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2-Module 2 Identification Part 1

Please demonstrate how to correctly measure the mid-upper arm circumference (MUAC). [DEMONSTRATION OF CORRECT MUAC MEASUREMENT TECHNIQUE] Thank you for the demonstration. Can you summarize the key steps in measuring MUAC?

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Mathilda Noynay Taneo
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40 views

2-Module 2 Identification Part 1

Please demonstrate how to correctly measure the mid-upper arm circumference (MUAC). [DEMONSTRATION OF CORRECT MUAC MEASUREMENT TECHNIQUE] Thank you for the demonstration. Can you summarize the key steps in measuring MUAC?

Uploaded by

Mathilda Noynay Taneo
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Identification of Acute

Malnutrition
Learning Objectives
At the end of the module, you will be able to:
• Identify children with MAM and SAM
• Measure weight and height/length correctly
• Determine the appropriate Z-score based on weight and height
• Measure the mid-upper arm circumference correctly
• Test for the presence or absence of edema
• Perform the appetite test
Measuring Malnutrition

1. Clinical signs
2. Biochemical testing
3. Dietary intake
4. Anthropometry
Determine Age and Sex

• Record age and sex


• Girls and boys grow and
develop differently
• Record Age in months
Determine Age in Months
• Date of examination minus date of birth in the following
arrangement: year/month/day
2017 03 14 2016 15 14
2013 11 08 2013 11 08
3 4 06
• Borrow 12 months from 2017
• Convert 3 years to 36 months
Therefore: Age in months = 40 months
Exercise!
Age in months computation
Demo-Return Demo

Date of Examination: April 18, 2017


Date of birth: October 22, 2014
Date of Examination: April 18, 2017
Date of birth: October 22, 2014
2016 15 48
2017 04 18 2017 04 18
2014 10 22 2014 10 22
2 5 26
Age in months: 29
Measuring Malnutrition
Anthropometry
• The study and technique of • Basic information and
taking measurements of the body measurements
human body needed to assess an
• Method to assess growth individual’s
based on measures of physical anthropometric status
characteristics of the body include:
(e.g. weight, height, etc.) ✔ Age
✔ Sex
• Cannot detect micronutrient
malnutrition ✔ Weight
✔ Height/Length
✔ Left Mid-Upper Arm

Circumference
Measuring Weight
• Measure at eye level
• Measure to the nearest 100g
• A hanging scale, a plastic basin, malong or
others may be used as long as it is secured
by at least 4 ropes
• The carrier should be close to the ground
• Best if the child would not have clothes on for
weighing, ensure s/he will not be cold
• Always record immediately
Measuring Weight
Standardize scales daily or whenever they are moved:
• Set the scale to zero
• Weigh three objects of known weight (e.g. 5, 10, and 15 kg)
and record the measured weights
• Repeat the weighing of these objects and record the weights
again
• Check the scales or replace them when there is a difference
of 0.01 kg or more between duplicate weighing

NOTE: A measured weight differs by 0.01 kg or more from the known standard
Exercise:

Is this Correct
or Incorrect?
Incorrect.
• Scale not at eye level.
• Child is dressed.
Exercise!

Demo-Return Demo
Measuring Length/Height
Measure length Measure height
• Less than 87 cm (or less than 3 feet) • 87 cm or taller
• Less than 2 years • 2 years and older
• Or those too weak to stand • Capable of standing up

NOTE: NOTE:
For children < 2 y/o For children ≥ 2 y/o or
or < 87cm who can ≥87cm who are unable
stand, the HEIGHT is to stand, the LENGTH
measured and 0.7cm is measured and 0.7cm
is added to the is deducted from the
measurement. measurement.
Measuring Length
• Requires a partner to help position
child
• Use a length board with:
▪ a fixed head board and
▪ a movable foot plate
• Place on a level floor
• Remove the child’s socks and
shoes
• Remove lower garments/diapers
• Remove any worn hair ornaments
Measuring Length
• Child MUST look straight ahead with
his/her head parallel to the
baseboard
• Legs are straight
• Feet firmly planted on the foot plate
• Read length/height to the nearest
0.1 cm
How is this position?

