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Threshold for interventions using MUAC

This question was posted the Assessment and Surveillance forum area and has 4 replies.

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Anonymous 502


Normal user

8 Jul 2016, 11:35

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.

Alison Donnelly

Normal user

11 Jul 2016, 08:16

FEWS NET recently provided guidance for thresholds using MUAC for the IPC classifications. <6% is classed as IPC 1 (acceptable) 6.0 to 10.9% IPC 2-3 (Alert to Serious) 11.0 to 16.9% IPC 4 (Critcal) and =17% IPC Extreme Critical.


Forum Moderator, ENN

Forum moderator

12 Jul 2016, 09:16

Dear all,

This is interesting news and we are following up to learn more about these tools and their relevance for use within IPC countries and/or potentially beyond the specific context where they have been developed.

There is no official guidance for their use as yet, but they are part of new tools being developed and piloted for the IPC classifications and were used in the recent IPC exercise in South Sudan.

This is the FEWS NET IPC website with information on development of tools:

Although nutrition elements are integrated within the IPC food insecurity analysis, currently the IPC does not incorporate a full nutrition situation overview in terms of considering malnutrition caused by other factors than food insecurity. However, with the constant expansion of IPC, a new interest has risen to complement the standard IPC analysis with a comprehensive nutrition component.

In response to this demand from countries and governments, the IPC Global Partnership has committed to developing IPC Nutrition Classification tools and procedures based on the Nutrition Classification tool used by the Food Security and Nutrition Analysis Unit (FSNAU) in Somalia. The FSNAU’s tool will be reviewed and a prototype IPC Nutrition Phase Classification will be developed.

The new IPC Nutrition tools and procedures will be compatible with whatever nutrition data collection systems, methodological approaches, and institutional arrangements exist in-county, allowing comparison of findings over time and across countries.

We welcome further information on these new tools from those in the region who were involved in their development.

Best wishes,


Nutritionist /NRC

Normal user

12 Jul 2016, 14:15

Dear Tasmin and et al,

Acute Malnutrition Classification is getting a lot momentum lately. Piloting of the initiative, sensitization exercise is underway in the East African bloc, as far as I know. South Sudan, Kenya and soon to be rolled out in Somalia.

To keep abreast of ENN members and to this thread in particular, I will ask Douglas Jayasekaran and Kamau Wanjohi from the Global and Regional IPC office to join in to this discussion.

Best regards, Asmelash

Anonymous 502


Normal user

13 Jul 2016, 14:41

Dear all,

Thanks so far for the input into this issue, I would be interested in hearing the case of South Sudan and Kenya and the further investigations done on it!

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