Some of the recently piloted innovative approaches for the management of acute malnutrition in children use the “expanded MUAC-only” approach, with Mid Upper Arm Circumference (MUAC) < 125 mm as the sole anthropometric criterion for screening and admission, classification of cases as severe using the 115 mm cut-off, and use Ready-to-Use-Therapeutic-Food (RUTF) for the management of both moderate (MAM) and severe (SAM) cases of acute malnutrition. Our study aimed at exploring the potential consequences of this “expanded MUAC-only” program scenario on the eligibility for treatment and RUTF allocation, as compared with the existing WHO normative guidance. We analyzed data from 550 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as SAM and MAM according to currently used case definitions, and calculated the proportions of SAM children who would be excluded from treatment, misclassified as MAM, or whose specific risks (because of having both MUAC and weight-for height deficits) would be ignored. We also analyzed the expected changes in the number and demographics (sex, age) of children meant to receive RUTF according to the new approach. We found that approximately one quarter of SAM children would not be detected and eligible for treatment under the “expanded MUAC-only” scenario, and another 20% would be classified as MAM. A further 17% of the total SAM children would be admitted and followed only according to their MUAC or oedema status, while they also present with a severe weight-for height deficit on admission. Considering MAM targeting, about half of the MAM children would be left undetected. This scenario also shows a 2.5 time increase in the number of children targeted with RUTF, with approximately 70% of MAM and 30% of SAM cases among this new RUTF target. This empirical evidence suggests that adoption of “expanded MUAC-only” programs would likely lead to a priori exclusion from treatment or misclassifying as MAM a large proportion of SAM cases, while redirecting programmatic costs in favor of those less in need. It underscores the need to explore other options for improving the impact of programs addressing the needs of acutely malnourished children.

中文翻译：

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扩大仅 MUAC 计划对针对急性营养不良儿童和即食治疗食品分配的潜在后果：来自横断面调查的经验教训

一些最近试行的儿童急性营养不良管理创新方法使用“仅扩展 MUAC”方法，上臂中围 (MUAC) < 125 mm 作为筛查和入院的唯一人体测量标准，病例分类为严重使用 115 毫米截止值，并使用即用治疗食品 (RUTF) 管理中度 (MAM) 和严重 (SAM) 急性营养不良病例。我们的研究旨在与现有的 WHO 规范性指南相比，探索这种“扩展的 MUAC-only”计划方案对治疗资格和 RUTF 分配的潜在影响。我们分析了自 2007 年以来进行的 550 次具有人口代表性的横断面聚类调查的数据。我们检索了根据当前使用的病例定义归类为 SAM 和 MAM 的所有儿童，并计算了 SAM 儿童将被排除在治疗之外、被错误归类为 MAM 或具有特定风险（因为同时具有 MUAC 和身高比体重缺陷）的比例) 将被忽略。我们还分析了根据新方法接受 RUTF 的儿童数量和人口统计（性别、年龄）的预期变化。我们发现，在“仅扩展 MUAC”的情况下，大约四分之一的 SAM 儿童不会被检测到并且没有资格接受治疗，另外 20% 将被归类为 MAM。另外 17% 的 SAM 儿童将仅根据他们的 MUAC 或水肿状态入院和随访，同时他们在入院时也出现严重的身高体重不足。考虑到 MAM 目标，大约一半的 MAM 儿童将未被发现。这种情况还显示 RUTF 的目标儿童数量增加了 2.5 倍，其中大约 70% 的 MAM 和 30% 的 SAM 病例属于这个新的 RUTF 目标。这一经验证据表明，采用“仅扩展 MUAC”计划可能会导致先验排除治疗或将大部分 SAM 病例错误分类为 MAM，同时将计划成本重新定向到需要较少的患者。它强调有必要探索其他方案，以提高解决严重营养不良儿童需求的方案的影响。在这个新的 RUTF 目标中，大约 70% 的 MAM 和 30% 的 SAM 案例。这一经验证据表明，采用“仅扩展 MUAC”计划可能会导致先验排除治疗或将大部分 SAM 病例错误分类为 MAM，同时将计划成本重新定向到需要较少的患者。它强调有必要探索其他方案，以提高解决严重营养不良儿童需求的方案的影响。在这个新的 RUTF 目标中，大约 70% 的 MAM 和 30% 的 SAM 案例。这一经验证据表明，采用“仅扩展 MUAC”计划可能会导致先验排除治疗或将大部分 SAM 病例错误分类为 MAM，同时将计划成本重新定向到需要较少的患者。它强调有必要探索其他方案，以提高解决严重营养不良儿童需求的方案的影响。