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A simplified, combined protocol admitting children with a mid‐upper‐arm circumference (MUAC) of <125 mm or oedema to malnutrition treatment with ready‐to‐use therapeutic food (RUTF) uses two sachets of RUTF per day of those with MUAC < 115 mm and/or oedema and one sachet of RUTF per day for those with MUAC 115–<125 mm. This treatment previously demonstrated noninferior programmatic outcomes compared with standard treatment and high recovery in a routine setting. We aimed to observe the protocol's effectiveness in a routine setting at scale, in two health districts of the Central African Republic through an observational cohort study. The pilot enrolled children for 1 year in consortium by the Ministry of Health and nongovernmental partners. A total of 7909 children were admitted to the simplified, combined treatment. Treatment resulted in an 81.2% overall recovery, with a mean length of stay (LOS) of 38.7 days and a mean RUTF consumption of 43.4 sachets per child treated. Among children admitted with MUAC < 115 mm or oedema, 67.9% recovered with a mean LOS of 48.1 days and consumed an average of 70.9 RUTF sachets. Programme performance differed between the two districts, with an overall defaulting rate of 31.1% in the Kouango‐Grimari health district, compared to 8.2% in Kemo. Response to treatment by children admitted with severe acute malnutrition (SAM) by MUAC and SAM by oedema was similar. The simplified, combined protocol resulted in a satisfactory overall recovery and low RUTF consumption per child treated, with further need to understand defaulting in the context. We observed the effectiveness of a simplified, combined, MUAC‐based daily ready‐to‐use therapeutic food dosage for the treatment of acute malnutrition in children under 5 in a routine setting at scale. Our results indicate satisfactory recovery and low RUTFconsumption per child treated. Key messages The simplified, combined protocol with a mid‐upper‐arm circumference (MUAC)‐based ready‐to‐use therapeutic food (RUTF) resulted in a recovery rate that reached SPHERE standards, low length of stay and low RUTF consumption per child among all children treated. Response to treatment was similar among children admitted with severe acute malnutrition (SAM) by oedema and those admitted SAM by MUAC. Contextual factors such as insecurity and stockouts in treatment products affect programme outcomes by increasing defaulting and decreasing recovery rates. The simplified, combined protocol might present an opportunity to treat more children with less product; decentralised delivery should continue to be explored.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross‐sectional mixed‐methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid‐upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready‐to‐use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas. The use of the simplified, combined protocol to treat acute malnutrition was well received and supported by most stakeholders involved in implementation. The protocol provided care for children with moderate or severe acute malnutrition (MAM or SAM) within a shorter treatment duration and using a reduced ready‐to‐use therapeutic food dose. Key messages The use of the simplified, combined protocol to treat acute malnutrition received overwhelming support from most stakeholders involved in implementation. Stakeholders were supportive of the use of the protocol to provide care for both severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) children with a shorter length of stay in treatment. Most stakeholders supported the use of mid‐upper arm circumference only for the admission and discharge of children. The majority of stakeholders reported that the ready‐to‐use therapeutic food given for MAM and SAM was sufficient for the child's recovery. The idea of training and equipping community health volunteers to treat acute malnutrition was well supported by caregivers and health care workers and should be explored further.

Background Using Mid-Upper Arm Circumference (MUAC) in place of Body Mass Index (BMI) may be preferable for identifying malnutrition in various situations, especially in resource-poor settings. The primary objective of this study was to determine MUAC cut-offs corresponding to BMI < 20 kg/m 2 , < 18.5 kg/m 2 , < 17 kg/m 2 and < 16 kg/m 2 in a cohort of patients with tuberculosis from West Africa. The secondary objective was to examine the prognostic value of MUAC cut-offs in predicting mortality at two months of tuberculosis treatment. The aim was to propose unisex MUAC cut-offs that could be used to identify malnutrition and to identify patients at increased risk of dying. Methods This prospective, observational cohort study was conducted from 2003 to 2022. Diagnostic accuracy of MUAC to identify BMI cut-offs was assessed for every 0.5 cm in the range < 20.0 cm to < 27.0 cm. Area under the receiver operating characteristic curves (AUROCCs), sensitivity (SENS), specificity (SPEC), false negative and false positive were determined. Cox proportional hazard model was used to examine the association between MUAC cut-offs and mortality. Results Data from 2,098 patients were included. MUAC was found to be excellent in its ability to identify BMI cut-offs with AUROCCs close to 0.9. The MUAC cut-offs that best corresponded to BMI < 20 kg/m 2 , < 18.5 kg/m 2 , < 17 kg/m 2 and < 16 kg/m 2 were < 25 cm (SENS 75.1%, SPEC 83.0%), < 24 cm (SENS 75.1%, SPEC 80.0%), < 23 cm (SENS 77.9%, SPEC 83.2%) and < 22.5 cm (SENS 80.3%, SPEC 81.9%). Mortality risk significantly increased with MUAC values < 22 cm. Conclusions MUAC cut-off < 25 cm was proposed to be used in place of BMI < 20 kg/m 2 to identify malnourishment and MUAC cut-off < 22 cm was proposed to identify patients at increased risk of dying and thus in need of further attention.

