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Death of children with SAM diagnosed by WHZ or MUAC: Who are we missing?

par Golden, Michael M.H.;Grellety Bosviel, Emmanuel
Référence Action Against Hunger’s Research for Nutrition Conference(2: 13th November 2017: Pavillon de L’Eau), Death of children with SAM diagnosed by WHZ or MUAC: Who are we missing?, Field Exchange, Oxford, Vol. 57, page (77)
Publication Publié, 2018-03

Abstract de conférence

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Résumé :

What we know: Both weight-for-height z-score (WHZ) and mid-upper arm circumference (MUAC) are recommended to identify severely malnourished children for treatment. MUAC has distinct advantages for community-level screening; however several countries have gone further to instigate MUAC-only admissions for treatment.What this article adds: A recent review examined the consequences of excluding children with severe acute malnutrition (SAM) identified using WHZ from admission to treatment programmes. Analysis of individual data from 14,935 children admitted to a range of treatment programmes over 22 years and a literature review examined case fatality rates (CFR) with different indicators and caseload. Simpson’s paradox (mathematical coupling) results in reversal of significance that affects interpretation of the relative mortality rates of WHZ and MUAC. The analysis suggests that children with SAM identified by WHZ <-3Z and admitted for treatment have as high a risk of death as children in treatment with MUAC <115mm. Review of 21 datasets that compared WHZ and MUAC mortality rates show problems with interpretation of the reported CFRs; inconsistencies greatly limit analysis, comparability and interpretation. Caseload is a more important determinant of the number of SAM-related child deaths than the relative CFR to give SAM-attributable deaths. Where most of the children are identified as SAM using WHZ rather than MUAC, it is estimated that fewer than half of all SAM-related deaths will be identified using a MUAC-only programme. Strong advocacy for the use of MUAC to maximise coverage of treatment programmes has developed into MUAC-only programmes that are inadequately evidenced on the consequences of excluding WHZ cases. Urgent research is needed to develop simple methods to identify children with low WHZ at community level.