Query (MUAC increase)

In a facility based management centre for SAM, how much MUAC increase is expected in a child in 2 weeks after starting him on RUTF such as Plumpy Nut if ...

1. The child gains between 0-5% of admission weight
2. Between 5-10% of admission weight
3. 10-15% of admission weight
4. >15% of admission weight
5. Achieves target weight of 15%


Not much help but ...

This is an interesting question because it highlights a problem with using proportional weight gain as a discharge criteria. The amount of weight gain or MUAC gain achieved by proportional weight gain depends upon the severity of wasting at admission. A very severely wasted child needs to gain less weight than a less severely wasted child to reach the target weight gain. This means that the most wasted get the least treatment and the least wasted get the most treatment. This is the opposite of what we want.

The idea of using proportional weight gain arose because the use of W/H for monitoring and discharge was difficult. Most government health facilities do not have height boards (they are not part of essential clinic equipment packs) and training in height measurement and calculation of a W/H z-score or W/H percentage of reference median is not part of common medial education syllabi (e.g. the IMCI syllabus covers measurement of weight as well as adjustment and maintenance of weighing scales but has nothing on height). Data from CTC programs indicated that a proportional weight gain of 15% would result in > 50% of patients reaching or exceeding 80% W/H reference median and a proportional weight gain of 18% would result in > 50% of patients reaching or exceeding 85% W/H reference median. Use of the 15% threshold in CTC programs resulted in reasonable lengths of stay (i.e. 8 weeks or less) and very low levels of relapse and mortality. All of this work was done in high coverage CTC programs which admitted most patients at or just below the 110 mm MUAC threshold. This meant that the problem of the most wasted getting the least treatment and the least wasted getting the most treatment was not apparent.

Work is ongoing to see ascertain safe MUAC thresholds for discharge and to develop MUAC monitoring tools.

To get back to your question ... I have no data on MUAC gain in facilities-based programs. Data from CTC programs and MoH run CMAM programs range between 0.25 mm / day (MoH run CMAM with poor logistics) and 0.40 mm / day (NGO CTC program). These are median values. You might expect slightly better figures in a facilities-based program.

Sorry not to be of more help. You may want to try one of the treatment forums on EN-NET and report back here.