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Open Access 01-12-2019 | Malnutrition | Research

Assessing effectiveness of a novel mid-upper arm circumference Z-score tape in a community setting in Guatemala

Authors: Mikaela A. Miller, Kristen Mallory, Manolo Escobedo, Ana Cecilia Tarot, Susan Abdel-Rahman

Published in: Archives of Public Health | Issue 1/2019

Abstract

Background

Mid-Upper Arm Circumference (MUAC) is an independent anthropometric measurement used to identify malnutrition in children. While much research has been dedicated to applying fixed estimates of MUAC to identify cases of malnutrition in children under 5 years of age, far less has been done with age-specific MUAC Z-score values across the continuum of age from birth through adolescence.

Methods

The present study examined the effectiveness of a novel MUAC Z-score tape, in the hands of community health volunteers, to identify children over the age of 5 who would benefit from nutritional rehabilitation. In January of 2019, 112 community health volunteers working within Children International in Guatemala were trained to use the MUAC Z-score tape and asked to collect measurements on children or youth in their communities.

Results

Of the 818 MUAC Z-score tape measurements obtained by volunteers, 88.26% (722/818) were concordant with nutritional risk status as predicted by BMI Z-score, and 90.95% (744/818) were concordant with MUAC Z-score tape measurements made by field medical staff. MUAC Z-scores identified 87.10% (27/31) of the severely or moderately undernourished children as determined by the BMI Z-score who would be candidates for the nutrition rehabilitation program (Z-score ≤ − 2) along with an additional six children that would not have been classified as such with BMI Z-score. A qualitative survey distributed to the volunteers showed moderate rates of understanding of nutritional risk using the tape, and 62.50% reported the tape was easy to use.

Conclusions

These quantitative and qualitative findings suggest that with more in-depth training and education the MUAC Z-score tape is a viable, low-cost, low-burden alternative for community-level nutritional status assessment among the population served by Children International in Guatemala.

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Black RE, Victora CG, Walker SP, Qar A, Bhutta Z, Christian P, De Onis M, et al. Maternal and child nutrition 1 maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–51. https://doi.org/10.1016/S0140-6736(13)60937-X.CrossRefPubMed

Nyirenda H, Lelijveld N, Seal A, Wells JC, Kirkby J, Opondo C, et al. Chronic disease outcomes after severe acute malnutrition in Malawian children (ChroSAM): a cohort study. Artic Lancet Glob Heal. 2016;4:654–62. https://doi.org/10.1016/S2214-109X(16)30133-4.CrossRef

Bwakura-Dangarembizi M, Amadi B, Bourke CD, Robertson RC, Mwapenya B, Chandwe K, et al. Health outcomes, pathogenesis and epidemiology of severe acute malnutrition (HOPE-SAM): rationale and methods of a longitudinal observational study the HOPE-SAM study team. BMJ Open. 2019;9:23077. https://doi.org/10.1136/bmjopen-2018-023077.CrossRef

Dewey KG, Begum K. Long-term consequences of stunting in early life. Matern Child Nutr. 2011;7:5–18. https://doi.org/10.1111/j.1740-8709.2011.00349.x.CrossRefPubMed

Prentice AM, Ward KA, Goldberg GR, Jarjou LM, Moore SE, Fulford AJ, et al. Critical windows for nutritional interventions against stunting 1−3. Am J Clin Nutr. 2013;97:911–8. https://doi.org/10.3945/ajcn.112.052332.CrossRefPubMedPubMedCentral

Isaacs E, Oates J. Nutrition and cognition: assessing cognitive abilities in children and young people. Eur J Nutr. 2008;47:4–24. https://doi.org/10.1007/s00394-008-3002-y.CrossRefPubMed

Kim JY, Kang SW. Relationships between Dietary Intake and Cognitive Function in Healthy Korean Children and Adolescents. J Lifestyle Med. 2017;7:10–7. https://doi.org/10.15280/jlm.2017.7.1.10.CrossRefPubMedPubMedCentral

Best C, Neufingerl N, van Geel L, van den Briel T, Osendarp S. The nutritional status of school-aged children: why should we care? Food Nutr Bull. 2010;31:400–17.CrossRef

World Bank. Repositioning nutrition as central to development a strategy for large-scale action. 2006.

10.

Martins VJB, Toledo Florê Ncio TMM, Grillo LP, Do M, Franco CP, Martins PA, et al. Long-lasting effects of undernutrition. Int J Environ Res Public Heal. 2011;8:1817–46. https://doi.org/10.3390/ijerph8061817.CrossRef

11.

Jackson A, Ashworth A. The development of capacity at scale. Food Nutr Bull. 2015;36(Supplement):S47–52.CrossRef

12.

