The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis
Background/Objectives: The 2023 World Health Organization (WHO) guideline on infants aged under six months (u6m) wasting now includes mid-upper arm circumference (MUAC) and weight for age Z score (WAZ) as malnutrition treatment programme enrolment criteria. Evidence for the new criteria and optimal...
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2025-01-01
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| author | Ayenew Negesse Tsinuel Girma Beruk Berhanu Desalegn Melkamu Berhane Marko Kerac |
| author_facet | Ayenew Negesse Tsinuel Girma Beruk Berhanu Desalegn Melkamu Berhane Marko Kerac |
| author_sort | Ayenew Negesse |
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| description | Background/Objectives: The 2023 World Health Organization (WHO) guideline on infants aged under six months (u6m) wasting now includes mid-upper arm circumference (MUAC) and weight for age Z score (WAZ) as malnutrition treatment programme enrolment criteria. Evidence for the new criteria and optimal cut-offs is, however, sparse. We aimed to explore the potential caseload implications of the new criteria and explore how different cut-offs might affect them. Methods: We conducted a secondary analysis of data from 1048 Ethiopian infants u6m using STATA software version 17. Frequency tables and percentages were used to present malnutrition across various characteristics. The chi-square test with 95% confidence intervals (CIs) at a <i>p</i> value of <0.05 was used to compare infant caseload identified by the WHO-2023 versus WHO-2013 criteria. Results: We found substantial overlaps among anthropometric indicators of malnutrition in infants defined by the WHO-2023 programme enrolment criteria. New WHO criteria result in a larger potential caseload (19.2% for 6 weeks to 6 months and 15.1% for infants under 6 weeks) compared with WHO-2013 criteria (2.4%). Whilst there are marked overlaps between low WAZ, low WLZ, and low MUAC, they capture different infants. An MUAC of <110 mm alone would capture only a third of all cases identified by WAZ and/or WLZ < −2. Conclusions: In Ethiopia, the WHO-2023 criteria markedly increase malnutrition caseloads compared with WHO-2013 criteria. There might be a case for increasing MUAC thresholds in MUAC-focused programs where WLZ or WAZ measurements are difficult. Future longitudinal data are needed to know which criteria best identify infants at highest risk of mortality/morbidity/poor development. |
| format | Article |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-01c492b802844ae3a9f0bcdb61114dff2025-08-20T02:44:31ZengMDPI AGChildren2227-90672025-01-0112211810.3390/children12020118The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data AnalysisAyenew Negesse0Tsinuel Girma1Beruk Berhanu Desalegn2Melkamu Berhane3Marko Kerac4Academic Center of Excellence for Human Nutrition, School of Nutrition, Food Science and Technology (SNFST), Hawassa University, Hawassa P.O. Box 05, EthiopiaDepartment of Paediatrics and Child Health, Faculty of Medical Science, Jimma University, Jimma P.O. Box 378, EthiopiaAcademic Center of Excellence for Human Nutrition, School of Nutrition, Food Science and Technology (SNFST), Hawassa University, Hawassa P.O. Box 05, EthiopiaDepartment of Paediatrics and Child Health, Faculty of Medical Science, Jimma University, Jimma P.O. Box 378, EthiopiaLondon School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UKBackground/Objectives: The 2023 World Health Organization (WHO) guideline on infants aged under six months (u6m) wasting now includes mid-upper arm circumference (MUAC) and weight for age Z score (WAZ) as malnutrition treatment programme enrolment criteria. Evidence for the new criteria and optimal cut-offs is, however, sparse. We aimed to explore the potential caseload implications of the new criteria and explore how different cut-offs might affect them. Methods: We conducted a secondary analysis of data from 1048 Ethiopian infants u6m using STATA software version 17. Frequency tables and percentages were used to present malnutrition across various characteristics. The chi-square test with 95% confidence intervals (CIs) at a <i>p</i> value of <0.05 was used to compare infant caseload identified by the WHO-2023 versus WHO-2013 criteria. Results: We found substantial overlaps among anthropometric indicators of malnutrition in infants defined by the WHO-2023 programme enrolment criteria. New WHO criteria result in a larger potential caseload (19.2% for 6 weeks to 6 months and 15.1% for infants under 6 weeks) compared with WHO-2013 criteria (2.4%). Whilst there are marked overlaps between low WAZ, low WLZ, and low MUAC, they capture different infants. An MUAC of <110 mm alone would capture only a third of all cases identified by WAZ and/or WLZ < −2. Conclusions: In Ethiopia, the WHO-2023 criteria markedly increase malnutrition caseloads compared with WHO-2013 criteria. There might be a case for increasing MUAC thresholds in MUAC-focused programs where WLZ or WAZ measurements are difficult. Future longitudinal data are needed to know which criteria best identify infants at highest risk of mortality/morbidity/poor development.https://www.mdpi.com/2227-9067/12/2/118malnutritioncaseloadanthropometric indicatorsinfants u6m Venn diagrams |
| spellingShingle | Ayenew Negesse Tsinuel Girma Beruk Berhanu Desalegn Melkamu Berhane Marko Kerac The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis Children malnutrition caseload anthropometric indicators infants u6m Venn diagrams |
| title | The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis |
| title_full | The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis |
| title_fullStr | The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis |
| title_full_unstemmed | The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis |
| title_short | The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis |
| title_sort | impact of who 2023 malnutrition criteria on caseload of infants aged under six months secondary data analysis |
| topic | malnutrition caseload anthropometric indicators infants u6m Venn diagrams |
| url | https://www.mdpi.com/2227-9067/12/2/118 |
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