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November 23/30, 2005

Severe Malnutrition Assessment in Children in Rural Kenya—Reply

JAMA. 2005;294(20):2577-2578. doi:10.1001/jama.294.20.2577-b

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.