Dear Regine, Data are lacking to make clear recommendations re. the use of MUAC for monitoring recovery of SAM children although encouraging results are beginning to emerge. See abstract below: " Connor NE, Manary MJ. Monitoring the Adequacy of Catch-Up Growth Among Moderately Malnourished Children Receiving Home-Based Therapy Using Mid-Upper Arm Circumference in Southern Malawi. Matern Child Health J. 2010 Jan 16. [Epub ahead of print] Each year more children die from moderate than severe malnutrition. Home-based therapy (HBT) using Ready-to-Use Therapeutic Foods (RUTF) has proven to successfully treat uncomplicated childhood malnutrition on an outpatient basis. This study attempts to discern if Mid-upper Arm Circumference (MUAC) measurements collected by community-based health aides have the potential to monitor changes in nutritional status among moderately malnourished Malawian children while undergoing HBT using RUTF. Retrospective analysis was performed using the anthropometric data of 1,904 moderately malnourished children during treatment using RUTF. Changes in MUAC and changes in overall weight at 1 and 2 months of treatment were compared. Various geometric relationships were explored between the measures to find the most direct relationship. Models were developed to investigate anthropometric changes in children undergoing treatment. These data reveal that the correlation between the changes in MUAC and changes in weight over the course of treatment is statistically significant (P < 0.0001). The relationship between a child's change in MUAC and their change in weight is influenced by several cofactors related to their initial presentation. The power of change in weight to predict change in MUAC increases at the second month of treatment. Statistical modelling improves if children under the age of 12 months are omitted. Changes in MUAC reflect changes in overall body mass among moderately malnourished children undergoing HBT using RUTF suggesting that performance could possibly be monitored by village health aides in order to monitor a child's performance on feeding programmes in low resource settings." Arm circumference in well nourished children grows very slowly, and it is notoriously difficult to follow growth of these children on MUAC. However, SAM children during recovery phase have MUAC growing 10 times faster or more than in normal children. It is quite possible that MUAC can be used for follow up, but this needs to be confirmed by other studies.

It is usually enough just to monitor weight at follow-up visits and use either W/H calculated using admission height or percentage weight gain (e.g. > 15% for two visits for discharge) as outlined in the most recent WHO/WFP/SCN/UNICEF joint statement. The ideal situation would, I think, be MUAC-only programming. MUAC (and oedema) being used for admission, monitoring, and discharge. We know that MUAC responds in the same manner as weight during treatment so it may be possible to use MUAC for monitoring and discharge. Work on this (two projects to my knowledge) will start very soon. The main question will be the level of MUAC that is safe for discharge from OTP. Work on developing an testing of monitoring instruments will also be done within the same projects.

It is usually enough just to monitor weight at follow-up visits and use either W/H calculated using admission height or percentage weight gain (e.g. > 15% for two visits for discharge) as outlined in the most recent WHO/WFP/SCN/UNICEF joint statement. The ideal situation would, I think, be MUAC-only programming. MUAC (and oedema) being used for admission, monitoring, and discharge. We know that MUAC responds in the same manner as weight during treatment so it may be possible to use MUAC for monitoring and discharge. Work on this (two projects to my knowledge) will start very soon. The main question will be the level of MUAC that is safe for discharge from OTP. Work on developing and testing of monitoring instruments will also be done within the same projects.