Purpose We 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.
Design Diagnostic 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.
Results Of 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.
Conclusions Infants 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.
- tropical paediatrics
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Contributors CMW conceived the study design. IOE created the questionnaire, collected the data, undertook the initial analyses and produced the first draft of the paper. CMW and ALG helped plan the study and supervised the analyses. CMW undertook further analyses and ALG drafted the paper. All authors contributed to successive drafts and have approved the final draft.
Funding Ford Foundation International Fellowships Program (IFP), New York, USA.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was obtained from the College of Medicine Ethics Committee at the University of Glasgow (Reference No 2011018) and the Medical Research Ethics Committee of the UNTH, Enugu, southeast Nigeria (Reference No NHRE/05/01/2008B–FWA00002458–IRB00002323).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.
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