contributed (n 8459). Parents of forty-one children randomly selected from these same facilities participated in the interviews.
Results:
Overall, 80·3 % of the SAM cases identified during community screening and 64·1 % of those identified in the health facilities presented a 'WHZ-only' diagnosis. These figures reached 93·9 % and 84·5 %, respectively, in children aged over 24 months. Among children treated for SAM and discharged as recovered, 25·3 % were still severely wasted according to WHZ. While parents positively appraised the treatment received by their children, they also recommended to extend eligibility to other malnourished children in their neighbourhood.
Conclusion:
In this context, using MUAC as the sole anthropometric criterion for treatment decisions (referral, admission and discharge) resulted in a large number of missed opportunities for children in need of timely and adequate care.
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