title: Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh?
abstract: OBJECTIVE
  Mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ) identify different populations of children with severe acute malnutrition (SAM) with only some degree of overlap. In an urban slum in Bangladesh, we conducted a prospective cohort study on children assessed as being severely malnourished by WHZ (<-3) but not by MUAC (>115 mm), to: 1. Assess their nutritional outcomes, and 2. Report on morbidity and mortality.
  
  
  METHODS
  Children underwent 2-weekly prospective follow-up home visits for 3 months and their anthropometric evolution, morbidity and mortality were monitored.
  
  
  RESULTS
  Of 158 children, 21 did not complete follow-up (six were lost to follow-up and 15 changed residence). Of the remaining 137 children, nine (7%) required admission to the nutrition programme because of: MUAC dropping to <115 mm (5/9 children), weight loss ≥ 10% (1/9 children) and severe medical complications (3/9 children, of whom one died). Of the remaining 128 children who completed follow-up, 91 (66%) improved in nutritional status while 37 (27%) maintained a WHZ of <-3. Cough was less frequent among those whose nutritional status improved.
  
  
  CONCLUSIONS
  It seems acceptable to rely on MUAC as a single assessment tool for case finding and for admission of children with SAM to nutritional programmes.
authors.affiliation: Médecins Sans Frontières, Medical Department, Operational Research, Brussels, Belgium. engy.y.ali@gmail.com
authors.forename: Engy
authors.initials: E
authors.lastname: Ali
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.forename: Zubair
authors.initials: Z
authors.lastname: Shams
authors.forename: Lieven
authors.initials: L
authors.lastname: Vernaeve
authors.forename: Petra
authors.initials: P
authors.lastname: Alders
authors.forename: Flavio
authors.initials: F
authors.lastname: Salio
authors.forename: Marcel
authors.initials: M
authors.lastname: Manzi
authors.forename: Malik
authors.initials: M
authors.lastname: Allaouna
authors.forename: Bertrand
authors.initials: B
authors.lastname: Draguez
authors.forename: Pascale
authors.initials: P
authors.lastname: Delchevalerie
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D000886:Anthropometry / Q000379:methods*; D001132:Arm / Q000033:anatomy & histology*; D001459:Bangladesh; D001835:Body Weight; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000628:therapy; D009749:Nutrition Surveys; D009752:Nutritional Status; D011446:Prospective Studies; D014944:World Health Organization