Number of HIV-exposed infants with acute malnutrition at 12 months of age

How to use this indicator

Twelve months of age is a critical point in an infant’s development. Malnutrition can be caused by inadequate nutrition and/or management of infection. This indicator tracks the number of infants who are acutely malnourished, demonstrated by their mid-upper arm circumference (MUAC) at 12 months of age. This is a critical time to establish the nutritional status of infants, because it is when most mothers transition from breastfeeding to replacement and complementary feeding. As a result, infants are at greater risk of growth faltering and childhood infection at this age. Community workers can use this information to support mothers, helping them ensure the nutrition and growth of their infants. Anthropometric data can inform community-based strategies to intervene with nutrition care and support services or HIV testing and treatment, in the event of growth faltering and infection or extreme wasting. Community supervisors can use this data to determine whether nutritional care and support programs are effective and the extent of malnutrition among infants of patients receiving prevention of mother-to-child transmission services. Monitoring the child’s growth status at this age can confirm whether he or she should be admitted into a supplementary feeding program. Locating households where HIV-exposed infants are malnourished can assist in decision making regarding geographic targeting for planning care and support to address needs.

Numerator

Number of HIV-exposed infants who have a MUAC reading in the yellow, orange, or red categories

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

MUAC, or middle-upper arm circumference of the left upper arm, assesses nutrition status and is measured at the midpoint between the shoulder and the tip of the elbow. Community workers need minimal training to conduct the measurement; it requires little equipment and is easy to perform. This method for measuring malnutrition has been shown to be less susceptible to errors than other methods for active case finding. This measurement can be used for children between the ages of six and fifty-nine months; it can also measure acute energy deficiency among famished adults.

To measure MUAC, a flexible measuring tape should be wrapped around the middle-upper arm between the shoulder and the elbow. The child’s left arm should be bent and loosely hanging. A string can be used to find the midpoint between the shoulder and the tip of the elbow. The MUAC tapes are often supplied from The United Nations Children’s Fund (UNICEF) directly; one version is numbered, and the other is colored. For the numbered tapes, the end of the tape should be placed down through the first opening and up through the third opening. The measurement is read through the middle window where the arrows point.

On the colored version, the colors on the tape indicate the level of malnutrition, and different tapes use different readings and colors (green/yellow/orange/red versus green/yellow/red). The tape is placed down through the first opening and then through the second opening, and the reading is provided through the window where the arrows point. Regardless of the tape used, green signifies that the child is well nourished, and red signifies that the child is suffering from severe acute malnutrition. The yellow in the three-colored tape signifies moderate acute malnutrition. In the tape with the four-color scale, orange signifies moderate acute malnutrition, and yellow means that the child is at risk of acute malnutrition and should be counseled on growth promotion and monitoring.

These data can be collected by an appropriately trained community worker, but they should be collected when an infant is brought to the 12-month follow-up visit at a health facility, and results should be recorded on the child’s health card. The HIV-exposed child will also be tested at this time, if not already confirmed HIV-positive. Therefore, it is essential for community workers to motivate HIV-positive mothers to bring their infants for this visit, if there are insufficient resources for community workers to conduct the measurement in the field. To track this information at the community level, community workers can ask to see the child’s health card, or they can ask the caregiver for this information after the visit or referral.

Data must be treated with utmost care; identification of HIV-exposed infants versus non-exposed infants can lead to discrimination and stigma, both against the HIV-exposed infant and his or her mother.

Disaggregation

  • Sex
  • HIV status

Data quality considerations

This indicator is often underreported because it is difficult to capture all children who have been exposed to HIV whose exposure status is unknown. It is recommended that community workers be trained how to conduct MUAC, so they can collect these data at the community level. The overall number reported for this indicator should be equal to the sum of the numbers of people in each disaggregation type. Only one type of age disaggregation should be used throughout, and overlap should be avoided.

Reporting frequency

Community workers should collect this information regularly and monitor progress monthly with support from their supervisors. The indicator should be reported on a regular basis as required by national guidelines (monthly, quarterly, semiannually, or annually).

Data element

HIV-exposed infant nutritional status

Category

Vulnerable Children

Additional resources

UNICEF MUAC Lesson

Mother and Child Nutrition MUAC Details

References

The United Nations Children’s Fund. (2005). HIV and Infant Feeding. Retrieved from https://www.unicef.org/nutrition/index_24827.html

The United Nations Children’s Fund. (2016, August 22).  HIV and nutrition. Retrieved from https://www.unicef.org/nutrition/index_HIV.html

MUAC Tape - Mid-Upper Arm Circumference [MUAC] - Mother, Infant and Young Child Nutrition & Malnutrition - Feeding practices including micronutrient deficiencies prevention, control of wasting, stunting and underweight. (n.d.). Retrieved from http://motherchildnutrition.org/early-malnutrition-detection/detection-referral-children-with-acute-malnutrition/muac.htm

The United Nations Children’s Fund. (n.d.). Lesson list Assessment Mini-lesson 3.1.3. Retrieved from https://www.unicef.org/nutrition/training/3.1.3/6.html

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