Criteria for undernutrition screening in hospitalised infants under 6 months: a diagnostic accuracy study in a resource poor setting

Ezeofor, I. O., Garcia, A. and Wright, C. (2020) Criteria for undernutrition screening in hospitalised infants under 6 months: a diagnostic accuracy study in a resource poor setting. Archives of Disease in Childhood, 105(6), pp. 524-529. (doi: 10.1136/archdischild-2019-318313) (PMID:31852658)

Abstract

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.

• Item Type: Articles
• Additional Information: Funding: Ford Foundation International Fellowships Program (IFP), New York, USA
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ezeofor, Miss Ifeyinwa Obiage and Garcia, Dr Ada and Wright, Professor Charlotte
• Authors: Ezeofor, I. O., Garcia, A., and Wright, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Life Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Archives of Disease in Childhood
• Publisher: BMJ Publishing Group
• ISSN: 0003-9888
• ISSN (Online): 1468-2044
• Published Online: 18 December 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Archives of Disease in Childhood 105(6): 524-529
• Publisher Policy: Reproduced in accordance with the publisher copyright policy