Mid-upper arm circumference based nutrition programming: evidence for a new approach in regions with high burden of acute malnutrition

Abstract

Background: In therapeutic feeding programs (TFP), mid-upper arm circumference (MUAC) shows advantages over weight-for-height Z score (WHZ) and is recommended by the World Health Organization (WHO) as an independent criterion for screening children 6-59 months old. Here we report outcomes and treatment response from a TFP using MUAC ≤118 mm or oedema as sole admission criteria for severe acute malnutrition (SAM).

Methods: Patient data from September 2007 to March 2009 for children admitted by MUAC ≤118 mm or oedema to a Médecins Sans Frontières (MSF) TFP in Burkina Faso were retrospectively analyzed. Analysis included anthropometric measurements at admission and discharge, program outcomes and treatment response.

Results: Of 24,792 patient outcomes analyzed, nearly half (48.8%; n = 12,090) were admitted with MUAC 116-118 mm. Most patients (88.7%; n = 21,983) were 6-24 months old. At admission, 52.7% (n = 5,041) of those with MUAC 116-118 mm had a WHZ <-3 SD. At discharge, 89.1% (n = 22,094) recovered (15% weight gain or oedema resolution), 7.9% (n = 1,961) defaulted, 1.5% (n = 384) failed to respond to treatment, and 1.0% (n = 260) died. Average weight gain was 5.4 g/kg/day, and average MUAC gain was 0.42 mm/day. Patients with MUAC ≤114 mm at admission had higher average daily weight and MUAC gains at discharge compared to those admitted with MUAC 116-118 mm, but those in the latter category required longer lengths of stay to achieve recovery (P<0.001).

Conclusion: This analysis suggests that MUAC ≤118 mm as TFP admission criterion is a useful alternative to WHZ. Regarding treatment response, rates of weight and MUAC gain were acceptable. Applying 15% weight gain as discharge criterion resulted in longer lengths of stay for less malnourished children. Since MUAC gain parallels weight gain, it may be feasible to use MUAC as both an admission and discharge criterion.

Conflict of interest statement

Competing Interests: MSF staff participated in data collection (through their work in routine projects in collaboration with the Ministry of Health) and preparation of the manuscript (all authors were employed by MSF at the time the study was conducted). Epicentre verified the data collection and analysis for this study. Epicentre is a non-profit organisation created by MSF to conduct operational research/evaluations in MSF-supported projects to improve the quality of care provided and evaluate activities/strategies implemented in the projects. More information about this non-profit organisation can be found in the website: http://www.epicentre.msf.org/en/in-brief. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials and the authors declared that no competing interests exist.

Figures

Figure 1. Flowchart describing patient records used in data analysis.

Figure 2. Average cumulative weight gain with average cumulative MUAC gain, MSF Therapeutic Feeding Program, Burkina Faso.

Rate of average weekly MUAC gain mirrors average weekly weight gain for all 22,094 children who met discharge criteria for recovery.