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Brachial perimeter - variation

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 3 replies. You can also reply via email – be sure to leave the subject unchanged.

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Caroline André

Diététicienne Santé Publique

Normal user

22 Nov 2018, 21:06

Hello,

Could you tell me the variations considered as "normal" of the brachial perimeter? (in 1 week? 15 days? a month?)

Indeed, I often notice large variations (increase or decrease of 10mm / 20mm / 5mm in 1 week for example) in the medical records of children followed in nutrition centers for acute malnutrition.
I suspect it comes from the lack of sensitivity / misuse of the MUAC bracelet but could you guide me by giving me a "fork" deemed normal if the child takes or lose weight.

I thank you in advance for your help

Lio

CMAM advisor

Frequent user

25 Nov 2018, 13:55

We can expect a MUAC gain of about 0.3 mm to 0.4 mm / day (median). This comes from a personal communication with Dr. Mark Myatt who is a MUAC specialist

Mark Myatt

Consultant Epideomiologist

Frequent user

26 Nov 2018, 10:21

It is important to note that these gains (0.3 to 0.4 mm per day) are averages of averages. The first "average" is the average gain for each case measured over the entire treatment episode. See below. The second "average" is the average of the average gain for each case measured over the entire treatment episode for all cases.

The overall figure (i.e. 0.3 to 0.4 mm per day) can be seen as a program-level target and is taken from high coverage CMAM programs with high cure rates.

The per-case figure can be difficult to interpret as most gain / growth changes over time following at typical "growth curve" pattern. For example:

    muac
    |                                                        *
    |                                      *        
    |                            *          
    |                    *
    |
    |          *
    |
    |     *
    |
    |   *
    |
    |  *
    |
    | *
    +---------------------------------------------------------> time

The slope (which is gain) changes over time. Gains are large early in treatment but become smaller over time. The average is 0.3 to 0.4 mm per day. This means that we should probable treat 0.3 mm per day (c 2.1 mm per week) as a lower limit in the first week or so of treatment.

See here and here for some more information

Note that these gains are for SAM kids receiving treatment.

I hope this is of some help.

Caroline André

Diététicienne Santé Publique

Normal user

28 Nov 2018, 23:13

A big thank you for your answers.

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