Skip to content
DraconiticResearch
Search Sources API
186,123 studies31 sourcesUpdated 5 min ago
Peer-reviewedCC BY 4.0PLOS One

Effect of eligibility for referral following mass screening for severe acute malnutrition using mid-upper arm circumference: A prospective regression discontinuity design

  • Huiyu Hu1
  • Mamadou Ouattara2
  • Mamadou Bountogo3
  • Valentin Boudo4
  • Thierry Ouedraogo5
  • Clarisse Dah6
  • Elodie Lebas7
  • Till Bärnighausen
  • Benjamin F. Arnold
  • Kieran S. O’Brien
  • Thomas M. Lietman
  • Ali Sié
1 more authors
  • Catherine E. Oldenburg
7 affiliations
  1. 1Francis I Proctor Foundation, University of California, San Francisco, United States of America
  2. 2Centre de Recherche en Santé de Nouna, Burkina Faso
  3. 3Heidelberg Institute for Global Health, Heidelberg University, Germany
  4. 4Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States of America
  5. 5Department of Ophthalmology, University of California, San Francisco, United States of America
  6. 6Institute for Global Health Sciences, University of California, San Francisco, United States of America
  7. 7Department of Epidemiology & Biostatistics, University of California, San Francisco, United States of America
Open at sourcePDFDOICite

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.

Related

  1. The effect of herpes zoster vaccines on incident dementia in England: Protocol for an OpenSAFELY regression discontinuity study
    V. Walker, A. L. Schaffer, W. J. Hulme +7
    medRxivPreprintCC BYFull text1 citedEpidemiology & public healthmedRxiv
  2. Diagnostic Accuracy of Mid-Upper Arm Circumference for Screening Maternal Malnutrition: A Community-based Cross-sectional Study from Eastern India
    S. S. Hembrom, K. A. Kiran, M. Kujur +3
    medRxivPreprintCC BYFull textObstetrics, gynaecology & paediatricsmedRxiv
  3. Child malnutrition in the Democratic Republic of the Congo: A Bayesian Gaussian regression analysis using the 2023–24 demographic and health survey
    Zacharie Tsala Dimbuene, Hugues Sampasa-Kanyinga
    PLOS OnePeer-reviewedCC BY 4.0Full textNutritionPLOS
  4. Association between anthropometric criteria and body composition among children aged 6–59 months with uncomplicated severe acute malnutrition: A prospective cohort study from South Sudan
    Gabriele Rossi, Rachel M. Creighton, Patricia Ayebazibwe +5
    PLOS OnePeer-reviewedCC BY 4.0Full textPhysiologyPLOS
  5. Cumulative average lipoprotein combined index-waist circumference and incident cardiovascular disease in Chinese middle-aged and older adults
    Jie Zhou, Xiaoqing Lang, Zhuoka Luo
    Scientific ReportsPeer-reviewedCC BY-NC-ND 4.0Full textEndocrinology & metabolismCrossref

Cite

BibTeXRIS
BibTeX
@article{hu2026effect,
  title = {{Effect of eligibility for referral following mass screening for severe acute malnutrition using mid-upper arm circumference: A prospective regression discontinuity design}},
  author = {Huiyu Hu and Mamadou Ouattara and Mamadou Bountogo and Valentin Boudo and Thierry Ouedraogo and Clarisse Dah and Elodie Lebas and Till Bärnighausen and Benjamin F. Arnold and Kieran S. O’Brien and Thomas M. Lietman and Ali Sié and Catherine E. Oldenburg},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0359729},
  url = {https://doi.org/10.1371/journal.pone.0359729},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Effect of eligibility for referral following mass screening for severe acute malnutrition using mid-upper arm circumference: A prospective regression discontinuity design
AU  - Huiyu Hu
AU  - Mamadou Ouattara
AU  - Mamadou Bountogo
AU  - Valentin Boudo
AU  - Thierry Ouedraogo
AU  - Clarisse Dah
AU  - Elodie Lebas
AU  - Till Bärnighausen
AU  - Benjamin F. Arnold
AU  - Kieran S. O’Brien
AU  - Thomas M. Lietman
AU  - Ali Sié
AU  - Catherine E. Oldenburg
PY  - 2026
DA  - 2026/10/08
JO  - PLOS One
DO  - 10.1371/journal.pone.0359729
UR  - https://doi.org/10.1371/journal.pone.0359729
AB  - 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.
SN  - 1932-6203
ER  -