Association between mid-upper arm circumference and weight for height with long-term survival in South Kivu, eastern Democratic Republic of Congo: Lwiro cohort

Introduction: Little information is available on the relationship between mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ) with long-term survival. This study explores the association between MUAC and WHZ of former children hospitalized for severe acute malnutrition (SAM) with their long-term survival after nutritional rehabilitation. Methods: This was a cohort of adults followed in childhood for SAM between 1987 and 2008 at the Lwiro Pediatric Hospital (HPL) and traced 11 to 30 years after their nutritional rehabilitation in South Kivu, DRC. During childhood, data on anthropometric parameters, age, sex, vaccination status, albumin level, nutritional edema, SAM relapse, therapeutic failure, notion of transfusion and infectious diagnosis were used. Anthropometric indicators (WHZ, MUAC, height-for-age z-score (HAZ), and weight-for-age z-score (WAZ) were each classified into three categories according to the WHO anthropometric indicator thresholds. Dependent variables were long-term survival. Cox proportional hazards regression was used for survival analysis. Results: We sampled 670 subjects, 461 of whom were traced to adulthood, of whom 12.2% had died. The median age of living subjects was 26 years, with a mean age at admission of 32 months during childhood. Among them, 71.1% had nutritional edema, 88.5% had stunting, 14.5% had WHZ < -3, and 22.3% had MUAC < 115mm. Children with MUAC < 115 mm or WHZ < -3 had a higher, although non-significant, risk of long-term death compared to those without SAM as defined by these criteria. After adjustment for multiple factors, only WHZ < -3, when analyzed independently, was significantly associated with long-term mortality [adjusted HR (95% CI) = 2.7 (1.1-6.8), p = 0.03]. Conclusion: Our study showed that WHZ < -3 was associated with long-term mortality, underscoring the need for targeted interventions to improve survival outcomes in this high-risk group.