@article{fdi:010079132,
  title = {{R}outinely {MUAC} screening for severe acute malnutrition should consider the gender and age group bias in the {E}thiopian non-emergency context},
  author = {{T}essema, {M}. and {L}aillou, {A}. and {T}efera, {A}. and {T}eklu, {Y}. and {B}erger, {J}acques and {W}ieringa, {F}ranck},
  editor = {},
  language = {{ENG}},
  abstract = {{E}arly identification of children < 5 years with severe acute malnutrition ({SAM}) is a high priority to reduce child mortality and improved health outcomes. {C}urrent {WHO} guidelines for community screening for {SAM} recommend a {M}id-{U}pper-{A}rm {C}ircumference ({MUAC}) of less than 115 mm to identify children with {SAM}, but this cut-off does not identify a significant number of children with a weight-for-height {Z}-score <-3. {T}o establish new specific {MUAC} cut-offs, pooled data was obtained for 25,755 children from 49 {SMART} recent surveys in {E}thiopia (2016-2019). {S}ensitivity, proportion of false positive, and areas under receiver-operator characteristic curves ({AUC}) were calculated. {MUAC} below 115mm alone identified 55% of children with {SAM} identified with both methodologies. {MUAC} was worse in identifying older children (21%), those from a pastoral region (42%) and boys (41%). {U}sing current {WHO} cut-offs, the sensitivity ({S}e) of {MUAC} below 115mm to identify the children severly malnourished screened through {W}eight-for- height below-3 was 16%. {A}nalysing the {ROC} curve and {Y}ouden {I}ndex, {S}e and {S}pecificity ({S}p) were maximal at a {MUAC} < 133 mm cut-off to identify {SAM} (respectively {S}e 61.1%, {S}p 81.4%). {H}owever, given the high proportion of false-positive children, according to gender, region and age groups, a cut-off around 125 mm to screen {SAM} could be the optimal one. {I}n {E}thiopia, implementation of a {MUAC}-only screening program for the identification of severe acute malnutrition with the actual cut-off of 115 mm would be unethical as it will lead to many children remaining undiagnosed and untreated. {I}n addition, future study on implementation challenge on screening children with a higher cut-off or gender/age sensitive ones should be assessed with the collection of mortality and morbidity data to ensure that the most in need are being taking care of.},
  keywords = {{ETHIOPIE}},
  booktitle = {},
  journal = {{PL}o{S} {O}ne},
  volume = {15},
  numero = {4},
  pages = {e0230502 [11p.]},
  ISSN = {1932-6203},
  year = {2020},
  DOI = {10.1371/journal.pone.0230502},
  URL = {https://www.documentation.ird.fr/hor/fdi:010079132},
}