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The development of a MUAC-for-height reference, including a comparison to other nutritional status screening indicators

The setting and data To illustrate the use of stochastic dominance for difference-in-difference evaluation we use a unique, large dataset of child nutrition from arid and semi-arid lands (ASALs) in Kenya. These areas are characterized by extensive livestock production and highest incidences of poverty in Kenya. Over 60% of the population live below the poverty line and levels of access to basic services are very low. Infant mortality rates are high, in some districts more than double the (already high) national average. Child malnutrition levels in Kenyan ASALs are generally declining but are still above emergency threshold levels, worsened by recurrent droughts, high poverty rates, and HIV/AIDS. In the North Eastern Province, for example, 23.2 per cent of children under five suffer from acute malnutrition and infant and underfive mortality rates are rising (UNICEF 2008). The data we use were collected by the Kenyan government under the second phase of the Arid Lands Management Project (ALRMP II), a World Bank-financed community-based drought management initiative that provided additional financial resources to 28 arid and semi arid districts in Kenya from 2003 to 2010. The project sought to improve the effectiveness of emergency drought response while at the same time reducing vulnerability, empowering local communities, and raising the profile of arid and semi-arid areas in national policies and institutions. Since one of the objectives of ALRMP II was to reduce child malnutrition the project’s monitoring strategy included the collection of information on child nutritional status. The specific anthropometric indicator collected was the Mid-Upper Arm Circumference (MUAC) measurement for children younger than 60 months. MUAC is a reliable and relatively cheap-to-collect indicator for child nutrition status. It is also closely correlated with clinical and other anthropometric indicators of nutritional status