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Journal Article > Research

Prognostic value of different anthropometric indices over different measurement intervals to predict mortality in 6–59-month-old children

Briend A, Myatt M, Berkley JA, Black RE, Boyd EM, Garenne M, Lelijveld N, Isanaka S, McDonald CM, Mwangwome M, O’Brien KS, Schwinger C, Stobaugh H, Taneja S, West KP, Khara T
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Abstract
OBJECTIVE
To compare the prognostic value of mid-upper arm circumference (MUAC), weight-for-height Z-score (WHZ) and weight-for-age Z-score (WAZ) for predicting death over periods of 1, 3 and 6 months follow-up in children.

DESIGN
Pooled analysis of twelve prospective studies examining survival after anthropometric assessment. Sensitivity and false-positive ratios to predict death within 1, 3 and 6 months were compared for three individual anthropometric indices and their combinations.

SETTING
Community-based, prospective studies from twelve countries in Africa and Asia.

PARTICIPANTS
Children aged 6–59 months living in the study areas.

RESULTS
For all anthropometric indices, the receiver operating characteristic curves were higher for shorter than for longer durations of follow-up. Sensitivity was higher for death with 1-month follow-up compared with 6 months by 49 % (95 % CI (30, 69)) for MUAC < 115 mm (P < 0·001), 48 % (95 % CI (9·4, 87)) for WHZ < -3 (P < 0·01) and 28 % (95 % CI (7·6, 42)) for WAZ < -3 (P < 0·005). This was accompanied by an increase in false positives of only 3 % or less. For all durations of follow-up, WAZ < -3 identified more children who died and were not identified by WHZ < -3 or by MUAC < 115 mm, 120 mm or 125 mm, but the use of WAZ < -3 led to an increased false-positive ratio up to 16·4 % (95 % CI (12·0, 20·9)) compared with 3·5 % (95 % CI (0·4, 6·5)) for MUAC < 115 mm alone.

CONCLUSIONS
Frequent anthropometric measurements significantly improve the identification of malnourished children with a high risk of death without markedly increasing false positives. Combining two indices increases sensitivity but also increases false positives among children meeting case definitions.
Countries
BangladeshDemocratic Republic of CongoGhanaGuinea-BissauIndonesiaNepalNigerPeruPhilippinesSenegalIndiaSudan
Subject Area
pediatricsmalnutritionsevere acute malnutritionmortality
DOI
10.1017/S1368980023000149
Published Date
01-Jun-2023
PubMed ID
36722310
Languages
English
Journal
Public Health Nutrition
Volume / Issue / Pages
Volume 26, Issue 6, Pages 1210-1221
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