Mid-Upper Arm Circumference (MUAC), Mid-Upper Arm Circumference-for-Age Z-Score (MUACZ), or Weight-for-Length Z-Score (WHZ) are used to screen for acute malnutrition in children. Studies conducted in various countries, including Ethiopia, have indicated variability in the agreement between these assessments at the World Health Organization recommended cutoffs across different ethnic groups with varying body frames. The low sensitivity of MUAC at standard cutoffs has important implications for program effectiveness. Therefore, this study aimed to validate the diagnostic performance of MUAC and MUACZ in screening for acute malnutrition among children aged 6–23 months in Ethiopia. A community-based cross-sectional study was conducted on 457 randomly selected children aged 6–23 months in the Amhara Region, Ethiopia, from February 2–18, 2023. The Spearman’s rank correlation test, Cohen’s kappa statistics, and Receiver Operating Curve analysis were conducted. The optimal cutoff points for MUAC and MUACZ were determined by selecting the points that maximized the Youden index. Statistical significance was determined with a p-value < 0.05, using a 95% confidence interval. MUAC, MUACZ, and WHZ results revealed that 11.0%, 8.6%, and 13.2% of children were wasted, respectively, and the percentage of misclassification in screening acute malnutrition was approximately 16%. MUAC and MUACZ had low sensitivity but high specificity in screening for acute malnutrition. MUAC and MUACZ showed poor correlation with WHZ when screening subjects for acute malnutrition using the World Health Organization standard cutoffs. In the Receiver Operating Characteristics curve analysis, significant predictive ability was only observed with MUAC when screening global acute malnutrition cases, and it showed a poor predictive ability (AUC = 0.61, 95% CI: 0.53, 0.70) (p < 0.001). The Youden index statistics revealed that the optimal cutoff for MUAC and MUACZ to define global acute malnutrition at WHZ < -2 SD was 13.6 cm and -0.43 SD, respectively. In addition, the optimal cutoffs for diagnosing severe acute malnutrition in children with WHZ of < -3 SD were found to be 13.1 cm and -1.91 SD for MUAC and MUACZ, respectively. The optimal cutoff values also vary in sex and age categories. Both MUAC and MUACZ had poor performance in screening acute malnutrition, and a significant proportion of children were missed despite they were wasted as compared to WHZ at the standard cutoffs. The optimal cutoff levels differ for different age and sex categories. This may affect admission and discharge rates and have a significant impact on children’s health. Modifications in the standard cutoffs are needed to ensure the quality of acute malnutrition screening and treatment services.

Body mass index-for-age ( BMI-for-age ) is widely used indicator to assess the nutritional status of adolescent, however, its application in field settings can be challenging due to equipment and logistical constraints. Mid-upper arm circumference (MUAC) offers a simpler, low resource alternative, but its accuracy and validity among adolescents remain a subject of debate. This study aims to validate MUAC as a feasible alternative for assessing nutritional status in resource-limited settings like Ethiopia. Particularly, the study aimed to evaluate the screening performance of MUAC in detecting thinness compared to BMI-for-age Z-scores (BAZ) and to determine optimal MUAC cut-off points identifying undernutrition status among school students (10–19 years) in the West Hararge zone of Oromia, Ethiopia. A school based cross-sectional study was conducted involved 706 adolescents recruited from 10 schools in the West Harerghe Zone, Oromiia, Ethiopia. Participants were selected using a combination of simple random sampling at the school level and multistage sampling within schools. MUAC was measured on the left arm at the midpoint between the acromion and olecranon using a non-stretchable tape. Body mass index (BMI) was calculated from weight and height measurements taken using calibrated SECA electronic weighing scale (UNICEF) and a SECA portable stadiometer (SECA 213) respectively. All anthropometric measurements adhered to standardized World Health Organization (WHO) guidelines. The diagnostic performance of MUAC in predictor of thinness, as defined by BAZ was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curve analysis. The area under the ROC curve (AUC) for MUAC in detecting thinness compared to against BAZ was 0.76 (95% CI: 0.69–0.85) for adolescents aged 10–14 year group and 0.83 (95% CI: 0.68–0.96) for those aged 15–19 year group. Optimal MUAC cut-offs for detecting thinness were ≤ 19.85 cm the 10–14 year group and ≤ 22.1 cm for the 15–19 year group. For detecting severe thinness, the optimal cut-offs were ≤ 19.1 cm and ≤ 21.4 cm respectively, showed high sensitivity and specificity. MUAC demonstrated moderate effectiveness in detecting thinness among adolescents when compared to BAZ, with particularly high accuracy among those aged 10–14 years and 15–19 years. These findings support the use of MUAC is a reliable and feasible screening tool for undernutrition in resource limited settings. Age-specific MUAC cut-offs should be adopted for screening thinness in adolescents, particularly where BMI measurements are impractical. Further research and integration of MUAC into routine public health nutrition programs are recommended.

