Bern C, Nathanail L
Maternal and Child Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30341.
Lancet. 1995 Mar 11;345(8950):631-3. doi: 10.1016/s0140-6736(95)90527-8.
In refugee emergencies, rapid collection of nutritional data provides important information for public-health planning. In Rwandan refugee camps in eastern Zaire in August, 1994, a two-step procedure of screening for referral to supplementary feeding programmes was used--mid-upper-arm circumference (MUAC) followed by weight-for-height for children with MUAC of less than 12 cm. To assess the usefulness of this procedure, we analysed data from complete screening of 3681 children in three camps. The performance of MUAC varied with the cut-off chosen; a high cut-off of 14 cm allowed detection of 88% of children with low weight-for-height but at the cost of measuring more than 40% of children in the second step. MUAC preferentially selects younger children as malnourished, and misses older children with low weight-for-height. The groups of children chosen by low MUAC and by low weight-for-height have poor overlap, varying from 20% to 39% overlap depending on age. Thus two-step screening does not save as much time as might be expected and low MUAC cannot be used as a substitute for low weight-for-height. For decision-making in refugee settings, weight-for-height surveys or screening are probably more efficient strategies for data collection.
在难民紧急情况下，快速收集营养数据可为公共卫生规划提供重要信息。1994年8月在扎伊尔东部的卢旺达难民营，采用了两步筛查程序来确定哪些儿童需要转介到补充喂养计划中，即先测量中上臂围（MUAC），对于MUAC小于12厘米的儿童再测量身高别体重。为评估该程序的有效性，我们分析了来自三个营地3681名儿童的完整筛查数据。MUAC的筛查效果因所选切点而异；将切点设为14厘米时，能检测出88%身高别体重低的儿童，但代价是第二步要测量超过40%的儿童。MUAC优先将年龄较小的儿童判定为营养不良，而会遗漏身高别体重低的年龄较大的儿童。通过低MUAC和低身高别体重筛选出的儿童群体重叠性较差，根据年龄不同，重叠率在20%至39%之间。因此，两步筛查节省的时间可能不如预期，低MUAC不能替代低身高别体重。对于难民营中的决策而言，身高别体重调查或筛查可能是更有效的数据收集策略。
