@article{fdi:010062437,
  title = {{O}ptimal screening of children with acute malnutrition requires a change in current {WHO} guidelines as {MUAC} and {WHZ} identify different patient groups},
  author = {{L}aillou, {A}. and {P}rak, {S}. and de {G}root, {R}. and {W}hitney, {S}. and {C}onkle, {J}. and {H}orton, {L}. and {U}n, {S}. {O}. and {D}ijkhuizen, {M}. {A}. and {W}ieringa, {F}ranck},
  editor = {},
  language = {{ENG}},
  abstract = {{BACKGROUND}: {T}imely treatment of acute malnutrition in children <5 years of age could prevent >500,000 deaths annually. {S}creening at community level is essential to identify children with malnutrition. {C}urrent {WHO} guidelines for community screening for malnutrition recommend a {M}id {U}pper {A}rm {C}ircumference ({MUAC}) of <115 mm to identify severe acute malnutrition ({SAM}). {H}owever, it is currently unclear how {MUAC} relates to the other indicator used to define acute malnutrition: weight-for-height {Z}-score ({WHZ}). {METHODS}:{S}econdary data from >11,000 {C}ambodian children, obtained by different surveys between 2010 and 2012, was used to calculate sensitivity and {ROC} curves for {MUAC} and {WHZ}. {FINDINGS}: {T}he secondary analysis showed that using the current {WHO} cut-off of 115 mm for screening for severe acute malnutrition over 90% of children with a weight-for-height z-score ({WHZ}) <-3 would have been missed. {R}eversely, {WHZ}< -3 missed 80% of the children with a {MUAC}<115 mm. {CONCLUSIONS}:{T}he current {WHO} cut-off for screening for {SAM} should be changed upwards from the current 115 mm. {I}n the {C}ambodian data-set, a cut-off of 133 mm would allow inclusion of >65% of children with a {WHZ}< -3. {I}mportantly, {MUAC} and {WHZ} identified different sub-groups of children with acute malnutrition, therefore these 2 indicators should be regarded as independent from each other. {W}e suggest a 2-step model with {MUAC} used a screening at community level, followed by {MUAC} and {WHZ} measured at a primary health care unit, with both indicators used independently to diagnose severe acute malnutrition. {C}urrent guidelines should be changed to reflect this, with treatment initiated when either {MUAC} <115 mm or {WHZ}< -3.},
  keywords = {{CAMBODGE}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {9},
  numero = {7},
  pages = {e101159},
  ISSN = {1932-6203},
  year = {2014},
  DOI = {10.1371/journal.pone.0101159},
  URL = {https://www.documentation.ird.fr/hor/fdi:010062437},
}