title: Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?
abstract: OBJECTIVE
  The present study was performed to describe the operational implications of using mid-upper arm circumference (MUAC) as a single admission criterion for treatment of severe acute malnutrition in South Sudan.
  
  
  METHODS
  We performed a retrospective analysis of routine programme data of children with severe acute malnutrition aged 6-59 months admitted to a therapeutic feeding programme using weight-for-height Z-score (WHZ) and/or MUAC. To understand the implications of using MUAC as a single admission criterion, we compared patient characteristics and treatment outcomes for children admitted with MUAC<115 mm (irrespective of WHZ) v. children admitted with WHZ<-3 and MUAC≥115 mm.
  
  
  RESULTS
  Of 2205 children included for analysis, 719 (32·6 %) were admitted to the programme with MUAC<115 mm and 1486 (67·4 %) with WHZ<-3 and MUAC≥115 mm. Children who would have been admitted using a single MUAC<115 mm criterion were more severely malnourished and more likely to be female and younger. Compared with children admitted with WHZ<-3 and MUAC≥115 mm, children who would have been admitted using MUAC<115 mm were less likely to recover (54 % v. 69 %) and had higher risk of death (4 % v. 1 %), but responded to treatment with greater weight and MUAC gains. MUAC<115 mm would have failed to identify 33 % of deaths, while 98 % were identified by WHZ<-3 alone and 100 % by MUAC<130 mm.
  
  
  CONCLUSIONS
  The study shows that MUAC<115 mm identified more severely malnourished children with a higher risk of mortality but failed to identify a third of the children who died. Admission criteria for therapeutic feeding should be adapted to the programmatic context with consideration for both operational and public health implications.
authors: 1Epicentre,8 rue Saint Sabin,75011 Paris,France.
authors: Emmanuel
authors: E
authors: Grellety
authors: 2Montevia Health,Denver,CO,USA.
authors: L Kendall
authors: LK
authors: Krause
authors: 3Médecins Sans Frontières,Paris,France.
authors: Manal
authors: M
authors: Shams Eldin
authors: 1Epicentre,8 rue Saint Sabin,75011 Paris,France.
authors: Klaudia
authors: K
authors: Porten
authors: 1Epicentre,8 rue Saint Sabin,75011 Paris,France.
authors: Sheila
authors: S
authors: Isanaka
mesh_terms: D000367:Age Factors; D000886:Anthropometry; D001132:Arm; D001827:Body Height; D001835:Body Weight; D001837:Body Weights and Measures; D015362:Child Nutrition Disorders / Q000175:diagnosis* / Q000178:diet therapy / Q000401:mortality; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009752:Nutritional Status; D018579:Patient Selection; D011502:Protein-Energy Malnutrition / Q000175:diagnosis* / Q000178:diet therapy / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D000068037:South Sudan / Q000453:epidemiology; D015430:Weight Gain
keywords: Admission criteria; Child malnutrition; Community-based management of acute malnutrition; Mid-upper arm circumference; Weight-for-height Z-score