Family led measurement of the Mid-Upper Arm Circumference (MUAC)
Innovative approach seeks to empower mothers and caregivers to identify early signs of wasting in their children using the simple to use MUAC tape.
Baidoa, February 9, 2024: The humanitarian situation in Somalia remains one of the most complex in the world. The country is yet to fully recover from one of the worst droughts in decades, coupled with various hazards driven by climate change, conflict, and COVID-19. Children suffer the greatest brunt of this situation, with an estimated half a million requiring treatment for severe wasting every year. In 2022, over 43,000 excess deaths were reported due to the drought, with half of the deaths occurring among children below the age of five.
The nutrition situation in Baidoa in the Bay region of Somalia remains a major concern. According to the Food Security and Nutrition Analysis Unit, in 2022 at the peak of the drought, wasting prevalence among children in the surrounding camps for Internally Displaced Persons (IDPs) rose to as high as 28.6 percent and under five crude death rates reached 2.43 per 10,000. The area was on the verge of famine, a situation narrowly averted by the concerted intervention of humanitarian actors. Key to saving lives was to ensure that children with malnutrition were identified early and treated. The family-led MUAC approach was deployed to empower mothers and caregivers to identify early signs of wasting in their children using a simple-to-use Mid-Upper Arm Circumference (MUAC) tape, a role previously reserved only for health workers. The objective of this approach was to increase and improve coverage of treatment services, detect cases earlier, and enhance malnutrition awareness at the grass-roots level and in resource-constrained settings.
This approach had been adopted by the Ministry of Health and nutrition partners, with UNICEF support, in 2020 during the COVID-19 pandemic with the sole purpose of infection prevention, control and programme continuity. The approach has subsequently demonstrated its effectiveness not only as context-relevant and reliable tool for service continuity but also as an empowering tool for caregivers to take charge of the health of their own children. It works well in hard-to-reach districts, with a special focus on referrals to nutrition treatment service delivery points.
“I am now able to screen my children without the help of the community health workers,’’ says Leyla Mukhtar, a mother of five from Berdale village in Baidoa. Her eyes fixed on the MUAC tape, she beams with pride when the tape on her child’s arm shows green, a sign of good health.
“My daughter once suffered from severe malnutrition and I did not realize it until a community health worker visited me and told me about her condition,’’ she says. ‘’Ever since I was trained and given this tape, I regularly check my children’s nutritional status and refer them to the clinic close to us,’’ she says.
Leyla is one of many mothers that the International Medical Corps (IMC), a UNICEF partner, have trained on family led MUAC screening. The accuracy of her screening is stunning. She has accurately screened the children she has referred for treatment with either moderate or severe malnutrition.
‘’I have recently referred three children from my neighbor; they were moderately and severely malnourished. I also advised her to bring them to me for screening whenever they fell ill and were losing weight,” she says.
According to IMC, Leyla referred the malnourished children to Horseed Health Center, which UNICEF and WFP support in partnership with IMC, where the children were treated with ready-to-use therapeutic food. Despite the lack of clear reporting procedures and mechanisms for the family led MUAC approach, IMC estimates that 22 per cent of the total cases referred to Berdale Health Center were referred by mothers.
‘’We have a problem with proper documentation of the referral pathway,” says Adnan Mohamed Hassan, a community health supervisor with IMC. “It is a bit difficult to trace the exact number of cases referred for treatment by the mothers.’’ But the approach is working perfectly, says Hassan, as the admission rate at the facility remained steady during COVID-19 due to the introduction of the MUAC approach.
Challenges with reporting are compounded by the lack of standardization of the approach and strategy, inadequate resources for capacity building, and the non-availability of reporting tools. Nevertheless, UNICEF, in collaboration with the Nutrition Cluster and the Ministry of Health, has recently developed a standardized protocol and tools on the family MUAC approach that await government approval.
As more mothers like Leyla Mukhtar emerge, it means more children with malnutrition will be detected early and treated, potentially saving thousands of lives. UNICEF and its partners will continue to actively advocate for required financing to systematically roll out the approach to the rest of the country.
