A community health worker must triage children after a flood. Which anthropometric sign is most sensitive for detecting severe acute malnutrition in a child for immediate referral to therapeutic feeding programs?

• A. Ankle circumference alone, since it is a validated global measure of protein status and acute nutrition.
• B. Height‑for‑age below −2 z‑scores (stunting), because stunting reflects immediate life‑threatening malnutrition.
• C. Presence of goiter, because thyroid enlargement is the earliest sign of severe acute malnutrition.
• D. Very low weight‑for‑height (wasting) or mid‑upper arm circumference (MUAC) below emergency thresholds, because these indicate acute malnutrition requiring urgent treatment.

Answer: (D)