Van Tonder E, Mace L, Steenkamp L, Tydeman-Edwards R, Gerber K, Friskin D. Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition. South African J Clin Nutr. 2018:1–6. https://doi.org/10.1080/16070658.2018.1484622.

13.

Jackson AA. Identifying children at risk of malnutrition. Nutr J. 2018;17:1–4. https://doi.org/10.1186/s12937-018-0392-4.CrossRef

14.

Grellety E, Golden MH. Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: I. empirical data demonstrates Simpson’s paradox. Nutr J. 2018;17:1–21. https://doi.org/10.1186/s12937-018-0384-4.CrossRef

15.

WHO | BMI-for-age (5–19 years). WHO 2019. https://www.who.int/growthref/who2007_bmi_for_age/en/ ().

16.

Roberfroid D, Hammami N, Lachat C, Prinzo ZW, Sibson V, Guesdon B, et al. Utilization of mid-upper arm circumference versus weight-for-height in nutritional rehabilitation programmes: a systematic review of evidence. 2013.

17.

Chiabi A, Mbanga C, Mah E, Dongmo FN, Nguefack S, Fru F, et al. Weight-for-height Z score and mid-upper arm circumference as predictors of mortality in children with severe acute malnutrition. J Trop Pediatr. 2017;63:260–6. https://doi.org/10.1093/tropej/fmw083.CrossRefPubMed

18.

Grellety E, Krause LK, Shams Eldin M, Porten K, Isanaka S. Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality? Public Health Nutr. 2015;18:2575–81. https://doi.org/10.1017/S1368980015000737.CrossRefPubMed

19.

Briend A, Maire B, Fontaine O, Garenne M. Mid-upper arm circumference and weight-for-height to identify high-risk malnourished under-five children. Matern Child Nutr. 2012;8:130–3. https://doi.org/10.1111/j.1740-8709.2011.00340.x.CrossRefPubMed

20.

Hossain I, Ahmed T, El Arifeen S, Billah SM, Faruque A, Islam MM, et al. Comparison of midupper arm circumference and weight-for-height z score for assessing acute malnutrition in Bangladeshi children aged 6-60 mo: an analytical study. Am J Clin Nutr. 2017;106:1232–9. https://doi.org/10.3945/ajcn.CrossRefPubMed

21.

Goossens S, Bekele Y, Yun O, Harczi G, Ouannes M, Shepherd S. Mid-upper arm circumference based nutrition programming: evidence for a new approach in regions with high burden of acute malnutrition. PLoS One. 2012;7:e49320. https://doi.org/10.1371/journal.pone.0049320.CrossRefPubMedPubMedCentral

22.

Fiorentino M, Sophonneary P, Laillou A, Whitney S, de Groot R, Perignon M, et al. Current MUAC cut-offs to screen for acute malnutrition need to be adapted to gender and age: the example of Cambodia. PLoS One. 2016;11:e0146442. https://doi.org/10.1371/journal.pone.0146442.CrossRefPubMedPubMedCentral

23.

Sultana T, Nazmul Karim M, Ahmed T, Iqbal HM. Assessment of under nutrition of Bangladeshi adults using anthropometry: can body mass index be replaced by mid-upper-arm-circumference? PLoS One. 2015;10:–e0121456. https://doi.org/10.1371/journal.pone.0121456.CrossRef

24.

Sachdeva S, Dewan P, Shah D, Malhotra RK, Gupta P. Mid-upper arm circumference v. weight-for-height Z-score for predicting mortality in hospitalized children under 5 years of age. Public Health Nutr. 2016;19:2513–20. https://doi.org/10.1017/S1368980016000719.CrossRefPubMed

25.

Mogendi JB, De Steur H, Gellynck X, Saeed HA, Makokha A. Efficacy of mid-upper arm circumference in identification, follow-up and discharge of malnourished children during nutrition rehabilitation. Nutr Res Pract. 2015;9:268. https://doi.org/10.4162/nrp.2015.9.3.268.CrossRefPubMedPubMedCentral

26.

Fernandez MAL, Delchevalerie P, van Herp M. Accuracy of MUAC in the detection of severe wasting with the new WHO growth standards. Pediatrics. 2010;126:e195–201. https://doi.org/10.1542/peds.2009-2175.CrossRefPubMed

27.

Mantilla-Hernández LC, Niño-Bautista L, Prieto-Pinilla EE. Validating mid-upper arm circumference (MUAC) measurement for detecting acute malnutrition in 6-59 month-old children in emergency and disaster situations. Rev Salud Pública. 2014;16:195–207.CrossRef

28.

