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  • Title: Ethnic and age differences in prediction of mortality by mid-upper arm circumference in children below 3 years of age in Nepal.
    Author: Gupta A, Tielsch JM, Khatry SK, LeClerq SC, Mullany LC, Katz J.
    Journal: Public Health Nutr; 2018 Aug; 21(12):2230-2237. PubMed ID: 29667569.
    Abstract:
    OBJECTIVE: To assess ethnicity- and age-modified associations between mid-upper arm circumference (MUAC) and mortality in Nepalese children and whether sociodemographic factors explain these associations. DESIGN: Secondary data analysis of children followed until 3 years of age. Estimated mortality hazard ratios (HR) for MUAC<11·5cm (recommended cut-off for identifying severe acute malnutrition among children ≥6 months old) compared with ≥11·5cm in younger (<6 months) and older children (≥6 months) of Pahadi and Madhesi ethnicity, adjusting for sex, socio-economic status (SES) and mother's education using Cox proportional hazard models. SETTING: Sarlahi, Nepal (21 October 2001-2 February 2006). SUBJECTS: Children (n 48 492) enrolled in the Nepal Nutrition Intervention Project, Sarlahi-4. RESULTS: Among children aged ≥6 months, MUAC<11·5 cm was associated with increased risk of mortality in both Pahadis (HR=4·01; 95 % CI 1·42, 11·76) and Madhesis (HR=5·60; 95 % CI 3·87, 8·11) compared with those with MUAC≥11·5 cm, after adjusting for sex, SES and maternal literacy. Among children <6 months old, MUAC<11·5 cm was not associated with mortality in Pahadis with (HR=1·12; 95 % CI 0·72, 1·73) or without adjusting (HR=1·17; 95 % CI 0·75, 1·18) as compared with Madeshis (adjusted HR=1·76; 95 % CI 1·35, 2·28). CONCLUSIONS: Among older children, MUAC<11·5 cm is associated with subsequent mortality in both ethnicities regardless of other characteristics. However, among children aged <6 months, it predicted mortality only among Madhesis, while sociodemographic factors were more strongly associated with mortality than MUAC<11·5cm among Pahadis.
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