A COMPARISON BETWEEN MID UPPER ARM CIRCUMFERENCE AND WEIGHT FOR HEIGHT Z-SCORE FOR ASSESSMENT OF NUTRITIONAL STATUS IN CHILDREN 6 MONTHS TO 5-YEAR-OLD AGE GROUP.
Main Article Content
Keywords
Malnutrition, Mid upper arm circumference, Under five children, WHZ score
Abstract
Background: The World Health Organization (WHO) defines severe acute malnutrition (SAM) in children aged 6–60 months as weight-for-height below –3 standard deviations (severe wasting) of the reference population. The preference for using the weight-for-height Z-score (WHZ) over other anthropometric measures, such as weight-for-age (WAZ) or height-for-age (HAZ), is due to its ability to indicate both current nutritional status and, indirectly, past growth patterns through height measurement.
Objective: To compare MUAC and Z-SCORE for assessment of nutritional status in children 6 months to 5 years of age.
Materials and Methods: This hospital-based cross-sectional analytical study was conducted among 300 children at the tertiary care centre in Gujarat from November 2022 to May 2023. WHZ scoring was done and compared with MUAC.
Results: According to Z-score criteria, the prevalence of SAM was 8.7% and the prevalence of MAM was 20% in the present study. According to MUAC criteria, the prevalence of SAM was 6% and the prevalence of MAM was 16%. The Sensitivity and Specificity of the MUAC criteria for SAM patients were 42.3% and 97.4%, respectively. The Sensitivity and Specificity of the MUAC criteria for MAM patients were 35% and 88.7%, respectively.
Conclusion: With the use of the currently recommended WHO cut-off for MUAC, a considerable number of children would not have been identified as either severely or moderately malnourished compared to the number detected if the WHZ criteria had been used. A higher cut-off value is therefore recommended for screening acute malnutrition, thereby increasing sensitivity.
Keywords: Malnutrition, Mid upper arm circumference, Under five children, WHZ score.
References
2. Behera SK, Mohapatra SS, Kar S, Das D, Panda C. Incidence and mortality of hospitalized diarrhea cases. Part III. Indian Pediatr. 1980;17:607-12.
3. Sehgal V, Sethi GR, Sachdev HP, Satyanarayana L. Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections. Indian Pediatr. 1997;34:213-9.
4. National Family Health Survey (NFHS-5). rchiips.org. Archived from the original on 24 November 2021. Retrieved 19 August 2022.
5. World Health Organization: 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. Geneva: WHO. 2009.
6. Kumar P, Bijalwan V, Patil N, Daniel A, Sinha R, Dua R, et al. Comparison between Weight-for-Height Z-Score and Mid Upper Arm Circumference to Diagnose Children with Acute Malnutrition in five Districts in India. Indian J Community Med. 2018 Jul-Sep;43(3):190-194.
7. Shukla N, Toppo NA, Thakur A, Kasar PK, Sharma B.Mid-upper arm circumference versus weight for height Z-score for detecting malnutrition in children aged 06-59 months in rural and urban areas of Jabalpur district, Madhya Pradesh, India. Int J Community Med Public Health2020;7:1794-8.
8. MehtaN,BhattRG, VoraH, ParmarB.Comparison of midupperarm circumference and weight-for-height z score for assessing acute malnutrition in children aged6-60 months: an analytical study. Int J Contemp Pediatr 2019;6:522-6.
9. KananiSM, BharaniSN. A comparison of mid-upper arm circumference and weight-for-height z score of world health organization growth standards in detecting moderate and severe acute malnutrition in children aged 6-60 months. Int J Contemp Pediatr 2024;11:38-44.
10. Grellety E, Golden MH. Weight-for-height and mid-upper-arm circumference should be used independently to diagnose acute malnutrition: policy implications. BMC Nutr. 2016;2(1):10.
11. Bhan MK, Bhandari N, Bahl R. Management of the severely malnourished child: perspective from developing countries. BMJ. 2003 Jan 18;326(7381):146–151.
