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03 months child entry in data anthromometry tab in ENA software shows pink flag

This question was posted the Assessment and Surveillance forum area and has 13 replies.

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Adnan Ahmed Sheikh

Research Associate

Normal user

16 Dec 2021, 09:27

I am assessing muac and anthropmetry measurements from 0-59 months and entering the data , but in ENA in options it is by default  from 06 months to 59 months, however i have tried to change from 03 to 59 months and clicked the save option but still for 3 months child it is giving me pink flag, im using 2020 latest version of ena downloaded from smart website.. 

thanks in advance

Saeed Rahman

Normal user

16 Dec 2021, 10:09

I think you may have to change the new setting and save, then close and reopen ENA. For me at least I didn't see the change take effect until I reopened the program. 

Mbaye Diop

Normal user

16 Dec 2021, 11:56

Hello,

But you should know that MUAC is only taken in children from 6 months.

Samuel T

Nutrition and food security consultant

Normal user

16 Dec 2021, 12:49

Hello;

Why you interested to do Anthro for children bellow 6 month? What type of program are you planning to recommend for negative outcomes (such as undernutrition)? The target is to promote optimal breastfeeding (caring practices).

Regarding ENA, as long as you have all records try adjusting the age range in the option dialogue box and make sure that the hight dialogue box (cm) is not selected. 

Regards

Samuel

K. Mutegi

Normal user

16 Dec 2021, 13:38

@Adan

Assess ENA for SMART the tab indicated as Options. On the far right you can unselect child ages (6.00-59.999) to allow all age group including less than 6 months. Once you unselect please click save and return to your data entry anthropometry tab. 

This might be reason for flags in your data since ENA has an aspect of analysis of children aged (6-59) months or by corresponding height/length in cm(67.0-110.0cm) if option tab is not updated.  

Mark Myatt

Frequent user

16 Dec 2021, 15:48

I am not much of a user of the ENA for SMART software but the inclusion criteria for SMART surveys is 6 - 59 months. I guess that ENA is flagging your 3 month old child because it is outside the 'legal' range for a SMART survey. There are other software products  (e.g. zscore06 in STATA, the Igrowup macros for various systems from the WHO, and the zscorer library for R) that you could try. I think that zscore06 in Stata and the WHO's Igrowup macros will still flag your 3 month old child. The R library will calculate length-for-age, weight-for age, BMI-for-age, MUAC-for-age, TSF-for-age, SSA-for-age, and head-circumference-for-age  z-scores for child aged 3 month or younger. Weight-for height and weight-for length have height and length restrictions (65 cm and 45 cm respectively).

I hope this is of some use.
 

Anonymous 1224

Advisor

Normal user

17 Dec 2021, 12:13

Hi There, go to variable view of data entry and edit the months lower range to 0. ENA default value for age in month variable is 6-59.99 and therefore any value beyond that flagged as pink. And if you want to get result for 0-59 months then also change the setting in Option tab accordingly. Hope this help

Samuel T

Nutrition and food security consultant

Normal user

20 Dec 2021, 11:31

Dear Colleagues;

Sorry for not providing details during my previous email, here are steps

1. Select data entry field, and at the bottom there are two dialogue boxes, select variable value, and adjust lower range for age, height and weight

2. Go to the option dialogue and adjust the age range starting from 0 or 3 depending on your preference and then save your selection.

3. Import your data to the ENA data entry box, non of the variables flags. I have tried and works 

Best regards

Samuel

Adnan Ahmed Sheikh

Research Associate

Normal user

21 Dec 2021, 08:46

Thank you so much everyone,
for giving your input, I have done this way which most of you have told  I clicked on variable view and changed the figure from there from 6 months to 0 months,  then i went back to main data entry , opened my exisiting file where i wanted to make change and saved and when i re opened it again so it didnt showed me any pink flag, but it showed me pink flaf on some of the weight and height, as i have changed the month so i think i should change the weight and height range as well.. 

