A feasibility study using mid-upper arm circumference as the sole anthropometric criterion for admission and discharge in the outpatient treatment for severe acute malnutrition

Souna Garba; Halidou Salou; Fabienne Nackers; Amadou Ayouba; Montse Escruela; Ousmane Guindo; Mercé Rocaspana; Rebecca F Grais; Sheila Isanaka

doi:10.1186/s40795-021-00448-w

A feasibility study using mid-upper arm circumference as the sole anthropometric criterion for admission and discharge in the outpatient treatment for severe acute malnutrition

BMC Nutr. 2021 Aug 12;7(1):47. doi: 10.1186/s40795-021-00448-w.

Authors

Souna Garba¹, Halidou Salou¹, Fabienne Nackers², Amadou Ayouba³, Montse Escruela⁴, Ousmane Guindo¹, Mercé Rocaspana⁴, Rebecca F Grais⁵, Sheila Isanaka⁶

Affiliations

¹ Epicentre Niger, Maradi, Niger.
² Médecins Sans Frontières Operational Center Brussels, Brussels, Belgium.
³ District Sanitaire de Madaoua, Madaoua, Niger.
⁴ Médecins Sans Frontières Operational Center Barcelona, Barcelona, Spain.
⁵ Epicentre, 14-34 avenue Jean Juarès, 75019, Paris, France.
⁶ Epicentre, 14-34 avenue Jean Juarès, 75019, Paris, France. sheila.isanaka@epicentre.msf.org.

Abstract

Background: The World Health Organization recommends the use of a weight-for-height Z-score (WHZ) and/or mid-upper arm circumference (MUAC) as anthropometric criteria for the admission and discharge of young children for the community-based management of severe acute malnutrition. However, using MUAC as a single anthropometric criterion for admission and discharge in therapeutic nutritional programs may offer operational advantages to simplify admission processes at therapeutic nutritional centers and improve program coverage.

Methods: This pragmatic, non-randomized, intervention study compared a standard outpatient nutritional program (n = 824) for the treatment of uncomplicated severe acute malnutrition using WHZ < - 3 and/or MUAC< 115 mm and/or bipedal edema for admission and discharge to a program (n = 1019) using MUAC as the sole anthropometric criterion for admission (MUAC< 120 mm) and discharge (MUAC ≥125 mm at two consecutive visits) in the Tahoua Region of Niger.

Results: Compared to the standard program, the MUAC-only program discharged more children as recovered (70.1% vs. 51.6%; aOR 2.31, 95%CI 1.79-2.98) and fewer children as non-respondent or defaulters, based on respective program definitions. The risk of non-response was high in both programs. Three months post-discharge, children who were discharged after recovery in the MUAC-only program had lower WHZ and MUAC measures. Sixty-three children ineligible for the MUAC-only program but eligible for a standard program (MUAC ≥120 mm and WHZ < -3) were followed for twelve weeks and the anthropometric status of 69.8% of these children did not deteriorate (i.e. MUAC ≥120 mm) despite not immediately receiving treatment in the MUAC-only program.

Conclusions: The results from this study share the first operational experience of using MUAC as sole anthropometric criterion for admission and discharge in Niger and overall support the consideration for MUAC-only programming: the MUAC-only model of care was associated with a higher recovery and a lower defaulter rate than the standard program with very few children found to be excluded from treatment with an admission criterion of MUAC < 120 mm. Further consideration of the appropriate MUAC-based discharge criterion as it relates to an increased risk of non-response and adverse post-discharge outcomes would be prudent.

Keywords: Admission criteria; Community-based management of acute malnutrition; Discharge criteria; Mid-upper arm circumference; Niger; Severe acute malnutrition; Wasting.