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 19 February 2018

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News

Simple measures predict death in malnourished children

A recent study in rural Kenya has found that the mid-upper arm circumference as well as weight for height z score could provide a more practical way to identify children at high risk, reports the Journal of the American Medical Association.

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Severe malnutrition has a high mortality rate among hospitalized children in sub-Saharan Africa.

However, reports suggest that malnutrition is often poorly assessed.

The World Health Organization recommends using weight for height, but this method is problematic and often not undertaken in practice.

Mid upper arm circumference and the clinical sign "visible severe wasting" are simple and inexpensive methods but have not been evaluated in this setting.

Dr James Berkley and colleagues from Kenya conducted a cohort study with data collected at admission and at discharge or death.

The researchers determined predictive values for inpatient death using the area under receiver operating characteristic curves.

Participants were 8000 children aged 12 to 59 months admitted to a district hospital in rural Kenya between 1999 and 2002.

Overall, 4%, or 359 children included in the study died while in the hospital.

The team noted that 1282 of 8190 admitted children had severe wasting, of which 756 had a weight to height zero score of -3, while 778 had kwashiorkor, or both.

There were more clinical features of malnutrition with a mid upper arm circumference of about 12 cm or less
Journal of the American Medical Association

The research team observed that the areas under the receiver operating characteristic curves for predicting inpatient death did not significantly differ.

Sensitivity and specificity for subsequent inpatient death were 46% and 91%, respectively, for mid upper arm circumference of about 12 cm or less.

The researchers noted that weight for height less than or equal to -3, sensitivity was 42% and specificity was 92%.

For visible severe wasting, sensitivity and specificity was 47% and 93%, respectively.

In addition, the team found that the 3 indices identified different sets of children and were independently associated with mortality.

There were more clinical features of malnutrition in children with mid upper arm circumference of about 12 cm or less than in weight for height less than or equal to -3.

Dr Berkley comments, “Mid upper arm circumference is a practical screening tool that performs at least as well as weight for height z scores in predicting subsequent inpatient mortality among severely malnourished children hospitalized in rural Kenya.”

“Calculating the weight for height z score depends on correctly recording weight and height values and then looking up a third value on a chart, which must be readily available.”

“The measurement of weight depends on the presence of properly calibrated and functioning scales, which often are not available."

“Visible severe wasting is also a potentially useful sign at this level, providing appropriate training has been given.”

JAMA 2005: 294: 591-7
15 August 2005

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