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Admission of children 5 to 10 years - criteria to use in famine situation

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 2 replies. You can also reply via email – be sure to leave the subject unchanged.

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Erin McCloskey-Rebelo

Nutrition Specialist

Normal user

2 Sep 2011, 07:49

We're currently looking to expand admission criteria in Somalia to include children 5 to 10 years of age. Some partners are already doing this and using a variety of admission /discharge criteria. Other partners require some guidance.
We have a few questions to launch out to the Nut community:
(1) Admission criteria: A MUAC for height table was proposed. We're considering that children 5 to 10 years will likely have heights from >115cm to =or <145cm. The problem is that, given the table, we would have 3 different MUAC cut-offs for older children with SAM. This is not very practical, and we need to make things as simple as possible in southern Somalia. So what we want to propose is using one cut-off = MUAC <135mm fo SAM. This is the "bottom" MUAC on the table for the older children.
(2) RUTF ration: Some places may be able to weight older children but others may not. Can we assume a standard ration for older children? Although this may cause confusion between younger and older children....
(3) Discharge criteria: MUAC >135mm on two consecutive visits??... or a min length of stay of 2 months?

Any comments/criticisms/support are welcomed

Michael Golden

Normal user

2 Sep 2011, 17:59

Yes the analyses of the data from Somalia shows that the older children have a higher prevalence of severe wasting than younger children. If the famine progresses then there will also be adolescents and adults affected that need treatment.
There are no established MUAC cut-offs for older children, adolescents etc. and very little experience to guide us. If the "normal" MUAC cut-offs are used very few SAM children are identified and they will go untreated.

The tentative table proposed is by "height-range", which can be quite approximate and not by accurately measured height at all - so it is not a "MUAC for Height Table" in the usual sense. Much more a QUACK Stick approach - and a marked stick can be used to establish the hight-range of the person. The main thing at this stage is to get experience to see how these proposals work - MSF is already using the table and we hope to get feedback soon so that it can be simplified as soon as possible and as far as possible whilst remaining ethical and identifying those that really need treatment - we need evidence for this.
In terms of dealing with older children in a famine situation we are still very much at the learning phase and over-simplification to start with may end up with something that does not work as it should - on the other hand, we should do what we can do in this situation - if your organisation finds it impractical for one reason or another, then of course simplify - but carefully collect and analyse the data so that we can itteratively reach firmer recommendations.

Jay Berkley

Frequent user

2 Sep 2011, 21:18

Dear Colleagues

We have been frequently asked about the potential to use MUAC above 5 years for the detection of SAM, especially in the context of HIV clinics and emergency situations. The WHO references for this age group (DeOnis 2007) were derived from the NCHS datasets rather than the WHO growth reference curves. They included weight, length and BMI, but not MUAC. We have used the same data sources and methods to develop MUAC z score curves from 5 to 19 years. We are looking for datasets that could be used to validate the scores in this age group i.e. a MUAC and a subsequent outcome, which may include death, illness or starting ART. If you have such a dataset and would be willing to share it, I would be grateful if you would let me know. We would be happy to acknowledge significant contributions through co-authorship.

Jay

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