Question 1: Which of the following criteria are used for detecting a child with severe acute malnutrition according to WHO guidelines?
1. Bilateral pitting oedema
2. Weight for height Z-score less than minus three SD
3. Mid upper arm circumference of less than 11.5 cm (115 mm)
Select the correct answer using the code given below:
- A. 1 and 2 only
- B. 1 and 3 only
- C. 1, 2 and 3 (Correct Answer)
- D. 2 and 3 only
Explanation: ***1, 2 and 3***
- According to **WHO guidelines**, Severe Acute Malnutrition (SAM) in children aged 6-59 months is diagnosed by the presence of **ANY ONE** of these three criteria:
- **Bilateral pitting oedema** (nutritional edema) - indicates kwashiorkor
- **Weight-for-height Z-score (WHZ) < -3 SD** - indicates severe wasting
- **Mid-Upper Arm Circumference (MUAC) < 11.5 cm (115 mm)** - indicates severe wasting
- All three are **independent diagnostic criteria** for SAM, meaning any single criterion is sufficient for diagnosis
- These criteria are used in **community screening**, **facility-based assessment**, and **nutritional rehabilitation programs**
*1 and 2 only*
- This incorrectly excludes **MUAC < 11.5 cm**, which is a valid and widely used WHO criterion for SAM diagnosis
- MUAC is particularly useful for **community-based screening** as it's simple and doesn't require complex equipment
*2 and 3 only*
- This incorrectly excludes **bilateral pitting oedema**, which is a critical criterion for diagnosing **kwashiorkor** (edematous malnutrition)
- Oedema can occur even when weight-for-height appears normal due to fluid retention masking tissue wasting
*1 and 3 only*
- This incorrectly excludes **weight-for-height Z-score < -3 SD**, which is the **gold standard anthropometric measure** for severe wasting
- WHZ is essential for facility-based diagnosis and monitoring treatment response