Routinely MUAC screening for severe acute malnutrition should consider the gender and age group bias in the Ethiopian non-emergency context.

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  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science
    • Subject Terms:
      Arm/*anatomy & histology ; Body Weights and Measures/*methods ; Child Development/*physiology ; Severe Acute Malnutrition/*diagnosis; Age Factors ; Bias ; Body Height/physiology ; Body Weight/physiology ; Child, Preschool ; Diagnostic Tests, Routine/methods ; Ethiopia/epidemiology ; Female ; Growth Charts ; Health Status Indicators ; Humans ; Infant ; Male ; Mass Screening/methods ; ROC Curve ; Sensitivity and Specificity ; Severe Acute Malnutrition/epidemiology ; Sex Factors
    • Abstract:
      Early identification of children <5 years with severe acute malnutrition (SAM) is a high priority to reduce child mortality and improved health outcomes. Current WHO guidelines for community screening for SAM recommend a Mid-Upper-Arm Circumference (MUAC) of less than 115 mm to identify children with SAM, but this cut-off does not identify a significant number of children with a weight-for-height Z-score <-3. To establish new specific MUAC cut-offs, pooled data was obtained for 25,755 children from 49 SMART recent surveys in Ethiopia (2016-2019). Sensitivity, proportion of false positive, and areas under receiver-operator characteristic curves (AUC) were calculated. MUAC below 115mm alone identified 55% of children with SAM identified with both methodologies. MUAC was worse in identifying older children (21%), those from a pastoral region (42%) and boys (41%). Using current WHO cut-offs, the sensitivity (Se) of MUAC below 115mm to identify the children severly malnourished screened through Weight-for-height below-3 was 16%. Analysing the ROC curve and Youden Index, Se and Specificity (Sp) were maximal at a MUAC < 133 mm cut-off to identify SAM (respectively Se 61.1%, Sp 81.4%). However, given the high proportion of false-positive children, according to gender, region and age groups, a cut-off around 125 mm to screen SAM could be the optimal one. In Ethiopia, implementation of a MUAC-only screening program for the identification of severe acute malnutrition with the actual cut-off of 115 mm would be unethical as it will lead to many children remaining undiagnosed and untreated. In addition, future study on implementation challenge on screening children with a higher cut-off or gender/age sensitive ones should be assessed with the collection of mortality and morbidity data to ensure that the most in need are being taking care of.
      Competing Interests: The authors have declared that no competing interests exist.
    • References:
      Eur J Clin Nutr. 1989 Oct;43(10):715-26. (PMID: 2612460)
      Am J Clin Nutr. 1989 May;49(5):884-8. (PMID: 2718923)
      Nutr J. 2018 Sep 15;17(1):80. (PMID: 30217196)
      PLoS One. 2016 Dec 28;11(12):e0168585. (PMID: 28030627)
      Caspian J Intern Med. 2013 Spring;4(2):627-35. (PMID: 24009950)
      Glob Health Sci Pract. 2018 Oct 4;6(3):552-564. (PMID: 30185435)
      Am J Phys Anthropol. 1998 Aug;106(4):483-503. (PMID: 9712477)
      PLoS One. 2014 Jul 01;9(7):e101159. (PMID: 24983995)
      Cancer. 1950 Jan;3(1):32-5. (PMID: 15405679)
      Arch Public Health. 2015 May 18;73(1):26. (PMID: 25992287)
      Am J Public Health. 1993 Nov;83(11):1616-8. (PMID: 8238688)
      Br Med J (Clin Res Ed). 1986 Aug 9;293(6543):373-5. (PMID: 3089529)
      Acta Paediatr Suppl. 2006 Apr;450:76-85. (PMID: 16817681)
      Nutrients. 2017 Mar 11;9(3):. (PMID: 28287482)
      Nutrients. 2018 Jun 19;10(6):. (PMID: 29921769)
      Matern Child Nutr. 2012 Jan;8(1):130-3. (PMID: 21951349)
      Nutr Res Pract. 2019 Jun;13(3):247-255. (PMID: 31214293)
      Ann Hum Biol. 2009 Jan-Feb;36(1):5-20. (PMID: 19085192)
      PLoS One. 2012;7(11):e49320. (PMID: 23189140)
      Arch Public Health. 2018 Feb 22;76:11. (PMID: 29484177)
      PLoS One. 2015 Sep 16;10(9):e0137606. (PMID: 26376281)
      PLoS One. 2016 Feb 03;11(2):e0146442. (PMID: 26840899)
    • Publication Date:
      Date Created: 20200410 Date Completed: 20200721 Latest Revision: 20200721
    • Publication Date:
      20221213
    • Accession Number:
      PMC7144967
    • Accession Number:
      10.1371/journal.pone.0230502
    • Accession Number:
      32271790