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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

Mid Upper Arm Circumference and Weight-for-Height Z-score as Indicators of Severe Acute Malnutrition (2012

Reference this page

Chloe Angood (2014). MUAC and WHZ scores as indicators of SAM:. www.ennonline.net/ourwork/othermeetings/muacwhzscores

(ENN_1056)