Identification of Acute Malnutrition in Children in Cambodia Requires Both Mid Upper Arm Circumference and Weight-For-Height to Offset Gender Bias of Each Indicator
Malnutrition remains a serious health problem in Cambodia with over 10% of children less than five years of age suffering from acute malnutrition. In addition to the presence of nutritional edema, two indicators are recommended by the World Health Organization for the diagnosis of acute malnutrition...
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doaj-3193f0a95db34cd8892ac0f29af80c262020-11-25T00:21:38ZengMDPI AGNutrients2072-66432018-06-0110678610.3390/nu10060786nu10060786Identification of Acute Malnutrition in Children in Cambodia Requires Both Mid Upper Arm Circumference and Weight-For-Height to Offset Gender Bias of Each IndicatorFrank Tammo Wieringa0Ludovic Gauthier1Valérie Greffeuille2Somphos Vicheth Som3Marjoleine Amma Dijkhuizen4Arnaud Laillou5Chhoun Chamnan6Jacques Berger7Etienne Poirot8UMR-204 Nutripass, Institut de Recherche pour le Développement, IRD/UM/SupAgro, 34390 Montpellier, FranceUNICEF-Cambodia, Phnom Penh, CambodiaUMR-204 Nutripass, Institut de Recherche pour le Développement, IRD/UM/SupAgro, 34390 Montpellier, FranceDepartment of Health Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Nutrition, Excercise and Sports, Copenhagen University, 1165 Copenhagen, DenmarkUNICEF-Cambodia, Phnom Penh, CambodiaDepartment of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, CambodiaUMR-204 Nutripass, Institut de Recherche pour le Développement, IRD/UM/SupAgro, 34390 Montpellier, FranceUNICEF-Cambodia, Phnom Penh, CambodiaMalnutrition remains a serious health problem in Cambodia with over 10% of children less than five years of age suffering from acute malnutrition. In addition to the presence of nutritional edema, two indicators are recommended by the World Health Organization for the diagnosis of acute malnutrition: weight-for-height Z-scores (WHZ; with acute malnutrition defined as WHZ < −2 Z-score) and mid-upper arm circumference (MUAC, with acute malnutrition defined as MUAC < 12.5 cm). Earlier, we showed that WHZ and MUAC identified different subgroups of children with acute malnutrition. To explore factors associated with both indicators of acute malnutrition, we analyzed baseline data from a longitudinal study in three provinces in Cambodia: Phnom Penh (capital, urban environment), Kratie (rural province), and Ratanakiri (hilly, rural province). Data was available for 4381 children below 30 months of age. Malnutrition rates were higher in the two rural provinces than in the capital. Although both MUAC and WHZ showed gender bias, with MUAC identifying more girls, and WHZ identifying more boys with acute malnutrition, the gender effect was strongest for MUAC. The gender bias of MUAC diminished with older age, but remained significant up to 30 months of age. Only using both MUAC and WHZ as indicators resulted in gender neutral identification of acute malnutrition. WHZ alone always identified more children with acute malnutrition than MUAC alone. In Phnom Penh, MUAC alone identified only 11% with acute malnutrition in addition to WHZ. To conclude, both MUAC and WHZ showed gender bias in this cohort of Cambodian children. In Cambodia, implementation of a MUAC-only or a WHZ-only program for the identification of acute malnutrition would be unethical as it will lead to many children remaining undiagnosed.http://www.mdpi.com/2072-6643/10/6/786malnutritionanthropometryweight-for-heightmid upper arm circumerference (MUAC)gender |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Frank Tammo Wieringa Ludovic Gauthier Valérie Greffeuille Somphos Vicheth Som Marjoleine Amma Dijkhuizen Arnaud Laillou Chhoun Chamnan Jacques Berger Etienne Poirot |
spellingShingle |
Frank Tammo Wieringa Ludovic Gauthier Valérie Greffeuille Somphos Vicheth Som Marjoleine Amma Dijkhuizen Arnaud Laillou Chhoun Chamnan Jacques Berger Etienne Poirot Identification of Acute Malnutrition in Children in Cambodia Requires Both Mid Upper Arm Circumference and Weight-For-Height to Offset Gender Bias of Each Indicator Nutrients malnutrition anthropometry weight-for-height mid upper arm circumerference (MUAC) gender |
author_facet |
Frank Tammo Wieringa Ludovic Gauthier Valérie Greffeuille Somphos Vicheth Som Marjoleine Amma Dijkhuizen Arnaud Laillou Chhoun Chamnan Jacques Berger Etienne Poirot |
author_sort |
Frank Tammo Wieringa |
title |
Identification of Acute Malnutrition in Children in Cambodia Requires Both Mid Upper Arm Circumference and Weight-For-Height to Offset Gender Bias of Each Indicator |
title_short |
Identification of Acute Malnutrition in Children in Cambodia Requires Both Mid Upper Arm Circumference and Weight-For-Height to Offset Gender Bias of Each Indicator |
title_full |
Identification of Acute Malnutrition in Children in Cambodia Requires Both Mid Upper Arm Circumference and Weight-For-Height to Offset Gender Bias of Each Indicator |
title_fullStr |
Identification of Acute Malnutrition in Children in Cambodia Requires Both Mid Upper Arm Circumference and Weight-For-Height to Offset Gender Bias of Each Indicator |
title_full_unstemmed |
Identification of Acute Malnutrition in Children in Cambodia Requires Both Mid Upper Arm Circumference and Weight-For-Height to Offset Gender Bias of Each Indicator |
title_sort |
identification of acute malnutrition in children in cambodia requires both mid upper arm circumference and weight-for-height to offset gender bias of each indicator |
publisher |
MDPI AG |
series |
Nutrients |
issn |
2072-6643 |
publishDate |
2018-06-01 |
description |
Malnutrition remains a serious health problem in Cambodia with over 10% of children less than five years of age suffering from acute malnutrition. In addition to the presence of nutritional edema, two indicators are recommended by the World Health Organization for the diagnosis of acute malnutrition: weight-for-height Z-scores (WHZ; with acute malnutrition defined as WHZ < −2 Z-score) and mid-upper arm circumference (MUAC, with acute malnutrition defined as MUAC < 12.5 cm). Earlier, we showed that WHZ and MUAC identified different subgroups of children with acute malnutrition. To explore factors associated with both indicators of acute malnutrition, we analyzed baseline data from a longitudinal study in three provinces in Cambodia: Phnom Penh (capital, urban environment), Kratie (rural province), and Ratanakiri (hilly, rural province). Data was available for 4381 children below 30 months of age. Malnutrition rates were higher in the two rural provinces than in the capital. Although both MUAC and WHZ showed gender bias, with MUAC identifying more girls, and WHZ identifying more boys with acute malnutrition, the gender effect was strongest for MUAC. The gender bias of MUAC diminished with older age, but remained significant up to 30 months of age. Only using both MUAC and WHZ as indicators resulted in gender neutral identification of acute malnutrition. WHZ alone always identified more children with acute malnutrition than MUAC alone. In Phnom Penh, MUAC alone identified only 11% with acute malnutrition in addition to WHZ. To conclude, both MUAC and WHZ showed gender bias in this cohort of Cambodian children. In Cambodia, implementation of a MUAC-only or a WHZ-only program for the identification of acute malnutrition would be unethical as it will lead to many children remaining undiagnosed. |
topic |
malnutrition anthropometry weight-for-height mid upper arm circumerference (MUAC) gender |
url |
http://www.mdpi.com/2072-6643/10/6/786 |
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