Dear Mark I'm afraid I can't help you with any data regarding your questions but I am interested to know if you got any further with the issue. I have recently started working in Myanmar and would be really interested to hear any conclusions that you came to. We have been using MUAC for initial screening and then any child which measures below 140mm has then been referred, using WH for admission to receive treatment/intervention accordingly. As I understand it the children which would be classified as malnourished would be different using these 2 methods this in addition to your comments above, would you think that this is an even stronger argument for using MUAC alone in Myanmar? Many Thanks JH

I have got no further with the issue. There doesn't appear to be any historical data from Myanmar either. What is needed, as a minimum starting point, is a small survey measuring both sitting and standing height. This could be done as part of a nutritional anthropometry survey. One children > 85cm would need to have their sitting height measured. Even an opportunistic sample (e.g. from a clinic or CMAM program) would be better than nothing. The two stage screen for CMAM should be handled with care since if MUAC is a referral criteria and W/H is an admission criteria you may get the "problem of rejected referrals" which is a known coverage killer. See: [url]http://www.who.int/nutrition/topics/backgroundpapers_A_%20review.pdf[/url] and: [url]http://www.ncbi.nlm.nih.gov/pubmed/20002705[/url] This might be a problem for you particularly as you are using a high (and sensitive) MUAC threshold for referral. It you do both MUAC and W/H in the field then you should be OK. One of the main reasons for using MUAC is that it avoids the problem of rejected referrals. Depending on context MUAC and W/H may select very different sets of children or may select the same set of children. Body-shape plays a role here: [url]http://informahealthcare.com/doi/abs/10.1080/03014460802471205[/url] As may the general public health environment. If body shape is biassing W/H downwards in Myanmar then using MUAC would be advisable.

Many Thanks for you response. I hope to conduct a small scale study into this in the near future so hope you wont mind if I contact you again for some technical advice.

Thanks. Happy to help. I am on leave at present so you may have to wait a few days for replies.