title: Mid upper-arm circumference is an effective tool to identify infants and young children with severe acute malnutrition in India.
abstract: OBJECTIVE
  To assess the appropriateness of current mid upper-arm circumference (MUAC) cut-offs to identify children with severe acute malnutrition in India.
  
  
  METHODS
  The analysis concerned 6307 children admitted to nutrition rehabilitation centres (2009-2011) where they received therapeutic care as per guidelines by WHO and the Indian Academy of Pediatrics.
  
  
  METHODS
  States of Jharkhand, Madhya Pradesh and Uttar Pradesh, India.
  
  
  METHODS
  Children aged 6-59 months with bilateral pitting oedema or weight-for-height Z-score (WHZ)<-3 or MUAC<115 mm at admission.
  
  
  RESULTS
  Children aged 6-23 months represented ~80 % of the admissions. Among them, the proportion with WHZ<-3 was similar to that with MUAC<115 mm (85·7 % v. 81·8 %); the proportion with MUAC<115 mm whose WHZ was <-3 was 82·6 %; and the proportion with WHZ<-3 whose MUAC<115 mm was 78·8 %. MUAC<115 mm was as effective as WHZ<-3 in identifying 6-59-month-old children with medical complications (32·2 % v. 31·6 %, respectively), the most important risk factor of death among oedema-free children. Furthermore, death rates in children with MUAC<115 mm were higher than in children with WHZ<-3 (0·61 % v. 0·58 %, respectively) and 91 % of the deaths among oedema-free children were deaths of children with MUAC<115 mm.
  
  
  CONCLUSIONS
  In populations similar to those included in our analysis, MUAC<115 mm appears to be an appropriate criterion to identify children with severe acute malnutrition who are at a greater risk of medical complications and death, particularly among children 6-23 months old.
authors.affiliation: 1United Nations Children's Fund (UNICEF),Regional Office for South Asia,PO Box 5815,Lekhnath Marg,Kathmandu,Nepal.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Aguayo
authors.affiliation: 2Department of Pediatrics,Lady Hardinge Medical College,New Delhi,India.
authors.forename: Satinder
authors.initials: S
authors.lastname: Aneja
authors.affiliation: 1United Nations Children's Fund (UNICEF),Regional Office for South Asia,PO Box 5815,Lekhnath Marg,Kathmandu,Nepal.
authors.forename: Nina
authors.initials: N
authors.lastname: Badgaiyan
authors.affiliation: 3Child Development and Nutrition Programme,UNICEF,New Delhi,India.
authors.forename: Karanveer
authors.initials: K
authors.lastname: Singh
mesh_terms: D001132:Arm; D049628:Body Size; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004487:Edema / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D008403:Mass Screening; D015596:Nutrition Assessment; D009752:Nutritional Status; D017410:Practice Guidelines as Topic; D012047:Rehabilitation Centers; D012307:Risk Factors; D000067011:Severe Acute Malnutrition / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012871:Skin Diseases / Q000453:epidemiology / Q000209:etiology; D065927:Waist-Height Ratio; D019282:Wasting Syndrome / Q000453:epidemiology / Q000209:etiology
keywords: India; Mid upper-arm circumference; Severe acute malnutrition; Severe wasting