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Post a reply: Threshold for interventions using MUAC

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Dear ENN-ers,

Once again, thanking you all for all the valuable input this forum provides.

This question is a re-hash of an old debate that I have read here: and in which I am trying to gain a deeper understanding.

In brief:
The issue covers South Sudan, a country in which population data is so difficult to find. So while I agree with the comments on the forum that instead of rather arbitrary thresholds (of 15%), absolute numbers should be used to define magnitude of the nutritional problem, this is not possible. Furthermore, the various surveys that are conducted in the context are in a similar rural environment – we can analyse separately with regards to the displaced camps.

South Sudan, we know, has a population of “long legged” groups which we are aware distort the BMI downwards in adult populations. I have heard of a research by MSF in children which found a similar issue (I can’t find it though…and I know that GOAL have also tried to address this issue). So we know the WfH prevalence’s we get is “distorted” due to body shape.

All the points taken into account, maybe an alert system based on MUAC threshold could be useful – but again this comes with the question, what threshold? Using 15% could create a lot of discrepancy in where we classify as “more” critical as a result of these thresholds… Just for some examples on the differences we could see, using some of the data from 2014-2016 in South Sudan, only 6 of the 48 surveys with a GAM (wfH) >15% had a similar MUAC prevalence of >15%, while the majority had a corresponding MUAC of <10%. Similar trends exist for the threshold for SAM (WfH) for 2%. This means that using MUAC and using the thresholds for defining an emergency, only 6 areas surveyed would have been critical for GAM and 3 for SAM.

GAM MUAC <10% MUAC 10-15% MUAC >15% Total
WfH >15% 30 12 6 48

SAM MUAC <2% MUAC 2-5% MUAC >5% Total
WfH >2% 34 19 3 56

While the context is quite specific with some very specific challenges (body shape etc) and the issues highly politicized, I would love some guidance on how we could interpret MUAC in this context and at what point we declare a situation critical using MUAC. This could guide assessments that are conducted using MUAC only (for varying reasons). I am aware of the arguments stated on going away from these arbitrary thresholds, but as it was expressed “…the current climate of highly politicised aid, some kind of classification system for provoking response and ensuring accountablity is needed. Using malnutrition rates as one among a number of other indicators can help to focus donors and ensure that response is timely and appropriate”.

Thanks in advance for the guidance or discussions that come from this.

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