In recent years, the Sahel, a semi-arid region in West Africa, has faced numerous food crises, caused mainly by ongoing and escalating conflicts, population displacement, poor rainfall, failed harvests and severe poverty. According to UNICEF, in 2018, nearly 1.6 million children in this region will require treatment for severe acute malnutrition, many with complications that require hospitalization.
Typically, it has been health workers and community health workers who screen children for malnutrition by using a protocol that includes a MUAC bracelet. A MUAC bracelet is an inexpensive, simple color-coded (green, yellow and red) band that is part of a WHO-recognized protocol to detect malnutrition by measuring the circumference of a child’s upper arm. Green is good. Yellow indicates the child is in a danger zone and red means a child has severe acute malnutrition.
Malnutrition can develop very quickly and health workers and community health workers may only see a child once per month, if that. The result is that too often, when children are diagnosed, they are already in an advanced stage of malnutrition, which can lead to long-term consequences like stunting, developmental problems and, too frequently, death.
In 2011, The Alliance for International Medical Action (ALIMA) and its local partner, BEFEN (Bien Être de la Femme et de l’Enfant au Niger), struggling with these very issues, asked: Can mothers be trained to monitor their children’s nutritional status by using a MUAC bracelet?
A pilot study, followed by a large-scale study called MUAC for Mothers, conducted in Niger by ALIMA/BEFEN, showed that mothers, trained to use a MUAC bracelet were as effective at screening their children for malnutrition as health workers were. Moreover, these mothers brought their children for malnutrition treatment earlier, reducing the burden of the disease, decreasing the risk of complications, and reducing the costs, as fewer of their children needed to be hospitalized.
Dahara is a mom of six living in a small village in Niger. Like moms everywhere, Dahara does all she can to ensure the health of her children. Even so, her 10-month-old twins, Hassana and Ousseina, were diagnosed with acute malnutrition. Understandably, Dahara was devastated – but because she had been taught by ALIMA to detect malnutrition using a MUAC bracelet, Dahara detected that the girls needed care. She took them to the health center where they received outpatient treatment for malnutrition and have since fully recovered.
MUAC for Mothers has now been integrated into all of ALIMA’s nutrition programs throughout sub-Saharan Africa. Working closely with UNICEF, in 2017, ALIMA and its partners trained over 330,000 mothers to screen their children for malnutrition.
In 2018, ALIMA and its partners are significantly scaling up the MUAC for Mothers program and expect to train more than 800,000 caregivers to use the MUAC bracelet in Niger alone. Furthermore, the program has been replicated widely by other NGOs and incorporated into the national health protocols of countries like Niger and Mali.
“Mothers like Dahara feel empowered,” said Dr. Susan Shephard, ALIMA’s coordinator for field research. “They feel they can take better care of their children by themselves. And this new approach has encouraged them to be more proactive.”
ALIMA’s MUAC for Mothers program exemplifies how simple innovations can have significant positive impact on the lives of the most vulnerable.
The Alliance for International Medical Action (ALIMA) is a medical humanitarian organization based in Dakar, Senegal, and is currently working in 10 countries in sub-Saharan Africa. ALIMA’s programmatic model adheres to three overarching principles: to provide high quality medical care and humanitarian assistance to vulnerable families in need; to partner with and help build the capacity of local medical organizations; and to conduct medical and operational research that brings innovation to the field, leading to sustainable solutions and improved delivery of humanitarian assistance. Since 2009, ALIMA has treated three million patients, trained more than 500,000 mothers to screen their children for malnutrition through the MUAC for Mothers program, and launched more than a dozen research projects focused on malnutrition, malaria, surgery during natural disasters, and Ebola.
- Blackwell N, Myatt M, Allafort-Duverger T, Balogoun A, Ibrahim A, Briend A. Mothers Understand And Can do it (MUAC): a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years. Archives of Public Health. 2015;73(1):26. doi:10.1186/s13690-015-0074-z.
- Alé FG, Phelan KP, Issa H, Defourny I, Le Duc G, Harczi G, Issaley K, Sayadi S, Ousmane N, Yahaya I, Myatt M, Briend A, Allafort-Duverger T, Shepherd S, Blackwell N. Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers: results from a large-scale pragmatic trial in rural Niger. Arch Public Health. 2016 (74:38). DOI: 10.1186/s13690-016-0149-5.
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