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Highland Medical Research Journal

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A comparison of mid upper arm circumference with other Indices for discharge from community-based management of malnutrition clinics in Jigawa State, Nigeria

U.M. Diala, R.O. Adah, E.A. Envaladu, L. Lar, I. Adedeji, H. Abdu, K.E. Lasisi, O. Olosunde, J.B. Ajibuah, C. John

Abstract


Background: Community-based management of acute malnutrition (CMAM) program has saved millions of children with severe acute  malnutrition (SAM) globally. World Health Organization recommended discharge indices include Midupper arm circumference (MUAC) =12.5cm, =15-20% weight gain and weight-for-height Z score (WHZ) =-2. We compared MUAC with WHZ and percentage weight gain as discharge criteria from CMAM.
Methods: It was a community based cohort study of children aged 6-59 months with SAM discharged from CMAM clinics in Jigawa State, Nigeria. Socio-demographic data, nutrition history and anthropometry were recorded at enrolment and discharge.
Results: Of a total of 405 children studied, 209(51.6%) were females and had a peak age group of 12-23months (43.7%, range 6-42 months). At discharge, 353(87.2%) had MUAC = 12.5cm while 231(57.0%) and 204(50.4%) had percentage weight-gain =15% and WHZ=-2 respectively. There was weak agreement between MUAC and WHZ (agreement 50.8%, ê=0.012) and MUAC and percent weight-gain (agreement 54.8%, ê=-0.004). Children aged between 11-23 months (OR 2.12, p=0.006) and 24-35 months (OR 2.60, p=0.002) had increased risk of discharge with inadequate percentage weight gain. WHZ <-3 at enrolment was associated with increased risk of discharge with WHZ <-3 (OR 3.21, p<0.001) and reduced risk of discharge with inadequate percentage weight gain (OR 0.45, p<0.001). Age sex, WHZ at enrollment were not associated with MUAC at discharge.
Conclusion: The use of MUAC alone as discharge criterion allows a  significant proportion of children still needing urgent care exiting CMAM clinic prematurely. Stratifying these criteria may lead to better recovery before discharge.

Keywords: malnutrition, Community management of acute malnutrition, Mid upper-arm circumference, Weight-forheight Z score.




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