Cordovés P, Cuan H, Viamontes O, Pérez M, Pérez M. Perímetro braquial para diagnosticar estado nutricional en niños de dos a cinco años. Rev Argentina Anatomía Online. 2014;5:107–13.

29.

Fierro PM, Sanchez IY, Chinchilla M. Tobar LF. Frente a Los Indicadores Talla Para La Edad, Peso Para La Edad, y Peso Para La Talla En Las Comunidades Indigenas, Poblaciones Afrocolombianas y Mestizas: El Perímetro Braquial Para Diagnosticar Estado Nutricional; n.d. https://encolombia.com/medicina/materialdeconsulta/tensiometro-virtual/perimetro-branquial/ (

30.

Mramba L, Ngari M, Mwangome M, Muchai L, Bauni E, Walker AS, et al. A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study. BMJ. 2017;358:j3423. https://doi.org/10.1136/BMJ.J3423.CrossRefPubMedPubMedCentral

31.

Addo OY, Himes JH, Zemel BS. Reference ranges for midupper arm circumference, upper arm muscle area, and upper arm fat area in US children and adolescents aged 1–20 y. Am J Clin Nutr. 2017;105:111–20. https://doi.org/10.3945/ajcn.116.142190.CrossRefPubMed

32.

Abdel-Rahman SM, Bi C, Thaete K. Construction of lambda, mu, sigma values for determining mid-upper arm circumference z scores in U.S. children aged 2 months through 18 years. Nutr Clin Pract. 2017;32:68–76. https://doi.org/10.1177/0884533616676597.CrossRefPubMed

33.

Stephens K, Escobar A, Jennison EN, Vaughn L, Sullivan R, Abdel-Rahman S, et al. Evaluating mid-upper arm circumference Z-score as a determinant of nutrition status. Nutr Clin Pract. 2018;33:124–32. https://doi.org/10.1002/ncp.10018.CrossRefPubMed

34.

Bliss J, Lelijveld N, Briend A, Kerac M, Manary M, McGrath M, et al. Use of mid-upper arm circumference by novel community platforms to detect, diagnose, and treat severe acute malnutrition in children: a systematic review. Glob Heal Sci Pract. 2018;6:552–64. https://doi.org/10.9745/GHSP-D-18-00105.CrossRef

35.

Alé FGB, Phelan KPQ, Issa H, Defourny I, Le Duc G, Harczi G, et al. Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers: results from a large-scale pragmatic trial in rural Niger. Arch Public Health. 2016;74:38. https://doi.org/10.1186/s13690-016-0149-5.CrossRefPubMedPubMedCentral

36.

WHO | WHO Anthro (version 3.2.2, January 2011) and macros. WHO 2017.

37.

Efron B. Better bootstrap confidence intervals. J Am Stat Assoc. 1987;82:171. https://doi.org/10.2307/2289144.CrossRef

38.

Martinez B, Webb MF, Gonzalez A, Douglas K, Grazioso MDP, Rohloff P. Complementary feeding intervention on stunted Guatemalan children: a randomised controlled trial. BMJ Paediatr Open. 2018;2:213. https://doi.org/10.1136/bmjpo-2017-000213.CrossRef

39.

Corvalán C, Garmendia ML, Jones-Smith J, Lutter CK, Miranda JJ, Pedraza LS, et al. Nutrition status of children in Latin America. Obes Rev. 2017;18:7–18. https://doi.org/10.1111/obr.12571.CrossRefPubMedPubMedCentral

40.

Asfaw A. Does consumption of processed foods explain disparities in the body weight of individuals? The case of Guatemala. Health Econ. 2011;20:184–95. https://doi.org/10.1002/hec.1579.CrossRefPubMed

41.

Moubarac JC, Batal M, Martins APB, Claro R, Levy RB, Cannon G, et al. Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res. 2014;75:15–21. https://doi.org/10.3148/75.1.2014.15.CrossRefPubMed

42.

Ramirez-Zea M, Kroker-Lobos MF, Close-Fernandez R, Kanter R. The double burden of malnutrition in indigenous and nonindigenous Guatemalan populations. Am J Clin Nutr. 2014;100:1644S–51S. https://doi.org/10.3945/ajcn.114.083857.CrossRefPubMed

Title: Assessing effectiveness of a novel mid-upper arm circumference Z-score tape in a community setting in Guatemala
Authors: Mikaela A. Miller
Kristen Mallory
Manolo Escobedo
Ana Cecilia Tarot
Susan Abdel-Rahman
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Malnutrition
Published in: Archives of Public Health / Issue 1/2019
Electronic ISSN: 2049-3258
DOI: https://doi.org/10.1186/s13690-019-0370-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Assessing effectiveness of a novel mid-upper arm circumference Z-score tape in a community setting in Guatemala

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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