%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Laillou, A.
%A Prak, S.
%A de Groot, R.
%A Whitney, S.
%A Conkle, J.
%A Horton, L.
%A Un, S. O.
%A Dijkhuizen, M. A.
%A Wieringa, Franck
%T Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups
%D 2014
%L fdi:010062437
%G ENG
%J Plos One
%@ 1932-6203
%K CAMBODGE
%M ISI:000339635000061
%N 7
%P e101159
%R 10.1371/journal.pone.0101159
%U https://www.documentation.ird.fr/hor/fdi:010062437
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers17-08/010062437.pdf
%V 9
%W Horizon (IRD)
%X BACKGROUND: Timely treatment of acute malnutrition in children <5 years of age could prevent >500,000 deaths annually. Screening at community level is essential to identify children with malnutrition. Current WHO guidelines for community screening for malnutrition recommend a Mid Upper Arm Circumference (MUAC) of <115 mm to identify severe acute malnutrition (SAM). However, it is currently unclear how MUAC relates to the other indicator used to define acute malnutrition: weight-for-height Z-score (WHZ). METHODS:Secondary data from >11,000 Cambodian children, obtained by different surveys between 2010 and 2012, was used to calculate sensitivity and ROC curves for MUAC and WHZ. FINDINGS: The 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. Reversely, WHZ< -3 missed 80% of the children with a MUAC<115 mm. CONCLUSIONS:The current WHO cut-off for screening for SAM should be changed upwards from the current 115 mm. In the Cambodian data-set, a cut-off of 133 mm would allow inclusion of >65% of children with a WHZ< -3. Importantly, MUAC and WHZ identified different sub-groups of children with acute malnutrition, therefore these 2 indicators should be regarded as independent from each other. We 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. Current guidelines should be changed to reflect this, with treatment initiated when either MUAC <115 mm or WHZ< -3.
%$ 054