The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis
Ayenew Negesse1,2, Tsinuel Girma3,4, Beruk Berhanu Desalegn1
1Academic Center of Excellence for Human Nutrition, School of Nutrition, Food Science and Technology (SNFST), Hawassa University, Hawassa P.O. Box 05, Ethiopia.
Insights
The 2023 World Health Organization (WHO) guidelines for infant wasting significantly increase caseloads compared to 2013 criteria. Mid-upper arm circumference (MUAC) thresholds may need adjustment in programs where weight-for-age Z-scores (WAZ) are challenging to measure.
Area of Science:
- Pediatrics
- Public Health
- Nutrition Science
Background:
- The 2023 World Health Organization (WHO) guidelines introduce mid-upper arm circumference (MUAC) and weight-for-age Z-score (WAZ) for infant malnutrition treatment enrollment.
- Evidence supporting these new criteria and optimal cut-offs for infants under six months (u6m) is limited.
- This study evaluates the potential caseload implications of the new WHO criteria and explores the impact of different cut-offs.
Purpose of the Study:
- To assess the caseload impact of the WHO 2023 infant wasting criteria in Ethiopia.
- To compare the caseload identified by WHO 2023 criteria versus WHO 2013 criteria.
- To explore the utility of different anthropometric indicators and cut-offs for malnutrition screening.
Main Methods:
- Secondary analysis of data from 1048 Ethiopian infants under six months.
- Utilized STATA software for data analysis, including frequency tables, percentages, and chi-square tests.
- Compared caseloads identified by WHO 2023 criteria against WHO 2013 criteria using 95% confidence intervals and a p-value <0.05.
Main Results:
- The WHO 2023 criteria identified a substantially larger potential caseload: 19.2% for infants 6 weeks to 6 months and 15.1% for infants under 6 weeks, compared to 2.4% under WHO 2013 criteria.
- While overlaps exist between low WAZ, low weight-for-length Z-score (WLZ), and low MUAC, these indicators identify different infants.
- Using MUAC <110 mm alone would identify only one-third of infants identified by WAZ or WLZ < -2.
Conclusions:
- The WHO 2023 criteria significantly increase malnutrition caseloads in Ethiopian infants compared to the WHO 2013 guidelines.
- Consideration should be given to adjusting MUAC thresholds in MUAC-focused programs, especially where WAZ or WLZ measurements are difficult.
- Further longitudinal research is necessary to determine which criteria best predict infant mortality, morbidity, and poor developmental outcomes.
Background/Objectives:
The 2023 World Health Organization (WHO) guideline on infants aged under six months (u6m) wasting now includes mid-upper arm circumference (MUAC) and weight for age Z score (WAZ) as malnutrition treatment programme enrolment criteria. Evidence for the new criteria and optimal cut-offs is, however, sparse. We aimed to explore the potential caseload implications of the new criteria and explore how different cut-offs might affect them.
Methods:
We conducted a secondary analysis of data from 1048 Ethiopian infants u6m using STATA software version 17. Frequency tables and percentages were used to present malnutrition across various characteristics. The chi-square test with 95% confidence intervals (CIs) at a p value of <0.05 was used to compare infant caseload identified by the WHO-2023 versus WHO-2013 criteria.
Results:
We found substantial overlaps among anthropometric indicators of malnutrition in infants defined by the WHO-2023 programme enrolment criteria. New WHO criteria result in a larger potential caseload (19.2% for 6 weeks to 6 months and 15.1% for infants under 6 weeks) compared with WHO-2013 criteria (2.4%). Whilst there are marked overlaps between low WAZ, low WLZ, and low MUAC, they capture different infants. An MUAC of <110 mm alone would capture only a third of all cases identified by WAZ and/or WLZ < -2.
Conclusions:
In Ethiopia, the WHO-2023 criteria markedly increase malnutrition caseloads compared with WHO-2013 criteria. There might be a case for increasing MUAC thresholds in MUAC-focused programs where WLZ or WAZ measurements are difficult. Future longitudinal data are needed to know which criteria best identify infants at highest risk of mortality/morbidity/poor development.
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