Background: Childhood obesity has become a growing global epidemic. In South Africa, overweight and obesity during childhood and adolescence are rising. The objectives of this study were (i) to estimate the prevalence of overweight and obesity among selected students in Cofimvaba, a rural settlement in Eastern Cape province, South Africa, and (ii) to assess the accuracy of the mid-upper arm circumference (MUAC) and ultrasound triceps skin-fold thickness (TSF) methods of predicting these health parameters Methods: A cross-sectional study was conducted on 211 students (109 girls and 102 boys) selected randomly from five public schools in Cofimvaba and aged 6-19 years. The weight, height, MUAC and TSF were determined by standard techniques. Data obtained were subjected to descriptive statistics, Pearson correlations and receiver operating characteristic (ROC) curve analysis. P < 0.05 was considered statistically significant. Result: Overall 1.9% (1.8% girls and 2.0% boys) of the respondents were underweight, 14.8% (21.1% and 7.8% boys) were overweight and 2.8% (4.6% girls and 1.0% boys) were obese. The prevalence of overweight and obesity was significantly higher (p < 0.05) in girls than boys during adolescence but there was no gender difference in children (6-9 years). Most of the students (80.6%) had a healthy weight, with boys being significantly (p < 0.05) healthier than girls. The BMI showed significant strong correlations with MUAC (r = 0.926; p < 0.001) and TSF (r = 0.643; p < 0.001). ROC curve analysis gave an area under the curve (AUC) of 0.795 (95% CI, 0.761-0.889) and 0.835 (95% CI, 0.771-0.899) for MUAC and TSF respectively. Conclusion: The study found a high prevalence of overweight children in the sample and a low prevalence of stunting and underweight. The adolescent girls are at a higher risk of being overweight and obese than the boys. MUAC and TSF can adequately predict overweight and obesity among the selected students.

Sudden cardiac death (SCD) risk can be reduced by early detection of short-lived and transient cardiac arrhythmias using long-term electrocardiographic (ECG) monitoring. Early detection of ventricular arrhythmias can reduce the risk of SCD by allowing appropriate interventions. Long-term continuous ECG monitoring, using a non-invasive armband-based wearable device is an appealing solution for detecting early heart rhythm abnormalities. However, there is a paucity of understanding on the number and best bipolar ECG electrode pairs axial orientation around the left mid-upper arm circumference (MUAC) for such devices. This study addresses the question on the best axial orientation of ECG bipolar electrode pairs around the left MUAC in non-invasive armband-based wearable devices, for the early detection of heart rhythm abnormalities. A total of 18 subjects with almost same BMI values in the WASTCArD arm-ECG database were selected to assess arm-ECG bipolar leads quality using proposed metrics of relative (normalized) signal strength measurement, arm-ECG detection performance of the main ECG waveform event component (QRS) and heart-rate variability (HRV) in six derived bipolar arm ECG-lead sensor pairs around the armband circumference, having regularly spaced axis angles (at 30° steps) orientation. The analysis revealed that the angular range from −30° to +30°of arm-lead sensors pair axis orientation around the arm, including the 0° axis (which is co-planar to chest plane), provided the best orientation on the arm for reasonably good QRS detection; presenting the highest sensitivity (Se) median value of 93.3%, precision PPV median value at 99.6%; HRV RMS correlation (p) of 0.97 and coefficient of determination (R2) of 0.95 with HRV gold standard values measured in the standard Lead-I ECG.

