Mark,

Community data of untreated children are best to assess the respective value of MUAC vs WFH to assess the risk of death and need for treatment. Hospital data are a second choice. They can provide useful information however provided a MUAC or WFH based criterion is not used predominantly as admission criterion, which would lead to a truncated sample and would distort the results. Apparently there was no selection bias with MUAC or WFH in the study you quote which is based on an unselected sample of sick children. See this from the methods section:

“All consecutive children, aged 6 months to 5 years admitted to the paediatric emergency department during the study period from February 2012 to March 2013, were considered eligible for recruitment”.

This paper is yet another one showing that MUAC has a ROC curve clearly above that of WFH to predict death, suggesting that MUAC is better than WFH to identify high risk children in the Indian subcontinent as well. This is also consistent with 2 previous community studies in Bangladesh which showed the same thing. It reinforces the point that low mid-upper arm circumference identifies children with a high risk of death who should be the priority target for treatment

Yes. I agree. Clinical samples are not the best evidence (we have been through this elsewhere on this forum) but this is better than most in that it does not seems to have a selection bias in favour of MUAC or WHZ.

BTW ... I have put the article here.

Thanks Mark for your insight and sharing the article.

We here in Botswana just carried out a Rapid Field Assessment study, measuring height, weight and MUAC in children 6 to 59 months. It is interesting to note that MUAC reading is above 125 mm for children with WFH < -2 to -3. I hope to explain this better after analyzing the data.

Your response to MUAC issue dated 14 April 2010 explain very well as to why WFH is not a good predictor of mortality.

Dear ENN

Thanks for sharing the MUAC /WHZ paper by Golden and Grellety. Thanks too for sharing the responses by Briend et al and Mike.
The subsequent convergence -divergences of opinion have both gone along way into creating more insight,clarity and curiosity into the MUAC-WHZ debate for practitioners in the field .
Could you please share with me the personal email addresses of Golden / Grellety and Briend so that i can correspond with them directly.