Criteria for undernutrition screening in hospitalised infants under 6 months: a diagnostic accuracy study in a resource-poor setting

Abstract

PurposeWe aimed to describe the prevalence of undernutrition in hospitalised infants aged under 6 months and test the utility of simple index measures to detect undernutrition.DesignDiagnostic accuracy study: weight, length, mid-upper arm circumference (MUAC), triceps and subscapular skinfolds were measured in infants aged 2 weeks to 6 months admitted to a Teaching Hospital in Enugu, Nigeria. Index criteria: low (<−2SD) weight-for-age Z-scores (WAZ), weight-for-length Z-scores (WLZ); MUAC <11 cm. Reference definition: weight faltering (conditional weight gain below fifth percentile for healthy Nigerian infants) or sum of skinfolds (SSF) <10 mm.ResultsOf 125 hospitalised infants, only 5% (6) were admitted specifically for undernutrition, but low SSF were found in 33% (41) and, 24% (25) with known birth weight had weight faltering, giving an undernutrition prevalence of 36%. Low WAZ was the most discriminating predictor of undernutrition (sensitivity 69%, positive predictive value 86%, likelihood ratio 5.5; area under receiver operator curves 0.90) followed by MUAC (73%, 73%, 4.9; 0.86), while WLZ performed least well (49%, 67%, 2.9; 0.84). Where both MUAC and WAZ were low, there was sensitivity 90%, positive predictive value 82% and likelihood ratio 8.7.ConclusionsInfants aged under 6 months admitted to hospital in Nigeria had a high prevalence of undernutrition. In young, high-risk population, a low WAZ alone was a valuable screening criterion, while combining weight with MUAC gave even higher discrimination. Measurement of length to calculate WLZ was a less useful predictor in this population.

Malnutrition in Infants Aged under 6 Months Attending Community Health Centres: A Cross Sectional Survey

“…A small but growing number of studies have explored the utility of different anthropometric criteria to identify malnutrition in infants u6m [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The best of these look at the association between anthropometric measures and subsequent mortality.…”

“…In our study, we sampled infants u6m attending health centres for any reason. Most studies evaluating malnutrition burden in infants u6m focused on community representative samples [ 29 , 32 , 33 , 34 ], on infants hospitalised and receiving in-patient care [ 31 , 35 , 36 , 37 ], or they have followed-up a birth cohort [ 30 ]. Our study was a facility-based survey collecting data on infants attending health centres for any reason, which provides better understanding of the potential for care provision to the population covered by these health centres.…”

Malnutrition in Infants Aged under 6 Months Attending Community Health Centres: A Cross Sectional Survey

“…A small but growing number of studies have explored the utility of different anthropometric criteria to identify malnutrition in infants u6m [28][29][30][31][32][33][34][35][36]. The best of these look at the association between anthropometric measures and subsequent mortality.…”

“…In our study, we sampled infants u6m attending health centres for any reason. Most studies evaluating malnutrition burden in infants u6m focused on community representative samples [28,[31][32][33], on infants hospitalised and receiving in-patient care [30,[34][35][36], or they have followed-up a birth cohort [29].…”

Anthropometric indicators associated with childhood obesity. Is it time for a BMI successor?

“…Pomiar można wykonywać u dzieci sześciomiesięcznych i starszych. Jednak pojawiają się doniesienia, że przy ocenie stanu odżywienia można wykorzystywać ten parametr u młodszych dzieci [72] oraz dla kobiet w ciąży [73].…”