MUAC and WHZ scores as indicators of SAM:
A consultation for operational agencies and academic specialists to better understand the evidence, identify knowledge gaps and to inform operational guidance
Dates: December 2012
Venue: London, UK
Donors: SCUK, WHO, ACF, UNHCR
Facilitators: The ENN and SCUK
ENN project lead: Tamsin Walters (ENN Associate)
Summary
In December 2012, a two day meeting of academic specialist and agency representatives was convened in London, UK, and facilitated by the ENN to discuss technical and programmatic issues relating to the use of mid-upper arm circumference (MUAC) and weight for height (WHZ scores) in the treatment of Severe Acute Malnutrition (SAM) programmes.
A premise of the consultation was that there is no gold standard anthropometric indicator of acute malnutrition: MUAC and WHZ are two imperfect indicators used as a proxy to identify the same children and, when they do the proportions identified using both methods vary between regions and countries. The meeting was preceded by a detailed review of agency programme experiences of using these indicators as well as a review of the evidence base.
The meeting participants discussed the review in depth and agreed on 6 recommendations, as follows:
- Recommendation 1: At community level, there should be active case finding using MUAC to identify children requiring management of SAM. At health facility level there should be systematic case finding using MUAC to identify children requiring management of SAM. If a child is screened with MUAC but not identified as being SAM, WHZ should be measured where it is feasible without jeopardising other essential health services; WHZ should be measured in particular where there are relevant clinical conditions, visible severe wasting, maternal concern and/or contextual factors (e.g. acute or prolonged emergency where more older children are affected).
- Recommendation 2: All children 6 months and above with a MUAC of <115mm should be treated for SAM. Where WHZ is used, children 6 months and above with a WHZ <-3 should be treated for SAM.
- Recommendation 3: Weight gain should be used to monitor response to treatment for all children. MUAC should be recorded in millimetres at each visit in operational research settings to establish whether MUAC monitoring can be conducted accurately and whether it is feasible for use in monitoring progress of children.
- Recommendation 4: Currently there is no firm recommendation that can be made for discharge criteria of children admitted on MUAC for the treatment of SAM. More evidence is needed from various contexts.
- Recommendation 5: Pending further research, children admitted for the treatment of SAM based on WHZ should continue to be discharged when WHZ ≥-2 and the child is free from oedema for 2 weeks.
- Recommendation 6: The percentage of weight gain should no longer be used as a discharge criterion for children admitted on MUAC for the treatment of SAM.
Meeting Report
More like this
FEX: A consultation of operational agencies and academic specialists on MUAC and WHZ as indicators of SAM
Summary of meeting report1 The treatment of severe acute malnutrition (SAM) is a costeffective, evidence-based ‘direct’ nutrition intervention, according to the 2008 Lancet...
en-net: Target weight setting for MAM HIV positive in OTC
Dear ENN collegues, Please share your experiences on attainment of 20% target weight gain among MAM HIV positive children enrolled in Outpatient therapeutic care when admitted...
en-net: WFH versus MUAC
I would like experts input in this regard. I wish Mark Myatt to be one of the respondent of my question. Much has been said about the discrepancy of MUAC and WFH in some...
FEX: Substandard discharge rules in current severe acute malnutrition management protocols: An overlooked source of ineffectiveness for programmes?
View this article as a pdf Lisez cet article en français ici By Benjamin Guesdon and Dominique Roberfroid Benjamin Guesdon is a nutrition and health research advisor...
FEX: MUAC as discharge criterion and weight gain in malnourished children
Summary of published research1 A child on admission to the Gedaref nutrition programme In addition to guidance on admission criteria for nutrition programmes, the WHO...
en-net: Do we need to reconsider the CMAM admission and discharge criteria?; an analysis of CMAM data in South Sudan
You can find the paper through the link below and is also attached. please help share with...
FEX: Death of children with SAM diagnosed by WHZ or MUAC: Who are we missing?
Summary of presentation1 View this article as a pdf By Michael H. Golden and Emmanuel Grellety Michael Golden is a retired professor of medicine with 45 years' experience of...
FEX: Is MUAC alone a sufficient criterion for admission of children at high risk of mortality in South Sudan?
Summary of research 1 Location: South Sudan What we know: The operational implications of using MUAC as the sole anthropometric admission criterion to therapeutic feeding...
FEX: Weight-for-height and mid-upper-arm circumference should be used independently to diagnose acute malnutrition: policy implications
Summary of research1 Location: Global What we know: Overlap between mid-upper-arm circumference (MUAC) and weight-for-height Z-scores (WHZ) when assessing acute malnutrition...
FEX: MUAC alone admission to SAM treatment in Bangladesh
Summary of research1 Location: Bangladesh What we know: MUAC and weight-for-height z score (WHZ) are common anthropometric criteria to diagnose severe acute malnutrition...
FEX: Simplifying the response to childhood malnutrition: MSF’s experience with MUAC-based (and oedema) programming
By Kevin P.Q. Phelan, Candelaria Lanusse, Saskia van der Kam, Pascale Delchevalerie, Nathalie Avril and Kerstin Hanson Kevin P.Q. Phelan was the Nutrition Working Group Leader...
en-net: MUAC and WHZ as indicators of SAM - ENN produced report available
A report on a recent consultation on the role of MUAC and WHZ as indicators of SAM is now [url=http://www.ennonline.net/muacandweightforheightindicators]now available[/url]....
FEX: en-net update, August to October 2012
By Tamsin Walters, en-net moderator Forty-seven questions were posted on en-net in the three months August to October 2012 inclusive, eliciting 152 replies. In addition, 18...
en-net: MUAC vs W/H
I understand that MUAC has gender and age bias, identifying more girls and younger children with acute malnutrition. Has any work been done to show if MUAC only criteria were...
en-net: Target weight based minimum weight during treatment at OTP sites
Hello every one During treatment of SAM children in OTP we often find some drop in weight for new enrolled children in initial couple of weeks. Pakistan CMAM guideline...
en-net: Discharge Criteria in OTP: 15% GoW vs. W/H>-1.5SD
Dear all, Id like to know if there was a study comparing the efficiency of discharge criteria with 15% GoW only vs. W/H--1.5SD, especially regarding the risk of relapse and...
en-net: Borderline MUAC and Z-score measurements
What is the most appropriete practical decision should one make when confronted with cases of borderline MUACs and Z-scores of 11.5cm and -2 SD respectively in nutrition...
FEX: Integration of management of children with severe acute malnutrition in paediatric inpatient facilities in India
View this article as a pdf Lisez cet article en français ici By Praveen Kumar, Virendra Kumar, Sila Deb, Arpita Pal, Keya Chatterjee, Rajesh Kumar Sinha and Sanjay...
en-net: Only MUAC for admission and discharge?
There has been a discussion about the use of ONLY MUAC as an admission and discharge criteria (http://www.en-net.org/question/468.aspx). Although I understand the challenge in...
FEX: Putting Child Kwashiorkor on the Map
Jose Luis Alvarez, Nicky Dent, Lauren Browne, Mark Myatt and André Briend Putting Kwashiorkor on the Map started as a call for sharing data to give an idea of...
Reference this page
Chloe Angood (). MUAC and WHZ scores as indicators of SAM:. www.ennonline.net/ourwork/othermeetings/muacwhzscores
(ENN_1056)