Aims Severe Acute Malnutrition (SAM) underlies some 500,000 young child deaths per year. For the first time, new (December 2013) World Health Organisation Guidelines recognise SAM in infants <6 months (u6m). Research in this group is however lacking: WHO assessed the quality of current evidence as ‘VERY LOW’ according to the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation).
In this study we aimed to address a key question highlighted by WHO: how best to identify high risk infants u6m. We did this by:
- Comparing prevalence of infant SAM as defined by current weight-for-length (WFL)-based definitions with proposed new definitions based on mid-upper-arm circumference (MUAC).
- Identifying risk factors for use in future clinical assessment tools.
Methods A cross sectional prevalence survey conducted in two referral hospitals and three community health centres in Malawi. All infants u6m excluding twins attending for either medical attention or routine immunizations were measured and asked about potential malnutrition risk factors.
Results From October 2013–January 2014 we measured 6,787 infants u6m. After data cleaning, we analysed a total of 5,717 infants u6m: 582 from hospitals; 5,135 from health centres.
Defined by WFL <−3 z-scores, 1.6% (90) infants had SAM. Defined by MUAC <110mm, 3.9% (214) had SAM. By MUAC <115mm, an additional 3.5% (188) had SAM. However defined, prevalence was higher in the hospitals than in health centres (3.5% vs 1.4% by WFL; 4.5% vs 3.4% by MUAC).
There were no male/female sex differences. Infants with low birth weight (<2.5kg) were 2.2 times more likely to be malnourished. Those whose mothers reported a breastfeeding problem were 6.4 times as likely to be malnourished.
Conclusion Infant u6m SAM is an important problem, especially in hospital settings, but even in otherwise stable infants attending for immunizations. MUAC identifies more infants as having SAM than does WFL – these differences matter for calculating sample sizes for future intervention studies. MUAC, though not currently used for infants u6m is being actively researched in this age-group; MUAC is well established in older children in identfying those high risk of death. Risk factors identified here are also important towards future studies in this age group.
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