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Discrepancies of malnutrition prevalence among boys and girls

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Anonymous 2515

Concern Worldwide

Normal user

6 May 2014, 11:47

Dear all,

I was just looking at nutrition survey results which was conducted in 2012 in three locations of Darfur State, Sudan. The finding was analysed in both WHZ score (WHO 2006) and MUAC.
Using the WHZ score analysis higher malnutrition prevalence reported among boys in all three surveys. However, using MUAC analysis higher malnutrition prevalence reported among girls in all three surveys. I wonder if anyone can share reasons for this discrepancy.

Many Thanks,

Mark Myatt

Consultant Epideomiologist

Frequent user

6 May 2014, 16:14

There have been quite a few discussions WRT discrepancies between prevalence by MUAC and WHZ in these pages. Here are a few links:

http://www.en-net.org.uk/question/770.aspx
http://www.en-net.org.uk/question/759.aspx
http://www.en-net.org.uk/question/747.aspx
http://www.en-net.org.uk/question/744.aspx
http://www.en-net.org.uk/question/708.aspx
http://www.en-net.org.uk/question/649.aspx
http://www.en-net.org.uk/question/543.aspx
http://www.en-net.org.uk/question/328.aspx
http://www.en-net.org.uk/question/200.aspx
http://www.en-net.org.uk/question/83.aspx
http://www.en-net.org.uk/question/82.aspx

There are more!

A few reasons come to mind for your specific observation ...

Age distribution of cases : MUAC cases will tend to be younger than WHZ cases. This can be quite extreme in warm-climate pastoralist populations where WHZ may select healthy older children with long limbs. WHZ and MUAC select different populations and the relationship between the indicator and sex may be different in different populations.

Sex : Females tend to have slightly lower MUACs than males so any fixed cut-point is likely to select slightly more females than males even if males and females were equally at risk of wasting. If there is unequal risk it may favour boys (e.g. they may get the better food and receive preferential treatment when sick) leading to proportionally more girls being wasted.

Body shape : Males may have a more extreme body shape (i.e lower sitting to standing heigh ratio) than girls. This could be genetic or environmental (e.g. boys get more milk, better treatment seeking when sick, better food). WHZ is strongly influenced by body shape (i.e. boys may have lower WHZ than girls).

Error : It might be error or chance (unlikely given that it has happened in multiple surveys.

It might be a combination of these things.

I hope this helps.

Anonymous 2515

Concern Worldwide

Normal user

6 May 2014, 19:49

Dear Mark,

Thank you very much for the detailed explanation and sharing the link on similar discussions.

Regards,
Lubaba

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