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Evidence of cut-off MUAC of 115-124 mm for MAM detection

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Elisa Dominguez

ACF-Spain

Normal user

3 Mar 2011, 16:03

Dear colleagues,
I would like to know if there is some documentation that confirm/evidence the cut-off of MUAC between 125 and 115 mm as a good indicator range for detection of moderate acute malnutrition (in the same way, that cut-off MUAC for SAM was moved from 110 mm to 115 mm - in fact from <110 mm to <115 mm-).

Someone knows if there is any international validated methodology for rapid assessments using MUAC?

Thanks in advance!

Mark Myatt

Consultant Epideomiologist

Frequent user

5 Mar 2011, 09:40

There are a few issues here ...

(1) It is important o realise that case-defining thresholds for MUAC are based on near-term mortality risk.

(2) Mortality and MUAC between 115 and 125 mm : Data from a considerable number of cohort studies show that mortality is elevated (i.e. above the 1 / 10,000 / day standard) in children with a MUAC in this interval. This finding is consistent in all studies. This is the same evidence-base used to derive the MUAC thresholds for SAM. Reviews of this evidence-base can be found at:

http://tng.brixtonhealth.com/node/18

and:

http://tng.brixtonhealth.com/node/15

(3) The move from 110 mm to 115 mm : In many settled agrarian populations the MUAC < 110 mm threshold selected a very similar number of children and many of the same children as WHZ < -3 z-scores using the NCHS reference population. When the WGS was adopted it was found that MUAC < 110 mm selected fewer children than WHZ < -3 z-scores and the MUAC threshold was raised to 115 mm based on an analysis of a large number of anthropometry survey datasets. The decision was not based on mortality risk (as was the 110 mm threshold) although mortality risk does increase rapidly when MUAC drops below 115 mm. It should be noted that many programs still use the 110 mm threshold for program admission. Before anyone starts screaming and shouting about this they should consider that the real issue here is timely case-finding. I have reviewed a program using the 110 mm threshold with a median admission MUAC of 109 mm. I have reviewed several programs using the 115 mm threshold with a median MUAC of about 95 mm. The former was, by far, the better program.

(4) Rapid assessment : MUAC is well suited to rapid assessment because of the many reasons outlined in:

http://tng.brixtonhealth.com/node/15

MUAC has suffered from a poor reputation because there has been a tendency to use it with convenience / opportunistic sample size reserving more sound sampling strategies for use with W/H. The term "rapid" often means quick, cheap, and dirty with "dirty" signifying a method that suffers from poor accuracy and poor reliability. It is not clear to me what is special about MUAC that requires a special methodology. Any survey method that can make rapid, accurate, and reliable estimates or classifications of a proportion (prevalence) may be used. There are plenty of methods to choose from. It is important that the method used is statistically and epidemiologically sound rather than it have some form of international validation. An interesting method can be found at:

http://tng.brixtonhealth.com/node/26

Methods such as these provide a great deal more information than cluster samples. CSAS methods also provide mapping of prevalence.

I hope this helps.

Aishwarya Rai

Normal user

2 Feb 2012, 16:37

Thankyou Mark, it did help a lot to me :-) Humbly very grateful for your guidance :-)

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