手臂周长与年龄、手臂周长与身高别体重 Z 评分用于评价严重急性营养不良：刚果民主共和国东部的一项回顾性队列研究。

Arm circumference for age, arm circumference and weight-for-height z-score for the evaluation of severe acute malnutrition: a retrospective cohort study in eastern Democratic Republic of Congo.

机构信息

Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.

Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.

出版信息

BMC Public Health. 2024 Feb 23;24(1):587. doi: 10.1186/s12889-024-18083-y.

DOI:10.1186/s12889-024-18083-y

PMID:38395784

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10885520/

Abstract

BACKGROUND

Little is known about the use of mid-upper arm circumference for age (MUACZ) for diagnosing of severe acute malnutrition (SAM) and its correlation with WHZ (weight-for-height Z-score) in an area endemic for severe acute malnutrition (SAM) and with a high prevalence of kwashiorkor. Our study aims to analyze the concordance between the diagnostic criteria of SAM in a region presenting these characteristics.

METHODS

We analyzed a database of children admitted from 1987 to 2008 for the management of SAM in Eastern Democratic Republic of Congo. Anthropometric indicators (z-score) were calculated and classified into 3 categories according to WHO standards. Cohen's kappa coefficient (κ) was calculated to assess the concordance between these indicators.

RESULTS

Out of the 9969 selected children aged 6 to 59 months, 30.2% had nutritional edema, 70.1% had a height-for-age (HAZ) z-score <-2, 11.5% WHZ<-3 z-score, 14.9% had a MUAC < 115 mm and 21.8% had a MUACZ <-3 z-score. With the classic combination WHZ and MUAC, 36% of children with SAM had both criteria at the same time and MUAC alone being the indicator that recruited more children with SAM (77%) compared with 65% with WHZ only. By replacing MUAC with MUACZ, 34% of SAM children fulfilled both criteria, WHZ and MUACZ. MUACZ alone recruited more children with SAM (88%) compared with 46% with WHZ alone. Considering these three indicators together, MUACZ remained the indicator that recruited more children with SAM (85%). WHZ and MUAC showed a moderate agreement [ κ (95% CI) = 0.408(0.392-0.424)], WHZ and MUACZ a weak agreement [ κ (95% CI) = 0.363(0.347-0.379)] and MUAC and MUACZ a good agreement [ κ (95% CI) = 0.604 (0.590-0.618)].

CONCLUSION

Adjusting MUAC according to age improves its effectiveness in identifying severe acute malnutrition. With low concordance, MUAC and WHZ remain complementary in our context. MUACZ proves to be crucial, especially in the presence of kwashiorkor and chronic malnutrition, becoming a valuable tool for assessing severe acute malnutrition in our context.

摘要

背景

对于在严重急性营养不良（SAM）流行地区，使用中上臂围（MUACZ）来诊断严重急性营养不良（SAM）以及其与 WHZ（体重与身高 Z 评分）的相关性，我们知之甚少。我们的研究旨在分析在具有这些特征的地区，SAM 诊断标准之间的一致性。

方法

我们分析了 1987 年至 2008 年期间在刚果民主共和国东部地区接受 SAM 管理的儿童的数据库。根据世卫组织标准计算了人体测量学指标（Z 评分）并将其分为 3 类。计算 Cohen's kappa 系数（κ）以评估这些指标之间的一致性。

结果

在所选择的 9969 名 6 至 59 个月大的儿童中，30.2%有营养性水肿，70.1%有身高年龄（HAZ）z 评分<-2，11.5%WHZ<-3 z 评分，14.9%MUAC<115mm，21.8%MUACZ<-3 z 评分。经典的 WHZ 和 MUAC 联合使用，36%的 SAM 儿童同时符合这两个标准，而 MUAC 单独招募的 SAM 儿童（77%）多于 WHZ 单独招募的（65%）。用 MUACZ 代替 MUAC，34%的 SAM 儿童同时符合 WHZ 和 MUACZ 标准。MUACZ 单独招募的 SAM 儿童（88%）多于 WHZ 单独招募的（46%）。综合考虑这三个指标，MUACZ 仍然是招募 SAM 儿童（85%）最多的指标。WHZ 和 MUAC 显示出中等一致性[κ（95%CI）=0.408（0.392-0.424）]，WHZ 和 MUACZ 显示出弱一致性[κ（95%CI）=0.363（0.347-0.379）]，MUAC 和 MUACZ 显示出良好一致性[κ（95%CI）=0.604（0.590-0.618）]。