title: Efficacy of mid-upper arm circumference in identification, follow-up and discharge of malnourished children during nutrition rehabilitation.
abstract: OBJECTIVE
  Although it is crucial to identify those children likely to be treated in an appropriate nutrition rehabilitation programme and discharge them at the appropriate time, there is no golden standard for such identification. The current study examined the appropriateness of using Mid-Upper Arm Circumference for the identification, follow-up and discharge of malnourished children. We also assessed its discrepancy with the Weight-for-Height based diagnosis, the rate of recovery, and the discharge criteria of the children during nutrition rehabilitation.
  
  
  METHODS
  The study present findings from 156 children (aged 6-59 months) attending a supplementary feeding programme at Makadara and Jericho Health Centres, Eastern District of Nairobi, Kenya. Records of age, weight, height and mid-upper arm circumference were selected at three stages of nutrition rehabilitation: admission, follow-up and discharge. The values obtained were then used to calculate z-scores as defined by WHO Anthro while estimating different diagnostic indices.
  
  
  RESULTS
  Mid-upper arm circumference single cut-off (< 12.5 cm) was found to exhibit high values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio at both admission and discharge. Besides, children recorded higher rate of recovery at 86 days, an average increment of 0.98 cm at the rate of 0.14mm/day, and a weight gain of 13.49gm/day, albeit higher in female than their male counterparts. Nevertheless, children admitted on basis of low MUAC had a significantly higher MUAC gain than WH at 0.19mm/day and 0.13mm/day respectively.
  
  
  CONCLUSIONS
  Mid-upper arm circumference can be an appropriate tool for identifying malnourished children for admission to nutrition rehabilitation programs. Our results confirm the appropriateness of this tool for monitoring recovery trends and discharging the children thereafter. In principle the tool has potential to minimize nutrition rehabilitation costs, particularly in community therapeutic centres in developing countries.
authors.affiliation: Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium. ; Department of Nutrition and Dietetics, School of Health Sciences, Mount Kenya University 342-01000, Thika, Kenya.
authors.forename: Joseph Birundu
authors.initials: JB
authors.lastname: Mogendi
authors.affiliation: Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: De Steur
authors.affiliation: Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Gellynck
authors.affiliation: School of Health and Related Research, University of Sheffield, (ScHARR); Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
authors.forename: Hibbah Araba
authors.initials: HA
authors.lastname: Saeed
authors.affiliation: Department of Food Science, Technology and Nutrition, Faculty of Agriculture, Jomo Kenyatta University of Agriculture and Technology, 62000-00200, Nairobi, Kenya.
authors.forename: Anselimo
authors.initials: A
authors.lastname: Makokha
keywords: MUAC; Malnutrition; nutrition rehabilitation; recovery; weight-for-height