Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts
Date
2023-02-03
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Abstract
Objective: To understand which anthropometric diagnostic criteria best discriminate
higher from lower risk of death in children and explore programme implications.
Design: A multiple cohort individual data meta-analysis of mortality risk (within
6 months of measurement) by anthropometric case definitions. Sensitivity,
specificity, informedness and inclusivity in predicting mortality, face validity and
compatibility with current standards and practice were assessed and operational
consequences were modelled.
Setting: Community-based cohort studies in twelve low-income countries between
1977 and 2013 in settings where treatment of wasting was not widespread.
Participants: Children aged 6 to 59 months.
Results: Of the twelve anthropometric case definitions examined, four (weight-forage Z-score (WAZ) <−2), (mid-upper arm circumference (MUAC) <125 mm),
(MUAC < 115 mm or WAZ < −3) and (WAZ < −3) had the highest informedness
in predicting mortality. A combined case definition (MUAC < 115 mm or
WAZ < −3) was better at predicting deaths associated with weight-for-height
Z-score <−3 and concurrent wasting and stunting (WaSt) than the single WAZ < −3
case definition. After the assessment of all criteria, the combined case definition
performed best. The simulated workload for programmes admitting based on
MUAC < 115 mm or WAZ < −3, when adjusted with a proxy for required intensity
and/or duration of treatment, was 1·87 times larger than programmes admitting on
MUAC < 115 mm alone.
Conclusions: A combined case definition detects nearly all deaths associated with
severe anthropometric deficits suggesting that therapeutic feeding programmes
may achieve higher impact (prevent mortality and improve coverage) by using
it. There remain operational questions to examine further before wide-scale adoption can be recommended.
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Keywords
Wasting Stunting Underweight Mid-upper arm circumference Anthropometry Mortality Therapeutic feeding