Prognostic value of different anthropometric indices over different measurement intervals to predict mortality in 6-59-month-old children
Briend A, Myatt M, Berkley JA, Black RE, Boyd E, Garenne M, Lelijveld N, Isanaka S, McDonald CM, Mwangwome M, O'Brien KS, Schwinger C, Stobaugh H, Taneja S, West KP, Khara T
Public Health Nutr. 2023;
OBJECTIVE: To compare the prognostic value of mid-upper arm circumference (MUAC), weight-for-height Z-score (WHZ) and weight-for-age Z-score (WAZ) for predicting death over periods of 1, 3 and 6 months follow-up in children. DESIGN: Pooled analysis of twelve prospective studies examining survival after anthropometric assessment. Sensitivity and false-positive ratios to predict death within 1, 3 and 6 months were compared for three individual anthropometric indices and their combinations. SETTING: Community-based, prospective studies from twelve countries in Africa and Asia. PARTICIPANTS: Children aged 6-59 months living in the study areas. RESULTS: For all anthropometric indices, the receiver operating characteristic curves were higher for shorter than for longer durations of follow-up. Sensitivity was higher for death with 1-month follow-up compared with 6 months by 49 % (95 % CI (30, 69)) for MUAC < 115 mm (P < 0.001), 48 % (95 % CI (9.4, 87)) for WHZ < -3 (P < 0.01) and 28 % (95 % CI (7.6, 42)) for WAZ < -3 (P < 0.005). This was accompanied by an increase in false positives of only 3 % or less. For all durations of follow-up, WAZ < -3 identified more children who died and were not identified by WHZ < -3 or by MUAC < 115 mm, 120 mm or 125 mm, but the use of WAZ < -3 led to an increased false-positive ratio up to 16.4 % (95 % CI (12.0, 20.9)) compared with 3.5 % (95 % CI (0.4, 6.5)) for MUAC < 115 mm alone. CONCLUSIONS: Frequent anthropometric measurements significantly improve the identification of malnourished children with a high risk of death without markedly increasing false positives. Combining two indices increases sensitivity but also increases false positives among children meeting case definitions.