Relationship between MUAC and weight changes in children aged 6–59 months

Just FYI.

Here is an article on MUAC and weight change during treatment for SAM.

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Fred,

I had not thought of using a MUAC chart as you would a weight-for-age growth chart in (e.g.) a growth monitoring program (GMP). we have had considerable success using MUAC in an integrated GMP and CMAM program. In this program we measured MUAC and admit on a single MUAC threshold and watch-listed based on proximity to that threshold. This has proved feasible.

I think the main issue with using MUAC for GMP is that MUAC does not change very much or very rapidly with age after about 12 months of age. There is a lot going on in terms of the composition of the upper arm, tissue mass increases over time with increasing limb-length in children that are not stunting or stunted, but MUAC does not increase very much very rapidly. The fear is that (e.g.) monthly monitoring might not be very sensitive to detect faltering. I think that the best approach would be to do SAM and MAM case-finding using MUAC within GMP programs.

We do see measurable and rapid MUAC response to treatment for SAM. The next thing to work on is a simple monitoring tool. This could be a sort of growth chart as in this early example from the Malawi study:

or a simple algorithm such as:

    if current MUAC <= previous MUAC
        then [ACTION PROTOCOL]

Replacing weight monitoring with MUAC monitoring will allow further decentralisation of CMAM services (e.g. to be delivered by CHWs). I think, with careful design, we could develop a tool that could be safely used by CHWs with limited letter and number skills.

Fred,

Looking at your points in turn:

(1) The chart does work well on the population in which it was developed but it does need calibration and further testing. A key issue with this is that this type of chart requires some number skills that cannot be taken for granted when working with CHWs in some settings. This may limit its use. It would work OK with an integrated GMP and CMAM program (as done by SC-US and Tufts in Bangladesh) as the GMP workers do have the relevant skills ... but they can monitor response using weight anyway. I think the longitudinal strap might be a better bet in such settings.

(2) I do not doubt that growth faltering starts early but I do not think that DHS is a good tool to detect this because of (a) poor data quality and (b) faltering is a process and a cross-sectional survey cannot detect a process only the outcomes of processes. That said, there has been some interesting work from the Kilifi team on MUAC in children aged < 6 months.

(3) I think the work done by ALIMA under the heading "MUAC = Mothers Understand And Can use it" (something like that) and in the nascent MUAC bangle / bracelet work by ACF. This work is all about mothers using MUAC classification devices. The approach shows a lot of promise. ALIMA has a second paper in preparation.

(4) I'd very much like to see the monitoring tape. This might save a lot of time and work looking at monitoring tools. Is this the tape shown as "longitudinal" in your AJCN 1975 paper? IRC plan to test something like that:

in an iCCM (CMAM by CHWs) program.

MSF are working with others to produce broad (2.5 cm) straps.

Best wishes for the New Year.