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How often to measure MUAC for nutrition screening of Under 5 year children in the community?

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Anonymous 411

Nutritionist

Normal user

19 Aug 2010, 12:07

We plan to introduce surveillance system using MUAC as screening tool in flood affected areas and am not sure how often we need to conduct the measurement e.g monthly or quarterly? I am experienced in using weight for height and as you know with children weight could change within very short time and you could weigh children monthly as the GMP programs do. I believe MUAC does not change that fast and that is why UNICEF and WHO recommend for the CMAM programs to use percentage of weight gain rather than MUAC for discharge. I would like to hear from the experts and those who have experience of using MUAC as screening tool regarding the above question. Thank you

Mark Myatt

Consultant Epideomiologist

Frequent user

19 Aug 2010, 15:57

MUAC is a good surveillance tool. It meets the criteria of simplicity, acceptability, cost, objectivity, quantitativeness, age-independence, precision, and accuracy required of a case-defining indicator for surveillance better than W/H. See:

http://www.who.int/nutrition/topics/backgroundpapers_A_%20review.pdf

for a (pretty) full discussion.

André Briend and colleagues:

http://horizon.documentation.ird.fr/exl-doc/pleins_textes/pleins_textes_5/b_fdi_23-25/30635.pdf

have looked at this and conclude that weight change, MUAC, and W/H respond well (this was in response to flooding in Bangladesh). The decision between (e.g.) MUAC and W/H can be informed by practicality. Since they both work and MUAC is quicker and cheaper it would make sense to use MUAC.

I think that 3 months the longest interval between measurements that would be useful. I would prefer 1 month. There are clever things you can do with surveillance systems to reduce costs. I suggest that you contact SC-UK or ACF for a copy of their HUMS guideline which has a small sample surveillance component using both weight change and MUAC. The dumbest thing is to do a series of SMART type surveys (far too costly).

The use for percentage weight gain in CMAM programs was due to a few things. CMAM is not restricted to emergency use but to be run in primary healthcare centres in both emergency and development settings. Weight-for-height cannot be used for either admission, monitoring, or dicharge because ehight boards ar enot standard clinic equipment and the IMCI sylabus does not cover height measurment or the W/H lookup. At the time these decisions were being made (2005/6/7) there was little data on MUAc reponse to treatment so percentage weight gain was adopted as a "stop-gap". Percentage weight gain is not an ideal measure because the severest need to gain the least weight to reach discharge. This is the opposite of what is needed. Experience has shown that it is probably safe at 15% or 18% weight gain. More data on MUAC response to treatment is available and this shows that MUAC responds in a similar manner to weight. The belief that MUAC does not respond rapidly is mistaken. It was an assumption made to fill in an absence of data. It is quite easy to see how the mistake was made. Moving from (e.g.) 108 mm to 125 mm is a 17 mm difference in circumference bit only a 5 mm difference in diameter which might be difficult to spot without measurment. Work is currently underway to test the safety of MUAC discharge criteria.

Anonymous 411

Nutritionist

Normal user

20 Aug 2010, 14:00

Thanks Mark, as always being straight forward with the response. I will contact Save and ACF for the HUMs. Hope these will shade more light on the question regarding frequency of MUAC measurement. Thanks

Mark Myatt

Consultant Epideomiologist

Frequent user

20 Aug 2010, 14:52

411 - Happy to help.

If you have difficulties with SC-UK and ACF regarding the HUMS material I will be able to help you some more (I did some of the design work on the HUMS project). Contact me via this thread or ENN if you don't already have my e-mail address.

I think the issue is not so much one of frequency. I think that quarterly is too infrequent ...if monthly collection all year round is tricky then you might increase frequency in the expected lean season so you have (e.g.) collection rounds in January, April, June, July, August, September, and November. That way you sample more intensively when you need to and save resources.

The thornier issues will be of sample design and data analysis strategy. I have seen a lot of "nutrition" surveillance systems that do repeated surveys and treat them as repeated surveys rather than as observations in time. The HUMS documents outline a small sample repeated survey method with a simple time-series analysis strategy. I think that some thing like this might be a decent starting point.

One suggestion ... you might want to start a thread on this forum asking for experiences with surveillance systems. We might get some interesting and useful responses.

Ranjith

Normal user

30 Oct 2010, 17:08

Couds the HUMS be made available online for easy use by all interested?

Mark Myatt

Consultant Epideomiologist

Frequent user

1 Nov 2010, 10:57

The HUMS material should be available from SC-UK and ACF.

I did some work on HUMS and I have, in case anyone is interested, some of the documents that I wrote regarding HUMS in a zip file at:

http://www.brixtonhealth.com/humsWork.zip

This archive contains a mix of "user guide" and technical material. I hope that someone finds these useful.

Please note that the material presented in these documents is entirely my responsibility and is not intended to reflect the policy or aims of either SC-UK or ACF.

Interested readers are urged to contact SC-UK and ACF for current HUMS documentation.

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