Prevalence of Malnutrition Among Children Under Five in Bolori II, Monguno, and Pulka Using Combined Mid-Upper-Arm Circumference and Weight-for-Height or Oedema Criteria

Abstract

Acute malnutrition remains a major public health challenge among children under five years of age in conflict-affected communities of North-East Nigeria. Accurate estimation of the burden requires the combined use of Mid-Upper Arm Circumference (MUAC), Weight-for-Height Z-score (WHZ), and bilateral oedema to identify all eligible cases. A community-based cross-sectional survey was conducted using the Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology in Bolori II, Monguno, and Pulka, Borno State. Children aged 6–59 months were selected through a two-stage cluster sampling technique. Anthropometric measurements, including MUAC, weight, height/length, and bilateral oedema, were collected and analyzed using ENA for SMART software based on the WHO Child Growth Standards. Based on MUAC, the prevalence of Global Acute Malnutrition (GAM) was 7.9% (95% CI: 5.6–11.1) in Bolori II, 18.4% (95% CI: 15.2–22.2) in Monguno, and 15.3% (95% CI: 11.1–20.8) in Pulka. Severe Acute Malnutrition (SAM) prevalence was 2.0%, 4.2%, and 2.6%, respectively. WHZ identified even higher levels of acute malnutrition, with GAM and SAM reaching 24.4% and 10.0%, respectively, in Monguno. Children aged 6–17 months consistently recorded the highest prevalence of moderate and severe acute malnutrition across all locations, while children aged 30–59 months had relatively few SAM cases. Girls showed a slightly higher prevalence of both GAM and SAM than boys. Combining MUAC, WHZ, and bilateral oedema substantially increased case detection, yielding GAM prevalences of 17.5%, 32.9%, and 21.9% and SAM prevalences of 4.9%, 11.8%, and 4.2% in Bolori II, Monguno, and Pulka, respectively. Only 18.8–26.7% of GAM cases and 2.5–11.4% of SAM cases were simultaneously identified by both MUAC and WHZ, demonstrating the limited overlap between the two indicators.Acute malnutrition remains critically high in the study areas, particularly in Monguno. The combined application of MUAC, WHZ, and bilateral oedema provides a more comprehensive estimate of malnutrition than either indicator alone and should be adopted for nutrition surveillance, programme planning, and Community Management of Acute Malnutrition (CMAM) in humanitarian settings.