ArticlePloS one2019
Severe acute malnutrition and mortality in children in the community: Comparison of indicators in a multi-country pooled analysis.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 4 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
40 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Household-level water, sanitation and hygiene factors and interventions and the prevention of relapse after severe acute malnutrition recovery: A systematic review.Maternal & child nutrition · 2024Pooled it
- Factors influencing concurrent wasting, stunting, and underweight among children under five who suffered from severe acute malnutrition in low- and middle-income countries: a systematic review.Frontiers in nutrition · 2024Pooled it
- Anthropometric deficits and the associated risk of death by age and sex in children aged 6-59 months: A meta-analysis.Maternal & child nutrition · 2023Pooled it
- Water, sanitation and hygiene interventions and the prevention and treatment of childhood acute malnutrition: A systematic review.Maternal & child nutrition · 2022Pooled it
- How does baseline anthropometry affect anthropometric outcomes in children receiving treatment for severe acute malnutrition? A secondary analysis of a randomized controlled trial.Maternal & child nutrition · 2022Trial
- Assessing WHO prioritisation criteria for children 6-59 months treated for moderate wasting in a MUAC-based protocol: a multicountry analysis in West and Central Africa.BMJ global health · 2026Observational
- Association between mid-upper arm circumference and weight for height with long-term survival in South Kivu, eastern Democratic Republic of Congo: Lwiro cohort.BMC nutrition · 2026Article
- Gastrointestinal Tolerance and Refeeding Syndrome in Severely Malnourished Children Treated with Oral Nutrition Supplements Compared to F-75/F-100: A Hospital-Based Randomized Controlled Pilot Trial.Pediatric gastroenterology, hepatology & nutrition · 2026Article
- Process evaluation of enhanced community health system activities to improve detection and management of acute malnutrition in Samburu County, Kenya.PLOS global public health · 2026Article
- Improving case-detection of wasting among under-five-year-old children in Ethiopia: A secondary analysis of community-based surveys in humanitarian settings.PLOS global public health · 2026Article
- Factors that influence acute malnutrition detection and treatment by community health promoters in Samburu and Turkana counties, Kenya: A mixed methods study.PLOS global public health · 2026Article
- Gut microbiome associations with poliovirus vaccine seroconversion in children in the Democratic Republic of the Congo.bioRxiv : the preprint server for biology · 2025Article
- Diagnostic criteria for severe acute malnutrition and fatal outcomes in children aged 6-59 months, Nigeria.Bulletin of the World Health Organization · 2025Observational
- Determinants of Caregivers' Ability to Accurately Detect Acute Malnutrition Using Color-Coded Mid-Upper Arm Circumference Tape and Pitting Edema.Current developments in nutrition · 2025Article
- Addressing dual deficiencies of SAM indicators; gaps and insights from inpatient admission to outpatient discharge, in conflict-affected Yemen; a retrospective study.Conflict and health · 2025Article
- 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.BMC public health · 2024Article
- Mid-upper arm circumference only protocol in Pakistan: missed opportunities for children suffering from severe acute malnutrition? A mixed-methods observational study.Public health nutrition · 2024Article
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- Inflammation: the driver of poor outcomes among children with severe acute malnutrition?Nutrition reviews · 2023Review
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThis study aims to describe the mortality risk of children in the community who had severe acute malnutrition (SAM) defined by either a mid-upper arm circumference (MUAC) <115mm, a low weight-for-height Z-score (WHZ) <-3 or both criteria.
methodsWe pooled individual-level data from children aged 6-59 months enrolled in 3 community-based studies in the Democratic Republic of the Congo (DRC), Senegal and Nepal. We estimate the mortality hazard using Cox proportional hazard models in groups defined by either anthropometric indicator.
resultsIn total, we had 49,001 time points provided by 15,060 children available for analysis, summing to a total of 143,512 person-months. We found an increasing death rate with a deteriorating nutritional status for all anthropometrical indicators. Children identified as SAM only by a low MUAC (<115mm) and those identified only by a low WHZ (Z-score <-3) had a similar mortality hazard which was about 4 times higher than those without an anthropometric deficit. Having both a low MUAC and a low WHZ was associated with an 8 times higher hazard of dying compared to children within the normal range. The 2 indicators identified a different set of children; the proportion of children identified by both indicators independently ranged from 7% in the DRC cohort, to 35% and 37% in the Senegal and the Nepal cohort respectively.
conclusionIn the light of an increasing popularity of using MUAC as the sole indicator to identify SAM children, we show that children who have a low WHZ, but a MUAC above the cut-off would be omitted from diagnosis and treatment despite having a similar risk of death.
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