17
Incorrect! Incorrect Hand Position.
Hands Pressing against Ears.
Thumbs Pressing on Shoulders.

18
How is this position?

19
Incorrect!
Incorrect Child Head Position.
Chin against Chest.

20
Feet flat, heels against board

21
How is this position?

22
Correct

23
How is this position?

24
Incorrect

25
Exercise!

Demo-Return Demo (Length Measurement)


Measuring Height
• Requires a partner
• Use a height board with
▪ a vertical backboard,
▪ a fixed base board, and
▪ a movable head board
• Place on a level floor
• Remove the child’s socks and
shoes for accurate measurement
• Remove any worn hair ornaments
Exercise!

94.2 cm
What is the
height?
Is this position correct or incorrect?

29
Incorrect

30
Is this position correct or incorrect?

31
Incorrect

32
Correct or Incorrect?
Incorrect
• No partner.
• Child's neck is not
straight. Head not
facing forward
• Feet are not flat on
the foot plate.
Exercise!

Demo-Return Demo (Height Measurement)


Determining the Z-score
What is the Z-score?
• It is a way to compare a child’s
weight-for-length (WFL) or weight-
for- height (WFH) to an “average”

• Use the WHO Child Growth


Standards Table
▪ 0-23 months (boys and girls)
▪ 24-60 months (boys and girls)
Remember!
Normal MAM SAM

WFL/H
-2 to + 2 < - 2 to -3 < -3
Z-score

WFL/H Z = Weight for Length/Height


Z-score
Steps in determining the Z-score
Do this after measuring weight and length/height
1. Take note of child’s sex
2. Determine the child’s age (in months preferably)
3. Use the correct WHO Child Growth Standards Table
4. Round off measured length or height for child's sex
and age in month to the nearest 0.5 cm
Rounding off Length/Height in centimeters (cm):

a. Subtract/Add 0.2 cm up and down from 81 cm


to get the lower and upper limits
80.8
80.9
81
81
81.1
81.2

b. Round off values between 80.8 and 81.2 to 81


Rounding off Length/Height in centimeters (cm):
Steps in determining the Z-score
Do this after measuring weight and height/length:
Locate the length/height on the correct WHO Growth Standard Table

Example: a 25 month old boy with length 66.0 cm and weight 6.3 kg. Use the CGS form for
BOYS ages 24-60 month:

NOTE: see if it is under


category “Severely Wasted”,
“Moderately Wasted”,
“Normal”, “Overweight” or
“Obese”
Steps in determining the Z-score
Do this after measuring weight and height/length:

Example: a 25 month old boy with length 66.0 cm and weight 6.3 kg.

✔ Note the Z-score


✔ Record
✔ 25 month old boy
✔ L 66.0 cm
✔ W 6.3 kg
✔ WFH Z between -3 and <-2 SD

A> MAM
Exercise!
A 32 month old girl’s height is 95.3 cm and her weight is 10.0 kg.
What is her WFH Z-score?
Do the steps:
1. Secure correct WHO Child Growth
Standards Table for age and sex.
2. Round off height to nearest 0.5 cm.
3. Round off 95.3 cm to 95.5 cm.
4. Locate 95.5 on Table.
5. Locate 10 kg along line i.e. < 10.7 kg
6. Classify nutritional status “severely
wasted” and record.
7. Record Z-score “< -3SD”
8. A> SAM
Remember!
Normal MAM SAM

WFL/H
-2 to + 2 < - 2 to -3 < -3
Z-score

WFL/H Z = Weight for Length/Height


Z-score
Measuring the Left Mid Upper Arm
Circumference (MUAC)
• Measured in children 6 to 59 months of age
• A simple measure of muscle wasting
• An independent measure of SAM
• Strongly predicts risk of dying from SAM
Measure the MUAC

Palpate the tip of


Always measure the shoulder
the left upper arm’s
midpoint between
shoulder and elbow
Landmarks – always measure from behind using
the left arm
1. Palpate the tip of the left shoulder
2. Palpate the tip of the bent elbow
3. Measure the distance between these two
landmarks.
4. Divide this measurement by 2.
5. This is the midpoint of the left upper arm.
6. Assistant marks the spot.
Example:
Measured distance is 15 cm.
15 cm ÷ 2 = 7.5 cm
Mark this point.
Measure the MUAC at this level.
Measuring the MUAC
Remember!

Normal MAM SAM


WFL/H
-2 to + 2 < - 2 to -3 < -3
Z-score
11.5 cm to
MUAC ≥ 12.5 cm < 11.5 cm
12.4 cm
Exercise!

Demo-Return Demo

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