{ "abstract": "Background: Severe Acute Malnutrition (SAM) is a major cause of morbidity and mortality in children under five. Mid-upper arm circumference (MUAC) is widely used for community screening, but the effect of referral eligibility on subsequent outcomes is uncertain. Objective: This study assesses the intention-to-treat effect of eligibility for referral to a nutritional program, triggered by MUAC below 11.5 cm, on subsequent nutritional status and all-cause mortality among children in Burkina Faso. Methods: A prospective regression discontinuity (RD) analysis was nested within the Community Health with Azithromycin Treatment (CHAT) trial, a cluster-randomized controlled trial in Nouna District, Burkina Faso (ClinicalTrials.gov NCT03676764). Children aged 6–59 months were screened during twice-yearly censuses; MUAC <11.5 cm triggered a referral recommendation. Because treatment uptake was unmeasured, the estimand was referral eligibility, not treatment receipt. Outcomes were MUAC at the next census and death before that census. Primary analyses used outcome-specific Imbens–Kalyanaraman bandwidths and mixed-effects models with a child random intercept. Results: Among 65,554 children, 226 (0.34%) met the referral threshold at least once. The selected bandwidth included 2,901 observations for the MUAC outcome (158 below and 2,743 above the cutoff) and 2,628 observations for mortality (148 below and 2,480 above). The estimated mean difference in MUAC at the cutoff was 0.21 cm (95% CI, −0.22 to 0.65), and the mortality odds ratio was 0.95 (95% CI, 0.03 to 31.37). Most sensitivity analyses were similar, although the widest fixed bandwidth produced discordant and unstable estimates. Conclusions: Near the 11.5-cm cutoff, we found no evidence that referral eligibility changed next-census MUAC or all-cause mortality. These findings do not evaluate SAM treatment receipt or effectiveness, and the mortality estimate was highly imprecise. Stronger mechanisms may be needed to complete referral and link children to treatment.", "abstract_shown": true, "affiliations": [ "Francis I Proctor Foundation, University of California, San Francisco, United States of America", "Centre de Recherche en Santé de Nouna, Burkina Faso", "Heidelberg Institute for Global Health, Heidelberg University, Germany", "Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States of America", "Department of Ophthalmology, University of California, San Francisco, United States of America", "Institute for Global Health Sciences, University of California, San Francisco, United States of America", "Department of Epidemiology & Biostatistics, University of California, San Francisco, United States of America" ], "article_type": "Research Article", "arxiv": null, "author_total": 13, "authors": [ { "affs": [ 0 ], "name": "Huiyu Hu" }, { "affs": [ 1 ], "name": "Mamadou Ouattara" }, { "affs": [ 2 ], "name": "Mamadou Bountogo" }, { "affs": [ 3 ], "name": "Valentin Boudo" }, { "affs": [ 4 ], "name": "Thierry Ouedraogo" }, { "affs": [ 5 ], "name": "Clarisse Dah" }, { "affs": [ 6 ], "name": "Elodie Lebas" }, { "name": "Till Bärnighausen" }, { "name": "Benjamin F. Arnold" }, { "name": "Kieran S. O’Brien" }, { "name": "Thomas M. Lietman" }, { "name": "Ali Sié" }, { "name": "Catherine E. Oldenburg" } ], "bibtex": "https://research.draconitic.com/paper/ec16yth5eg7ze.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0359729", "fulltext_url": null, "id": "ec16yth5eg7ze", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0359729", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2916|Child Nutrition and Water Access" ], [ "plos", "/Biology and life sciences/Nutrition" ], [ "plos", "/Biology and life sciences/Nutrition/Malnutrition" ], [ "plos", "/Biology and life sciences/Population biology/Population metrics/Death rates" ], [ "plos", "/Engineering and technology/Signal processing/Signal bandwidth" ], [ "plos", "/Medicine and health sciences/Health care/Health care facilities" ], [ "plos", "/Medicine and health sciences/Nutrition" ], [ "plos", "/Medicine and health sciences/Nutrition/Malnutrition" ], [ "plos", "/Medicine and health sciences/Pediatrics/Child health" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Child health" ], [ "plos", "/People and places/Population groupings/Age groups/Children" ], [ "plos", "/People and places/Population groupings/Families/Children" ], [ "plos", "/Research and analysis methods/Research design/Survey research/Census" ] ], "openalex": "W7221040304", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0359729&type=printable", "pmcid": null, "pmid": null, "published": "2026-10-08", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/ec16yth5eg7ze.ris", "sources": [ { "first_seen": "2026-10-30T12:17:30Z", "native_id": "10.1371/journal.pone.0359729", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0359729" } ], "subjects": [ { "field": "medicine", "origin": "plos:nutrition", "subfield": "nutrition" } ], "title": "Effect of eligibility for referral following mass screening for severe acute malnutrition using mid-upper arm circumference: A prospective regression discontinuity design", "title_text": "Effect of eligibility for referral following mass screening for severe acute malnutrition using mid-upper arm circumference: A prospective regression discontinuity design", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:30Z", "url": "https://research.draconitic.com/paper/ec16yth5eg7ze", "venue": "PLOS One", "versions": [] }