To assess the appropriateness of current mid upper-arm circumference (MUAC) cut-offs to identify children with severe acute malnutrition in India.

The analysis concerned 6307 children admitted to nutrition rehabilitation centres (2009–2011) where they received therapeutic care as per guidelines by WHO and the Indian Academy of Pediatrics.

States of Jharkhand, Madhya Pradesh and Uttar Pradesh, India.

Children aged 6–59 months with bilateral pitting oedema or weight-for-height Z-score (WHZ)<−3 or MUAC<115 mm at admission.

Children aged 6–23 months represented ~80 % of the admissions. Among them, the proportion with WHZ<−3 was similar to that with MUAC<115 mm (85·7 % v. 81·8 %); the proportion with MUAC<115 mm whose WHZ was <−3 was 82·6 %; and the proportion with WHZ<−3 whose MUAC<115 mm was 78·8 %. MUAC<115 mm was as effective as WHZ<−3 in identifying 6–59-month-old children with medical complications (32·2 % v. 31·6 %, respectively), the most important risk factor of death among oedema-free children. Furthermore, death rates in children with MUAC<115 mm were higher than in children with WHZ<−3 (0·61 % v. 0·58 %, respectively) and 91 % of the deaths among oedema-free children were deaths of children with MUAC<115 mm.

In populations similar to those included in our analysis, MUAC<115 mm appears to be an appropriate criterion to identify children with severe acute malnutrition who are at a greater risk of medical complications and death, particularly among children 6–23 months old.

To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy.

Cross-sectional study.

Five hundred and forty mother–infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW.

Of 540 infants, 100 (18·5 %) weighed ≤2·5 kg. Umbilical cord BLL was not significantly associated with LBW. Maternal poor self-rated health (adjusted prevalence ratio (adjPR) = 1·83; 95 % CI 1·09, 3·07) and none or one prenatal visit (adjPR = 2·18; 95 % CI 1·39, 3·43) were associated with LBW. A statistically significant interaction between mothers’ mid upper-arm circumference (MUAC) and dietary vitamin C intake was noted. Compared with mothers with MUAC above the median and dietary vitamin C intake above the 3rd quartile (>208·7 mg/d), infants of mothers with MUAC less than or equal to the median and dietary vitamin C intake >208·7 mg/d (adjPR = 10·80; 95 % CI 1·46, 79·76), mothers with MUAC above the median and vitamin C intake ≤208.7 mg/d (adjPR = 10·67; 95 % CI 1·50, 76·02) and mothers with MUAC less than or equal to the median and vitamin C intake ≤208·7 mg/d (adjPR = 13·19; 95 % CI 1·85, 93·79) more likely to give birth to an LBW infant.

In Pakistan, poor nutritional status and inadequate prenatal care were major determinants of LBW in this setting. Environmental factors including umbilical cord BLL were not significantly associated with LBW.

The present study aimed to compare two situations of endemic malnutrition among <5-year-old African children and to estimate the incidence, the duration and the case fatality of severe wasting episodes.

Secondary analysis of longitudinal studies, conducted several years ago, which allowed incidence and duration to be calculated from transition rates. The first site was Niakhar in Senegal, an area under demographic surveillance, where we followed a cohort of children in 1983–5. The second site was Bwamanda in the Democratic Republic of Congo, where we followed a cohort of children in 1989–92. Both studies enrolled about 5000 children, who were followed by routine visits and systematic anthropometric assessment, every 6 months in the first case and every 3 months in the second case.

Niakhar had less stunting, more wasting and higher death rates than Bwamanda. Differences in cause-specific mortality included more diarrhoeal diseases, more marasmus, but less malaria and severe anaemia in Niakhar. Severe wasting had a higher incidence, a higher prevalence and a more marked age profile in Niakhar. However, despite the differences, the estimated mean durations of episodes of severe wasting, calculated by multi-state life table, were similar in the two studies (7·5 months). Noteworthy were the differences in the prevalence and incidence of severe wasting depending on the anthropometric indicator (weight-for-height Z-score ≤–3.0 or mid upper-arm circumference <110 mm) and the reference system (National Center for Health Statistics 1977, Centers for Disease Control and Prevention 2000 or Multicentre Growth Reference Study 2006).

Severe wasting appeared as one of the leading cause of death among under-fives: it had a high incidence (about 2 % per child-semester), long duration of episodes and high case fatality rates (6 to 12 %).