Empowering Mothers to Detect Acute Malnutrition in Kenya

A new study by Action Against Hunger and partners indicates that mothers can use a simple armband measurement tool to accurately screen their children for acute malnutrition.

Mothers are powerful. We have always known it. And in celebration of Mother’s Day, we are happy to share some important new findings.

For nearly forty years, in our efforts to enable communities to be free from hunger, Action Against Hunger has sought to empower mothers and caregivers to understand the warning signs of acute malnutrition—and make sure they know when and where to take their children for screening and treatment for malnutrition. Over the years, we have trained thousands of frontline community health workers to bring screening services directly to remote, hard-to-reach villages. But there often aren’t enough community health workers to reach every child in need and detect acute malnutrition early, before it becomes severe—an essential key to saving children’s lives.

So, in a new research project in Kenya, we went a step further. We aimed to bring screening even closer to home: launching a project to explore how accurately mothers and caregivers could classify their children’s nutritional status without relying on a community health worker. 

The most common method used to screen for acute malnutrition in communities involves what looks like a simple measuring tape. The mid-upper arm circumference (MUAC) tape is a long, color-coded strip marked with graduated measurements. If the measurement of the girth of a child’s mid-upper arm is within the yellow part of the band, it indicates that the child is suffering from moderate acute malnutrition. If the measurement falls within the red part of the band, it indicates that the child is suffering from life threatening, severe acute malnutrition. 

Measuring a child’s mid-upper arm circumference with a color-coded, graduated band is a cheap and simple way to detect undernutrition.

Photo: Christophe Da Silva
for Action Against Hunger, Haiti

Precision in measurement matters: an error of even just a few millimeters can mean the difference between an accurate diagnosis and an inaccurate one. That’s why the use of MUAC tapes to detect undernutrition has traditionally been entrusted to trained, experienced community health workers, community health volunteers, nurses, doctors, and formal health workers.  

But years of success in training community health workers to accurately detect undernutrition with MUAC bands made nutrition scientists curious. Could mothers and other caregivers be trained to screen children for undernutrition using the MUAC tape?

A recent study led by Action Against Hunger in Kenya, indicates that yes, mothers and caregivers can screen their children as well as a community health worker would, when they are given adequate training and tools—a potentially game-changing discovery. Our study builds on existing evidence confirming that mothers can indeed carry out accurate measurements with a MUAC tape, while also providing new evidence on which type of MUAC device results in the most accurate readings.

IMPROVING DETECTION OF ACUTE MALNUTRITION: NEW FINDINGS FROM KENYA

The aim of Action Against Hunger’s research in Kenya was to develop, test, and compare new kinds of MUAC devices to assess which device resulted in the most accurate measurements of MUAC by mothers and caregivers.

The study team developed three new “Click-MUAC” devices, with the help of plastics specialists, which were designed to work almost like a plastic bracelet that could be adjusted by lightly squeezing (clicking) the bracelet into place on the mid-upper arm. We tested groups of mothers using these alternate “Click-MUAC” devices and a new type of improved MUAC tape (uniMUAC). Then, we compared the accuracy of the mothers’ diagnoses using the devices and the uniMUAC tape to see which performed best overall.

A community health worker in Isiolo County, Kenya shows a mother how to use a Click-MUAC device to screen her child for acute malnutrition.

Photo: Action Against Hunger, Kenya

Our results, recently published in Archives of Public Health, demonstrate that mothers were able to  carry out accurate MUAC measurements with all the devices, with higher levels of accuracy than in previously reported studies. Our research also found that the best-performing device to support mother-led screening was the improved uniMUAC tape, not the alternate “Click-MUAC” devices. These are important findings because they strongly support existing evidence that mothers and caregivers can accurately and precisely measure their children’s nutritional status with the MUAC tape alone. Finally, our results indicate that the simple, improved uniMUAC tape, which is inexpensive to manufacture, is the best tool to support this approach. Put simply: we have more evidence that supports investment in the mother and family-led approach to screen for acute malnutrition.

Building off the results of the study, Action Against Hunger piloted an even simpler version of the improved uniMUAC tape among mothers in Isiolo County in Kenya. In the pilot, two-thirds of the mothers and caregivers were able to use this simplified version of the uniMUAC tape accurately, even with very minimal training. Additional results suggest that training mothers and caregivers to detect acute malnutrition using the simplified uniMUAC tape may also lead to earlier detection of moderate acute malnutrition. Early detection helps to ensure that children are referred to programs for treatment before their condition becomes too severe and life threatening.

So, what’s next? Based on the existing evidence and these new findings, Action Against Hunger is advocating for the global scale-up of the mother- and family-led approach to nutrition screening at community level. We are also working to integrate the use of the simplified, improved, uniMUAC tape within our operational programs in Kenya and beyond.

“MY BOY IS HEALTHY”

Pamela Noel is one of mothers who took part in the pilot project in Isiolo County, Kenya. She was trained by Action Against Hunger to screen her child for acute malnutrition. Pamela is a single mother: it is up to her to ensure her children are well-fed and healthy. She has a small garden where she grows green vegetables for her young children.

Fortunately, Pamela’s MUAC measurement showed that her youngest child, two-year-old Vincent, is safely in the green zone on the MUAC tape. “My boy is healthy,” she says, recalling how she exclusively breastfed him until he was six months old.

Two-year-old Vincent’s screening shows that he is healthy and not suffering from undernutrition.

Photo: Action Against Hunger, Kenya

AS MOTHERS LEARN, COMMUNITY HEALTH VOLUNTEERS PROVIDE CRUCIAL SUPPORT

Trained local Community Health Volunteers work across Kenya in partnership with the Ministry of Health to provide basic health education and services to families who may not otherwise have access. In Kenya, these volunteers are selected by their neighbors and serve their own communities.

Judith Muthoni Ndegwa has been a Community Health Volunteer for seven years, and she covers 30 to 40 households. She regularly talks to mother-to-mother support groups organized and facilitated by Action Against Hunger about nutrition and the importance of breastfeeding infants. She also helps Action Against Hunger train mothers to detect undernutrition using MUAC tapes.

Judith makes it her business to know the nutrition status of all the children in the households under her care. Now, she is happy to know she can help ensure even more children are screened earlier by training mothers to do the screening themselves. Judith believes this has improved the health of her community and changed the lives of mothers.

Judith Muthoni Ndegwa, a Community Health Volunteer trained by Action Against Hunger, teaches mothers in her community.

Photo: Action Against Hunger, Kenya

Action Against Hunger is a global humanitarian organization that takes decisive action against the causes and effects of hunger. We save the lives of malnourished children. We ensure everyone can access clean water, food, training and healthcare. We enable entire communities to be free from hunger.