Core Criteria for Identifying Severe Acute Malnutrition
Identifying severe acute malnutrition (SAM) for children aged 6 to 59 months is based on three key indicators recognized by organizations like the World Health Organization (WHO) and UNICEF. A diagnosis is made if a child meets any one of these criteria.
Bilateral Pitting Edema
Bilateral pitting edema is a sign of SAM, often associated with kwashiorkor. It is checked by pressing a thumb on the top of both feet, with a lasting indentation indicating a positive result.
Mid-Upper Arm Circumference (MUAC)
MUAC is a screening tool, particularly useful in communities. A measurement below 115 mm for children 6 to 59 months old indicates SAM. MUAC is a good predictor of mortality.
Weight-for-Height Z-score (WHZ)
WHZ uses WHO Child Growth Standards to compare a child's weight to their height. A WHZ below -3 standard deviations signals SAM. This score indicates severe wasting (marasmus) and is often used in clinics due to the equipment needed.
Comparison of SAM Identification Criteria
| Indicator | Measurement Method | Target Age Group | Primary Setting | Ease of Use | Predictive Power for Mortality |
|---|---|---|---|---|---|
| Bilateral Pitting Edema | Clinical sign, finger pressure | 6–59 months | Community & Clinical | Very Easy | High |
| Mid-Upper Arm Circumference (MUAC) | Colored tape measure | 6–59 months | Community & Clinical | Easy | High |
| Weight-for-Height Z-score (WHZ) | Requires scale and stadiometer | 6–59 months | Clinical | Moderate | High |
In-depth Assessment of Anthropometric Measurements
What the Z-score Means
The Z-score shows how much a child's weight-for-height differs from the median of the WHO standards. A WHZ below -3 SD means severe wasting.
Role of MUAC in the Community
MUAC measurement is quick and affordable for widespread screening. Training community health workers to use MUAC tapes helps find children at risk early.
Complementary Clinical Assessment
A full clinical check is important for children with complicated SAM. Signs like lethargy or poor appetite are assessed, as well as other health problems. Children with complications may need inpatient care.
Management and Treatment Implications
Treatment depends on whether SAM is complicated. Uncomplicated cases can be treated with Ready-to-Use Therapeutic Food (RUTF) at home. Complicated cases need hospital care to stabilize medical issues like infections.
The Discrepancy Between MUAC and WHZ
MUAC and WHZ do not always identify the same children with SAM. The WHO recommends using all three criteria to improve identification, as both low MUAC and low WHZ are linked to higher mortality risk. MUAC reflects muscle and fat loss, while WHZ reflects overall wasting.
Conclusion
Identifying severe acute malnutrition in children aged 6 to 59 months is based on WHO criteria: bilateral pitting edema, MUAC below 115mm, and WHZ below -3 SD. Using these standard criteria helps health workers diagnose SAM accurately and guide treatment based on the child's condition. Applying these metrics is essential for providing timely care.
List of Key Identification Indicators
- Bilateral Pitting Edema: A lasting indentation after pressing on both feet.
- Mid-Upper Arm Circumference (MUAC): Below 115 mm for children 6-59 months.
- Weight-for-Height Z-score (WHZ): Below -3 SD based on WHO standards.
Other criteria may be used for children outside this age range.
Diagnostic Flowchart for SAM
Here is a simplified flowchart:
- Check for Bilateral Pitting Edema: If present, diagnose as SAM.
- Measure MUAC: If < 115 mm (6-59 months), diagnose as SAM.
- Measure WHZ: If < -3 SD, diagnose as SAM.
- No SAM: If none of the above are met, the child is not severely malnourished.
Outbound Link
For more in-depth information and technical guidance on the management of severe acute malnutrition, refer to the World Health Organization (WHO) website: https://www.who.int/tools/elena/interventions/sam-identification
