Comparison of mid-upper arm circumference with weight for height Z- score to detect acute malnutrition among children aged 6-59 months in Duhabi municipality of Sunsari, Nepal.

Thesis Report.

ABSTRACT:

Acute malnutrition is a major public health issue prevailing in low- and middle-income countries It results in a number of morbidities and poor productivity. Severe acute malnutrition contributes to over one million under-five deaths per annum globally. It is crucial to early identify the children with acute malnutrition for their appropriate management. In Nepal, active screening of acute malnutrition in the community is very limited. For those community screening among 6-to-59-month children, mid-upper arm circumference (MUAC) alone is widely used while weight for height Z score (WHZ) is often used in institutional setting. Therefore, the aim of this study was to compare the MUAC with WHZ to detect acute malnutrition among 6-to-59-month children.
The study used cross sectional descriptive design with quantitative approach. The study population included 6-to-59-month children residing in Duhabi municipality. Multistage cluster sampling technique was adopted for the selection of 370 participants. For this, anthropometric measurement including weight, height and MUAC of 6-59 months children was done using Seca scale, Stadiometer and Sakir tape recommended by UNICEF. Data were entered in MS-excel and WHO Anthro software and analyzed using SPSS 25.
The prevalence of acute malnutrition in Duhabi municipality was 19.2% including 16.8% moderate and 2.4% severe acute malnutrition. MUAC was able to detect only 38% of total acute malnutrition and 11% of severe acute malnutrition. Being female (AOR=2.64, 95% CI=1.04-6.7), and younger age (6-23 months) (AOR=6.26, 95% CI=2.20-17.80) were significantly associated with MUAC<125mm (p<0.05) making them more likely to be detected from current MUAC criteria. Better MUAC accuracy in acute malnutrition detection among female and 6–23-month children are also supported by Area under ROC curve (AUC) comparison with AUC .882 and .993 respectively. In contrast, current WHZ criteria was able to detect 94.4% of total children with global acute malnutrition, and 88.9% of total severe acute malnutrition.
Optimum cut off of MUAC for detection of severe acute malnutrition and moderate acute malnutrition among 6-to-59-month children as reference to WHZ<-3 SD and <-2 ≥-3 SD was 124mm and 136 mm with sensitivity of 100%, and 76.3% and specificity 94.8% and 74.3% respectively. In addition, the optimum cut off for global acute malnutrition detection among 6-23, 24-41, 42–59-month-old children were 133, 136 and 143mm respectively.