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Severe Malnutrition Assessment in Children in Rural Kenya—Reply
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In Reply: In our study, MUAC was more sensitive and specific than WHZ in identifying children with kwashiorkor (bipedal edema). The area under the receiver operating characteristic (ROC) curve for identifying children with edema was 0.79 (95% confidence interval, 0.77-0.81) for MUAC and 0.68 (95% confidence interval, 0.66-0.71) for WHZ. We agree with Dr Hogness that this may reflect the contribution to weight by retained body water among children with kwashiorkor in whom upper arm edema is unusual. An ROC analysis comparison of the predictive values of MUAC and WHZ for kwashiorkor among Malawian children was published by Sandiford and Paulin in 1995.1 They similarly concluded that MUAC had better sensitivity and specificity for kwashiorkor because of the effect of fluid retention.
The problem of the poor sensitivity of WHZ to detect kwashiorkor might seem to be resolved by the current WHO recommendation that severe malnutrition is detected by the . . . [Full Text of this Article]
James Berkley, MD
jberkley@kilifi.mimcom.net
Charles Newton, MD;
Kathryn Maitland, PhD
Kenya Medical Institute
Centre for Geographic Medicine Research (coast)
Kilifi, Kenya
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