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PLoS One. 2016 Feb 3;11(2):e0146442. doi: 10.1371/journal.pone.0146442. eCollection 2016.

Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia.

Author information

1
Institut de Recherche pour le Developpement, UMR 204, IRD/Montpellier1/Montpellier2/SupAgro (Nutripass), Montpellier, France.
2
National Nutrition Program, Maternal and Child Health Center, Phnom Penh, Cambodia.
3
UNICEF, Maternal Child Health and Nutrition section, Phnom Penh, Cambodia.
4
World Food Program, Phnom Penh, Cambodia.
5
Independent consultant, Phnom Penh, Cambodia.
6
Ministry of Agriculture, Forestry and Fisheries, FiA Administration DFPTQ, Phnom Penh, Cambodia.

Abstract

BACKGROUND:

Early identification of children <5 yrs with acute malnutrition is a priority. Acute malnutrition is defined by the World Health Organization as a mid-upper-arm circumference (MUAC) <12.5 cm or a weight-for-height Z-score (WHZ) <-2. MUAC is a simple and low-cost indicator to screen for acute malnutrition in communities, but MUAC cut-offs currently recommended by WHO do not identify the majority of children with weight-for-height Z-score (<-2 (moderate malnourished) or r<-3 (severe malnourished). Also, no cut-offs for MUAC are established for children >5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition.

METHODS:

To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011-2013). Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC) were calculated using wasting for children <5yrs and thinness for children ≥5yrs as gold standards. Among the highest values of AUC, the cut-off with the highest sensitivity and a false positive rate ≤33% was selected as the optimal cut-off.

RESULTS:

Optimal cut-off values increased with age. Boys had higher cut-offs than girls, except in the 8-10.9 yrs age range. In children <2yrs, the cut-off was lower for stunted children compared to non stunted children. Sensitivity of MUAC to identify WHZ<-2 and <-3 z-scores increased from 24.3% and 8.1% to >80% with the new cut-offs in comparison with the current WHO cut-offs.

CONCLUSION:

Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score <-2 z-scores. International reference of MUAC cut-offs by age group and gender should be established to screen for acute malnutrition at the community level.

PMID:
26840899
PMCID:
PMC4739613
DOI:
10.1371/journal.pone.0146442
[Indexed for MEDLINE]
Free PMC Article

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