You are correct. The 65 cm threshold is a proxy for age. If a child is clearly six months of age or older then there is no good reason to reject the child because they do not meet the 65 cm length threshold. Doing so will result in rejecting a child at high risk of death if untreated as there is both stunting and wasting. I agree that clear admission criteria / protocols are important but you need to beware of overly legalistic interpretation by staff. I have seen CMAM programs reject children with MUAC below 95 mm because their length was just shy of 65 cm. You need to allow some staff discretion here. I think you have it right though - the admission criteria need to be "clear" and this usually means simple (or, at least, uncomplicated). I cannot recommend W/H in community-based case-finding in CTC / CMAM programs (I have a long article on this subject if anyone is interested) but it could be used at a centre for children that arrive but do not fit the MUAC criteria. My experiences have been that this can confuse staff. I have seen programs rejecting many children with MUAC < 110 mm with W/H > 70% (and the other way round) because the admission criteria became complicated with a lot of "ifs" and "buts" and "<" and "<=" signs and inconsistent use of "and" and "or" (beware that in some languages "or" defaults to the exclusive "one but not both" case). There also remains an unfortunate tendency for some staff to view MUAC as a "second best" indicator and to shift the program entirely to W/H based admissions with very severe consequences in terms of program coverage. the overwhelming experience with using W/H in CTC programs is that it has a strong negative impact upon program coverage. The national protocol is, IMO, correct. Just my tuppence.

Dear Mark Myatt, I had to know you have a long article for W/H in CTC/CMAM and I would like to get it. Please could you send me to soe.nyi87@gmail.com because I am working in a nutrition which is combined by CMAM and IYCF. Thank you for you sharing. Sincerely, Soe Nyi Nyi

Soe Nyi Nyi, I have posted you the article that (I think) you want. This is also available at: [url]http://tng.brixtonhealth.com/node/15[/url] There are a collection of interesting articles on the MUAC Community Website: [url]http://tng.brixtonhealth.com[/url] Mark