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 Oct;18(14):2575-81. doi: 10.1017/S1368980015000737. Epub 2015 Mar 25.


Objective: The present study was performed to describe the operational implications of using mid-upper arm circumference (MUAC) as a single admission criterion for treatment of severe acute malnutrition in South Sudan.

Design: We performed a retrospective analysis of routine programme data of children with severe acute malnutrition aged 6-59 months admitted to a therapeutic feeding programme using weight-for-height Z-score (WHZ) and/or MUAC. To understand the implications of using MUAC as a single admission criterion, we compared patient characteristics and treatment outcomes for children admitted with MUAC<115 mm (irrespective of WHZ) v. children admitted with WHZ<-3 and MUAC≥115 mm.

Results: Of 2205 children included for analysis, 719 (32·6 %) were admitted to the programme with MUAC<115 mm and 1486 (67·4 %) with WHZ<-3 and MUAC≥115 mm. Children who would have been admitted using a single MUAC<115 mm criterion were more severely malnourished and more likely to be female and younger. Compared with children admitted with WHZ<-3 and MUAC≥115 mm, children who would have been admitted using MUAC<115 mm were less likely to recover (54 % v. 69 %) and had higher risk of death (4 % v. 1 %), but responded to treatment with greater weight and MUAC gains. MUAC<115 mm would have failed to identify 33 % of deaths, while 98 % were identified by WHZ<-3 alone and 100 % by MUAC<130 mm.

Conclusions: The study shows that MUAC<115 mm identified more severely malnourished children with a higher risk of mortality but failed to identify a third of the children who died. Admission criteria for therapeutic feeding should be adapted to the programmatic context with consideration for both operational and public health implications.

Keywords: Admission criteria; Child malnutrition; Community-based management of acute malnutrition; Mid-upper arm circumference; Weight-for-height Z-score.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Anthropometry
  • Arm*
  • Body Height*
  • Body Weight*
  • Body Weights and Measures
  • Child Nutrition Disorders / diagnosis*
  • Child Nutrition Disorders / diet therapy
  • Child Nutrition Disorders / mortality
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Nutritional Status*
  • Patient Selection*
  • Protein-Energy Malnutrition / diagnosis*
  • Protein-Energy Malnutrition / diet therapy
  • Protein-Energy Malnutrition / mortality
  • Retrospective Studies
  • Severity of Illness Index
  • Sex Factors
  • South Sudan / epidemiology
  • Weight Gain