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MUAC in SMART / ENA

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Mark Myatt

Consultant Epideomiologist

Frequent user

26 May 2009, 09:37

This is the latest advice from the WHO and UNICEF:

"To improve planning, it is therefore vital that the same criteria are used for estimating caseload as are being used for admission into programmes. This means that in settings where MUAC will be used as the admission criterion for therapeutic feeding, especially at the community level, it is important to include MUAC assessment in the nutritional prevalence surveys."

from their new guideline "WHO child growth standards and the identification of severe acute malnutrition in infants and children : A Joint Statement by the World Health Organization and the United Nations Children's Fund" released 15th May 2009.

Given this, I think it is now very important that SMART supports the use of MUAC in its documentation and software.

I have started this discussion thread to encourage workers to discuss the sort of support for MUAC that it would be useful to include in SMART and ENA software.

To start things off I have a list:

(1) Allow MUAC to be entered as either raw data (i.e. MUAC in mm or cm) or as case-status (e.g. coded fro red, orange, and green) so as to allow the use of either numbered and and non-numbered colour-banded MUAC straps.

(2) Provide similar "quality checks" on raw MUAC data as are provided for weight and height data. This may be problematic as many MUAC straps are numbered in 2 mm steps but this should be easy enough to resolve by allowing the user to specify a "step size".

(3) Provided training / enumerator assessment tools such as the "Method of Habitch" (raw data) and Cohen's Kappa (banded data).

(4) Report prevalence using MUAC. This should allow case-defining thresholds to be specified for both severe and moderate wasting since some countries may stick with the 110 mm threshold whilst others move quickly to the new 115 mm threshold. The question of thresholds for moderate wasting is due to be addressed by the WHO and UNICEF later this year and the situation may be similar. In addition, some countries use non-standard MUAC thresholds in large-scale programs (e.g. the EOS program in Ethiopia which uses 120 mm as a criteria to receive a supplementary ration). Reporting should be on MUAC and oedema only (useful in setting that do not use W/H as an admission criteria) and MUAC, oedema, and W/H (useful in settings that use both MUAC and W/H as admission criteria).

(5) Provide a tool that can take raw MUAC data and W/H case-status and report on the sensitivity and specificity of MUAC thresholds for detecting W/H cases (as is provided in the EpiInfo base program MUAC Screening Tool. This may be useful in settings where only W/H is used for admission but MUAC may be used in a two-stage screening process.

These are just preliminary ideas. Please add or take away or provide more detail. It would be interesting to here what the SMART people have in mind.

Mark Myatt

Consultant Epideomiologist

Frequent user

27 May 2009, 10:02

Forgot to include a link to the joint statement. You can download it here.

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