@ Samuel
@Mbaye diop

We are doing survey at intervention site and ofcourse than at control, so we are targeting stunted and malnourished children , and basically project targets the 1000 days approach so our eligibility criteria is PLW and 0-59 months children,


one quick question, there is no CM selection i can see  for MUAC field in ENA and in our survey form we have cm in reading for MUAC, so i have to rewrite it manually on each field in mm..
is there any option that i can enter muac in cenitmeter reading..

many thanks in advance

Anonymous 3600

Nutrition Analyst

Normal user

22 Dec 2021, 05:03

Dear Colleagues,

We have a threshold for wasting, stunting and underweight for those children with the age of 6-59 month old. I doubt if there is a cut-off point for the children aged between 0 - 5 months. Kindly update me if there is a threshold for wasting, stunting and underweight for the children age 0-5 months.

Thanks,

Kiross Tefera Abebe

Public Health nutritionist

Normal user

22 Dec 2021, 14:23

Dear 3600,

i don't think there is a separate treshholds for 0-5 months and 6-59 months. All the existing tresholds are for Under five that is 0-59 months.  

Bradley A. Woodruff

Self-employed

Technical expert

22 Dec 2021, 18:49

According to WHO recommendations:

https://www.who.int/data/gho/indicator-metadata-registry/imr-details/302#:~:text=Child%20wasting%20refers%20to%20a,death%2C%20but%20treatment%20is%20possible:

Wasting among children under 5 years of age is defined as "Prevalence of wasting (weight for height <-2 standard deviation from the median of the World Health Organization (WHO) Child Growth Standards) among children under 5 years of age."

https://www.who.int/data/gho/data/themes/topics/indicator-groups/indicator-group-details/GHO/gho-jme-global-and-regional-trends-stunting-jme-unicef-who-wb

Stunting in children under 5 is defined as "Stunting prevalence among children under 5 years of age (% height-for-age <-2 SD)".

Therefore, with the exception of MUAC which is not valid in children younger than 6 months of age, there is no separate definition of anthropometry-based indicators of nutritional status for children younger than vs. older than 6 months of age. 

Mbaye Diop

Normal user

23 Dec 2021, 09:06

To my knowledge I do not see separate thresholds for ages.

The z-scores are less than -2 for all ages and the MUAC less than 125 mm for children from 6 months.

Thank you

Mark Myatt

Frequent user

24 Dec 2021, 11:24

It is common to say, as Woody does above, that MUAC is not valid for younger children but recent work by KEMRI and LSHTM shows that MUAC is, as it is in older children, strongly predictive of mortality and suggests lower MUAC thresholds (i.e. MUAC < 110 mm @ 6 to 14 weeks) that can be applied at routine vaccination ages and at birth (i.e. MUAC < 90 mm @ birth). See:

Mwangome, MK, Fegan G, Fulford T, Prentice AM, Berkley JA, MUAC at age of routine infant vaccination to identify infants at elevated risk of death: a retrospective cohort study in the Gambia. Bulletin of the World Health Organization 90, 887–894 (2013).

Mwangome MK, Fegan G, Mbunya R, Prentice AM, Berkley JA, Reliability and accuracy of anthropometry performed by community health workers among infants under 6 months in rural Kenya. Tropical Medicine & International Health 17, 622–629 (2012).

Mwangome M et al., Anthropometry at birth and at age of routine vaccination to predict mortality in the first year of life: A birth cohort study in BukinaFaso. PloS one 14, e0213523 (2019).
  
But ... "Research on appropriate clinical guidelines for the treatment of severe acute malnutrition in infants aged less than 6 months is needed to support effective interventions.".

Work by the MAMI special interest group has moved forward with identifying appropriate care pathways for these chidlren. That SIG favours the use of the weight-for-age z-score in children ages between 0 and 6 months. See:

Lelijvelds N, Kerac M, McGrath M, Mwangome M, Berkley JA, A  review of methods to detect cases of severely malnourished infants less than 6 months for their admission into therapeutic care. ENN 1–14 (2017).

This article evaluates the performance of a number of anthropometric case-definitions for use in younger children.

I hope this is of use to someone.
 

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