Background The studies on the use and performance of the Mid-Upper Arm Circumference for age (MUACZ) for the diagnosis of severe acute malnutrition (SAM) are still rare. Our study aimed to analyze the performance of MUACZ for diagnosis of SAM in South Kivu, eastern DR Congo. Methods We analyzed a database of children admitted from 1987 to 2008 for management of SAM in the east of the DRC. Anthropometric indicators (z-score) were calculated and classified according to the standards of the World Health Organization (WHO). To evaluate the performance of MUACZ using the combination of weight-for-height (WHZ) and Mid-Upper Arm Circumference (MUAC) as the reference, we calculated sensitivity, specificity, positive and negative predictive values (PPV and NPV) overall. Subsequently, we stratified the results by age category, presence or absence of stunting, and presence or absence of edema. Results Of the 9969 children aged 6 to 59 months selected, 30.2% had nutritional edema, 70.1% had stunting. Of all cases of SAM (identified by at least one of the WHZ, MUAC, or MUACZ indicators), MUACZ alone identified 85% of them, surpassing other criteria such as MUAC (58%) and WHZ (45%). The MUACZ-WHZ combination identified 97%, surpassing the MUAC-WHZ combination (76%). In the presence of edema, MUACZ-WHZ identified 99%, while MUAC-WHZ identified only 72%. The proportions of SAM cases diagnosed by MUACZ increased according to age groups, with rates of 73% (6–11 months), 85% (12–23 months) and 91% (24–59 months). In the presence of stunting, the detection rates were 58% for MUAC alone, 44% for WHZ alone, 89% for MUACZ alone, 67% for the MUAC-WHZ combination, and 98% for the MUACZ-WHZ combination. MUACZ had a sensitivity of 80.7% (79.9–81.5), a specificity of 92.3% (91.8–92.8), a PPV of 71.5% (70.7–72.4) with a prior prevalence was 19,3% defined by the reference, and an NPV of 95.2% (94.8–95.7). Sensitivity increased in the presence of edema [90.1% (88.9–91.1)], stunting [84.7% (83.8–85.5)] and in children over 12 months [83.6% (82.2–84.9)]. Conclusion The MUACZ was performing well in our region. In a context of high prevalence of stunting and kwashiorkor, MUACZ appears to be a more reliable indicator than MUAC alone. Moreover, the MUACZ-WHZ combination also seems to outperform the MUAC-WHZ combination. These results highlight the MUACZ potential, as well as its combination with WHZ, in enhancing screening of SAM in similar contexts.

The International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist is a tool for everyday antenatal clinical practice, easy to use by most healthcare professionals, aiming to initiate a conversation regarding gestational weight gain (GWG) and nutrition and identify women who might require further assessment. The present cross-sectional study aimed to apply the FIGO nutrition checklist to pregnant women attending routine antenatal care and identify nutritional risk factors. Pregnant women (n = 200) were recruited from the outpatient pregnancy clinics of two hospitals in Thessaloniki and completed the checklist. The FIGO-diet quality score and the FIGO-nutritional risk score (NRS) were calculated. The results revealed that 99% of the women exhibited at least one nutritional risk factor based on the checklist. The median FIGO diet quality score of the sample was 4.0 (3.0–5.0), with 95% of the participants responding negatively to at least one question, indicating the need for improving diet quality. Improved diet quality was noted in cases of hyperemesis gravidarum and among those receiving vitamin D supplements. A large percentage of the participants (36%) exhibited five or more nutritional risk factors, as indicated by a total FIGO-NRS below 5. Women with low middle-upper arm circumference, indicative of protein-energy malnutrition (20.6% of the sample), exhibited more nutritional risk factors compared with the rest. On the other hand, being in the third trimester of pregnancy was associated with lower nutritional risk and, subsequently, better diet quality.

Background: the aim of this study is to evaluate the effectiveness and coverage of a simplified protocol that is implemented in health centers (HCs) and health posts (HPs) for children who are suffering from severe acute malnutrition (SAM) in the humanitarian context of Diffa. Methods: We conducted a non-randomized community-controlled trial. The control group received outpatient treatment for SAM, without medical complications, at HCs and HPs with the standard protocol of community management of acute malnutrition (CMAM). Meanwhile, with respect to the intervention group, the children with SAM received treatment at the HCs and HPs through a simplified protocol wherein the mid-upper arm circumference (MUAC) and the presence of edema were used as the admission criteria, and the children with SAM were administered doses of fixed ready-to-use therapeutic food (RUTF). Results: A total of 508 children, who were all under 5 years and had SAM, were admitted into the study. The cured proportion was 87.4% in the control group versus 96.6% in the intervention group (p value = 0.001). There was no difference between the groups in the length of stay, which was 35 days, but the intervention group used a lower quantity of RUTF—70 sachets versus 90 sachets, per child cured. Coverage increases were observed in both groups. Discussion: the simplified protocol used at the HCs and HPs did not result in worse recovery and resulted in fewer discharge errors compared to the standard protocol.