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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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- Author(s): Tessema M;Tessema M; Laillou A; Laillou A; Tefera A; Tefera A; Teklu Y; Teklu Y; Berger J; Berger J; Wieringa FT; Wieringa FT
- Source:
PloS one [PLoS One] 2020 Apr 09; Vol. 15 (4), pp. e0230502. Date of Electronic Publication: 2020 Apr 09 (Print Publication: 2020).- Publication Type:
Evaluation Study; Journal Article- Language:
English - Source:
- 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.
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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
- Source:
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