背景:在社区一级及时准确地筛查营养不良对识别营养不良儿童至关重要。世界卫生组织(WHO)指南使用中上臂围(MUAC)或身高体重Z评分(WHZ)对儿童非水肿性急性营养不良进行分类。研究设计:横断面研究。
方法:这项研究是在6-60个月的儿童中进行的。在必要的排除之后,使用多阶段简单随机抽样方法选择了433名参与者。使用WHO全球急性营养不良(GAM)指南[WHZ<-2,MUAC<12.5cm],灵敏度(Se),特异性(Sp),预测值,似然比,尤登指数,以WHZ为标准,计算MUAC的受试者工作特征(ROC)曲线。
结果:在433名参与者中,30%的人使用WHZ诊断为GAM,而使用MUAC测量发现17.6%营养不良。根据世卫组织的截止日期,Se,SP,阳性预测值(PPV),负预测值(NPV),尤登指数,正似然比(LR+),MUAC的负似然比(LR-)为48%,96%,83%,81%,分别为0.44、12和0.54。ROC曲线显示MUAC<12.5cm的曲线下面积为0.86(95%置信区间=0.83,0.90)。双变量Pearson相关性也证明了WHZ和MUAC变量之间的正线性关系(R2=0.302)。
结论:根据调查结果,MUAC正确识别了48%的儿童,GAM的概率为83%(PPV=0.83)。此外,非营养不良儿童有96%的Sp,只有4%的误报。因此,由于MUAC易于使用和简单,基层人员可以使用MUAC及时准确地筛查Anganwadi中心(AWC)的儿童。
BACKGROUND: Timely and accurate screening of malnutrition at the community level is essential to identifying malnourished children. The World Health Organization (WHO) guidelines classify non-oedematous acute malnutrition among children using mid-upper arm circumference (MUAC) or weight-for-height Z-score (WHZ). Study Design: A cross-sectional study.
METHODS: This study was conducted among children aged 6‒60 months. After necessary exclusions, 433 participants were selected using a multi-stage simple random sampling method. Using WHO guidelines for global acute malnutrition (GAM) [WHZ<-2, MUAC<12.5 cm], the sensitivity (Se), specificity (Sp), predictive values, likelihood ratios, Youden index, and receiver operating characteristic (ROC) curve were calculated for MUAC using WHZ as the criterion.
RESULTS: Out of 433 participants, 30% were diagnosed with GAM using WHZ, while 17.6% were found malnourished using MUAC measurements. As per WHO cut-offs, the Se, Sp, positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of MUAC were 48%, 96%, 83%, 81%, 0.44, 12, and 0.54, respectively. The ROC curve displayed an area under the curve of 0.86 (95% confidence interval=0.83, 0.90) for MUAC<12.5 cm. Bivariate Pearson correlation also demonstrated a positive linear relationship (R2=0.302) between the WHZ and MUAC variables.
CONCLUSIONS: Based on the findings, 48% of the children were correctly identified by the MUAC with an 83% probability of GAM (PPV=0.83). Moreover, there was 96% Sp in non-malnourished children, with only 4% false positives. Therefore, personnel at the grassroots level can use MUAC for timely and accurate screening of children in Anganwadi centers (AWCs) due to its ease of use and simplicity.