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Open AccessArticle

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

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UMR-204 Nutripass, Institut de Recherche pour le Développement, IRD/UM/SupAgro, 34390 Montpellier, France
2
UNICEF-Cambodia, Phnom Penh, Cambodia
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Department of Health Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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Department of Nutrition, Excercise and Sports, Copenhagen University, 1165 Copenhagen, Denmark
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Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(6), 786; https://doi.org/10.3390/nu10060786
Received: 14 May 2018 / Revised: 8 June 2018 / Accepted: 15 June 2018 / Published: 19 June 2018
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. View Full-Text
Keywords: malnutrition; anthropometry; weight-for-height; mid upper arm circumerference (MUAC); gender malnutrition; anthropometry; weight-for-height; mid upper arm circumerference (MUAC); gender
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Wieringa, F.T.; Gauthier, L.; Greffeuille, V.; Som, S.V.; Dijkhuizen, M.A.; Laillou, A.; Chamnan, C.; Berger, J.; Poirot, E. 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 2018, 10, 786.

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