12. Bari A, Nazar M, Iftikhar A, Mehreen S. Comparison of Weight-for-Height Z-score and Mid-Upper Arm Circumference to Diagnose Moderate and Severe Acute Malnutrition in children aged 6-59 months. Pak J Med Sci 2019 Mar-Apr;35(2)337-341.
13. Kumar P, Bijalwan V, Patil N, Daniel A, Sinha R, Dua R, Seth A. Comparison between Weight-for-Height Z-Score and Mid Upper Arm Circumference to Diagnose Children with Acute Malnutrition in five Districts in India. Indian J Community Med. 2018 Jul-Sep;43(3):190-194.
14. Abitew DB, Yalew AW, Bezabih AM, Bazzano AN. Comparison of Mid-Upper-Arm Circumference and Weight-For-Height Z-Score in Identifying Severe Acute Malnutrition among Children Aged 6-59 Months in South Gondar Zone, Ethiopia. J Nutr Metab 2021 May 5;20218830494.
15. Sachdeva S, Dewan P, Shah D, Kumar R, Malhotra RK, Gupta P. Mid-upper arm circumference v. weight-for-height Z-score for predicting mortality in hospitalized children under 5 years of age. Public Health Nutrit. 2016;19(14):2513-20.
16. Shukla N, Toppo NA, Thakur A, Kasar PK, Sharma B. Mid-upper arm circumference versus weight for height Z-score for detecting malnutrition in children aged 06-59 months in rural and urban areas of Jabalpur district, Madhya Pradesh, India. Int J Community Med Public Heal 2020;71794-8.
17. Shaikh Z, Pathak R. Revised Kuppuswamy and BG Prasad socio-economic scales for 2016. Int J Community Med Public Health. 2017;4(4):997-9.
18. Lambebo A, Mezemir Y, Tamiru D, Belachew T. Sensitivity and specificity of mid-upper arm circumference for assessment of severe acute malnutrition among children aged 6-59 months. Systematic review and meta-analysis. Nutrition. 2023 Mar:107:111918.
19. Dukhi N, Sartorius B, Taylor M. Mid-upper arm circumference (MUAC) performance versus weight for height in South African children (0–59 months) with acute malnutrition. South Af J Clin Nutr 2017;30(2)49-54
20. Bilukha O, Leidman E. Concordance between the estimates of wasting measured by weight-for-height and by mid-upper arm circumference for classification of severity of nutrition crisis: analysis of population-representative surveys from humanitarian setting. BMC Nutr 2018;4(1)24
21. Hossain M, Ahmed T, Arifeen S, Billah S, Faruque A, Islam M, et al. Comparison of midupper arm circumference and weight-for-height z score for assessing acute malnutrition in Bangladeshi children aged 6-60 month: an analytical study. Am J Clin Nutrit. 201.
22. Dairo MD, Fatokun ME, Kuti M. Reliability of the mid upper arm circumference for the assessment of wasting among children aged 12-59 months in urban Ibadan, Nigeria. Int J Biomed Sci. 2012;8:140-3.
23. Goossens S, Bekele Y, Yun O, Harczi G, Ouannes M, Shepherd S. Midupper arm circumference based nutrition programming: evidence for a new approach in regions with high burden of acute malnutrition. PLoS One. 2012;7:e49320.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Nisha Upadhyay
Professor (H.G.), Department of Pediatrics, GMERS Medical College, Gandhinagar, Gujarat,India
Dr. Divya Gohel
DNB Resident, Department of Pediatrics, GMERS Medical College, Gandhinagar, Gujarat, India
Dr. Gaurav Desai
Associate Professor, Department of Community Medicine, GMERS Medical College, Gandhinagar, Gujarat, India
Dr. Chintan Upadhyay
Professor & Head of Obstetrics and Gynecology Department, Dr. N. D. Desai faculty of Medical Science and Research, Dharmsinh Desai University, Nadiad, Gujarat, India