MUAC screening — DTM&H MCQ

Correct answer: A — Less than 115 mm

The correct answer is A, less than 115 mm. This is the WHO-defined MUAC threshold for severe acute malnutrition (SAM) in children aged 6 to 59 months, used globally including by UK-trained field teams and DTMH candidates working in humanitarian nutrition surveys. MUAC below 115 mm identifies children at markedly increased risk of mortality independent of weight-for-height, which is why it is used as a stand-alone admission criterion for therapeutic feeding programmes. This cut-off is age-independent within the 6-59 month band, making it ideal for rapid community and survey screening with a simple colour-coded tape (red zone). It is one of three independent SAM criteria alongside bilateral pitting oedema and weight-for-height z-score below -3. Why the other options are wrong: D. Less than 100 mm: this value is below the threshold ever used for MUAC classification in any age group and does not correspond to any recognised WHO cut-off; a MUAC this low would be exceptionally rare and is not the defined SAM boundary. C. Less than 125 mm: this is the upper boundary that separates the combined acute malnutrition range from normal nutritional status, not the SAM cut-off; MUAC 115 to less than 125 mm actually defines moderate acute malnutrition (the orange zone), not severe. B. Less than 135 mm: this figure does not correspond to any WHO MUAC classification boundary for children 6-59 months and would misclassify large numbers of adequately nourished children as malnourished. E. Less than 145 mm: this is far above any recognised malnutrition threshold in this age group and would capture the majority of normally nourished children, rendering the survey meaningless for targeting SAM. Key point: MUAC less than 115 mm in a child aged 6-59 months is the WHO cut-off for severe acute malnutrition, distinct from the 115 to less than 125 mm range that defines moderate acute malnutrition.

Reference: WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years, 2023: severe wasting defined as MUAC less than 115 mm in children 6-59 months of age. NCBI Bookshelf, https://www.ncbi.nlm.nih.gov/books/NBK601660/