Anthropometric indicators in identifying malnutrition risk among children younger than two years in Motherwell, Nelson Mandela Metropolitan Municipality

Abstract

Introduction: South Africa is burdened with a high prevalence of childhood malnutrition. The World Health Organisation (WHO) endorses weight for length (WFL) Z-scores and mid-upper arm circumference (MUAC) as tools for identifying children who are malnourished. The MUAC measurement offers many advantages for its use in community nutrition, and may aid in the early identification of malnourished children. More accurate and comprehensive data on child anthropometric status are needed in the Nelson Mandela Bay Health District (NMBHD), as well as assessment of the efficacy of using a simplified tool such as MUAC to screen for malnutrition. Aim: This study aimed to synthesise a profile of the nutritional status of children younger than two years old in Motherwell, Nelson Mandela Metropolitan Municipality (NMMM) to assess the value of MUAC as a predictor of malnutrition risk and develop malnutrition screening recommendations relevant to this population. Methods: This study followed a cross-sectional design using a quantitative approach. A convenience sample (n=419) of children below 24 months of age was selected from clinics and creches in Motherwell between October 2015 and February 2016 (Ethics approval: H15-HEA-DIET-002). Primary caregivers provided informed written consent for study participation. Trained fieldworkers performed anthropometric measurements according to standardised methods and completed a structured questionnaire. Data was described using means and standard deviations. Linear regression was used to assess relationships within the data. The MUAC’s ability to identify malnutrition was described using sensitivity and specificity probabilities. Results: Only 6% of the sample of children (n=23) were classified as stunted and 3% of the children (n=12) were severely stunted. The WHZ Z-score identified 0% (n=1) child with severe acute malnutrition (SAM), and 1% (n=3) children as MAM. The MUAC identified more children as SAM (2%) and MAM (3%). It was found that 16% of the children (n=65) were overweight or obese according to WHZ. It was found that there is a strong linear relationship between WHZ and MUAC (r=0.739). Using the least squares regression equation, a MUAC cut off value of 13,80cm for males and 13,5cm for females between six and 24 months old was projected. The male cut-off value has a 100% sensitivity and 94,5% specificity for MAM and SAM while the female MUAC cut off had a specificity of 96,4%. Low birth weight children had significantly (p<0.0005) lower mean WAZ and HAZ scores than normal birth weight children. Conclusions and recommendations The prevalence of overweight and obesity among children younger than two years was high in Motherwell, while stunting and wasting prevalence were lower than expected for the population. Raising the MUAC cut-off values from 12,5cm for MAM to 13,80cm for males and 13,47cm for females may increase the number of children younger than two years who are included in nutrition interventions. It is recommended that healthcare workers focus on breastfeeding and appropriate complementary feeding practices to reduce the risk of overweight in infants and young children