Arm circumference for age, arm circumference and weight-for-height z-score for the evaluation of severe acute malnutrition: a retrospective cohort study in eastern Democratic Republic of Congo.

BACKGROUND: Little is known about the use of mid-upper arm circumference for age (MUACZ) for diagnosing of severe acute malnutrition (SAM) and its correlation with WHZ (weight-for-height Z-score) in an area endemic for severe acute malnutrition (SAM) and with a high prevalence of kwashiorkor. Our study aims to analyze the concordance between the diagnostic criteria of SAM in a region presenting these characteristics. METHODS: We analyzed a database of children admitted from 1987 to 2008 for the management of SAM in Eastern Democratic Republic of Congo. Anthropometric indicators (z-score) were calculated and classified into 3 categories according to WHO standards. Cohen's kappa coefficient (κ) was calculated to assess the concordance between these indicators. RESULTS: Out of the 9969 selected children aged 6 to 59 months, 30.2% had nutritional edema, 70.1% had a height-for-age (HAZ) z-score <-2, 11.5% WHZ<-3 z-score, 14.9% had a MUAC < 115 mm and 21.8% had a MUACZ <-3 z-score. With the classic combination WHZ and MUAC, 36% of children with SAM had both criteria at the same time and MUAC alone being the indicator that recruited more children with SAM (77%) compared with 65% with WHZ only. By replacing MUAC with MUACZ, 34% of SAM children fulfilled both criteria, WHZ and MUACZ. MUACZ alone recruited more children with SAM (88%) compared with 46% with WHZ alone. Considering these three indicators together, MUACZ remained the indicator that recruited more children with SAM (85%). WHZ and MUAC showed a moderate agreement [ κ (95% CI) = 0.408(0.392-0.424)], WHZ and MUACZ a weak agreement [ κ (95% CI) = 0.363(0.347-0.379)] and MUAC and MUACZ a good agreement [ κ (95% CI) = 0.604 (0.590-0.618)]. CONCLUSION: Adjusting MUAC according to age improves its effectiveness in identifying severe acute malnutrition. With low concordance, MUAC and WHZ remain complementary in our context. MUACZ proves to be crucial, especially in the presence of kwashiorkor and chronic malnutrition, becoming a valuable tool for assessing severe acute malnutrition in our context.

Association between diagnostic criteria for severe acute malnutrition and hospital mortality in children aged 6-59 months in the eastern Democratic Republic of Congo: the Lwiro cohort study.

Background: Few studies have assessed the relationship between weight-for-height (WHZ) and mid-upper arm circumference (MUAC) with hospital mortality considering confounders. The particularity of MUAC for age (MUACZ) is less documented. Objective: This study aims to investigate this relationship in a region endemic for severe acute malnutrition (SAM). Methods: This is a retrospective cohort based on a database of children admitted from 1987 to 2008 in South Kivu, eastern DRC. Our outcome was hospital mortality. To estimate the strength of the association between mortality and nutritional indices, the relative risk (RR) with its 95% confidence interval (95% CI) was calculated. In addition to univariate analyses, we constructed multivariate models from binomial regression. Results: A total of 9,969 children aged 6 to 59 months were selected with a median age of 23 months. 40.9% had SAM (according to the criteria WHZ < -3 and/or MUAC<115 mm and/or the presence of nutritional edema) including 30.2% with nutritional edema and 35.2% had both SAM and chronic malnutrition. The overall hospital mortality was 8.0% and was higher at the beginning of data collection (17.9% in 1987). In univariate analyses, children with a WHZ < -3 had a risk almost 3 times higher of dying than children without SAM. WHZ was more associated with in-hospital mortality than MUAC or MUACZ. Multivariate models confirmed the univariate results. The risk of death was also increased by the presence of edema. Conclusion: In our study, WHZ was the indicator more associated with hospital death compared with MUAC or MUACZ. As such, we recommend that all criteria shall continue to be used for admission to therapeutic SAM programs. Efforts should be encouraged to find simple tools allowing the community to accurately measure WHZ and MUACZ.

Delayed initiation of breastfeeding in Bukavu, South Kivu, eastern Democratic Republic of the Congo: a cross-sectional study.

BACKGROUND: Timely initiation of breastfeeding can decrease neonatal mortality. However, about 50% of newborns are not breastfeed within 1 h of birth in the Democratic Republic of Congo. The aim of this study was to identify factors associated with delayed initiation of breastfeeding in an urban and rural area of Bukavu, South Kivu province, Democratic Republic of Congo. METHODS: We interviewed 396 mother-newborn pairs (185 in the urban area and 211 in the rural area) between 20 July and 10 October 2016. We used descriptive statistics to demonstrate the prevalence of early initiation of breastfeeding. Variables that showed association with delayed initiation of breastfeeding in the bivariate models were entered in a multivariable logistic model. RESULTS: Overall, the rate of early initiation of breastfeeding was 65.9% (69.7% in the rural area, 61.6% in the rural area). Two hundred and seventy-four (62.9%) mothers (159 in rural area and 115 in urban area) were counselled on early initiation of breastfeeding during prenatal care. Most mothers, 65.2% received counselling by a health professional. On multivariable regression analyses after adjusting for other variables in the model, unmarried mothers [Odds Ratio (OR): 1.5 (95% Confidence Interval (CI): 1.13, 1.95)], cesarean delivery [OR: 2.24 (95% CI: 1.74, 2.88)], no counselling on timely initiation of breastfeeding [OR: 1.71 (95% CI: 1.29, 2.20)] and counselling by a non-health professional [OR: 1.84 (95% CI: 1.08, 3.12)] were associated with delayed initiation of breastfeeding. CONCLUSION: Systemic changes are needed for women having caesarean births to experience skin-to-skin and early initiation. In addition, information, education and communication on the importance of timely initiation of breastfeeding must be supported to improve maternal and infant wellbeing.