Thank you for sharing Mark.

When I was in Niger last January, I visited ALIMA BEFEN in Zinder, and they shared the presentation with their results. Really impressive. MUAC at admission was higher, defaulter rates are much lower, accuracy from measurements of mothers was better (less children rejected at facility level), better coverage and costs were 2.5 times less than using community volunteers. You can download the presentation from my dropbox (In French): https://www.dropbox.com/s/9wl02jnnqlobphz/PPT%20restitution%20PB_VF%20251214.pptx?dl=0 Cheers

Oscar, Thank you for the presentation. I am also very impressed by the work of ALIMA and BEFEN. Higher MUAC at admission leads to better and faster response to treatment. These cases are cheaper to treat as their lengths of stay in the program are reduced. Defaulting is reduced. This creates a virtuous cycle that supports coverage: [img]http://www.brixtonhealth.com/virtuousCycle.png[/img] If such a cycle can be initiated and sustained then the program becomes cost-effective in terms of the cost per death averted. Program costs may increase but effectiveness also increases. More children with better outcomes at lower cost per case treated is the "holy grail" of interventions. I'd be interested to see some cost data. I'd guess that some of the savings you mention will be shifted to community mobilisation activities needed to mobilise and equip mothers. I would like to see this innovation duplicated. I think we need to look to an urban implementation - the focus on the household and the mother-child relationship might overcome some of the problems we have making community mobilisation work effectively in urban ("Gesellschaft") communities.

I wish to add that we can consider camps as "Gesellschaft" or fractured communities in which it can be difficult to make traditional community mobilisation work.

Hi Mark, I am hoping they will share the final report soon so the results can be seen in detail. For urban settings, it was also implemented in Freetown as an alternative to continue screening despite the no touch policy established as a result of the EVD outbreak. The field test was providing positive results, but lack some quality in terms of data collection and representation of the results. I will try to get more information as I got a bit disconnected from SL after much travel to other countries, but I agree, I am looking forward to test/implement this approach in camps and also in areas of South Sudan where access to program areas and population movements is limited during the 6 months of the rainy season, i.e. In case anyone is interested, or has more data to share, this is what I got from Sierra Leone's initial experience (Dec 2014): [url]https://www.dropbox.com/sh/rvoqkt9rza069nk/AABobTIc6LE_kk2JXbwqVIYta?dl=0[/url]

Dear Oscar, This is very interesting. Would you consider writing the Sierra Leone experience up for Field Exchange? We can clear about the limitations in terms of data/how representative, etc. I'll drop you a line, Many thanks, Marie

Oscar, Thanks for this. Were the mothers doing this on their own or were they prompted by the CHW? Looking at your results ... I think that you have been too stringent in Q3 as there is no evidence that it is necessary to measure on the left arm in children (this is a hangover from using MUAC in adults). There is also no evidence that finding the mid-point of the upper arm by measurement gives any different results than a "by-eye" judgement of position. ALIMA and BENFET have a PRJ article in press describing how they tested whether such an initiative could work which touches directly on these issues. That said, the sorts of mistake we see here (and the barriers / boosters seen in Q6 and Q7) are helpful in identifying common mistakes and in devising a short syllabus for training and (maybe) a pictorial instruction leaflet for mothers. I think it important that we do not neglect training and support to mothers if and when we roll this out. Sierra Leone has been a difficult context. It would also be interesting to hear about the ALIMA / BENFEN experience in Niger. Marie, Perhaps you can see if ALIMA / BENFEN can write an accompanying piece (i.e. to Oscar's piece ... if he agrees ... I urge him to) about their experience with their "Mothers Understand it And Can do it" (MUAC) initiative in Niger.

Hi Mark, Yes absolutely - I'll follow up with ALIMA on this. I've had discussion with them about featuring this in the past and it looks like quite an experience has now accumulated.

Hi all, Sorry, I was not very clear before, the data I shared was sent with me by the DFA of Ireland, as a expression of the joint efforts of several NGO (Plan international, ACF, GOAL and others) to determine if the use of the dedicated leaflets created to train the mothers to measure MUAC was useful and provided positive outcomes. I was not involved but as it was discussed with Marie and Hatty, I will work during these weeks to find out more details about it and possibly include it in the note that I have been asked to prepare re infant feeding in EVD outbreak. I will be contacting as many colleagues as possible to gather experiences and data. Cheers

[url=https://www.youtube.com/watch?v=V2bIYUjtq38]Here[/url] is a video from UNICEF about this mass screening model. [url=http://www.unicef.org/infobycountry/niger_71529.html]Here[/url] is a related story (with the same video) on UNICEF's website.

svp pouviez vous m'envoyer les résultats de la première étude réalisée par ALIMA BEFEN sur le projet MUAC? merci

Thank you. Well done! Mothers are smart. And MUAC is a community and family tool as well as assisting workers.

L'article (en anglais) est disponible sur le site : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436117/pdf/13690_2015_Article_74.pdf On peut aussi facilement le retrouver en mettant le titre sur google. 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

Mothers Understand And Can do it! well yes, of course they can! indeed mothers are smart - above all they care desperately about the well-being of their children and are with them all the time - not just a 'when passing through the village' health care worker, however dedicated they might be. MUAC has for too long been mystified as a 'medical tool' that requires a special training course, a health care worker and so on - we think it is perfectly normal in the resource rich world for mothers to have a thermometer, take their child's temperature when they are worried, and seek health care appropriately based on the result. what is so scary to those who are invested in the 'medicalisation' of anthropometry that we allow mothers access to this very simple, exceedingly cheap tool in order to monitor the nutritional status of their children in the resource poor world? ALIMA are currently preparing for publication the 'scaling-up' paper which details what we did after the pilot study in a large community setting. it will not surprise you to learn that 12 months later, ALL of the mothers, despite some of their precarious living conditions, had safe-guarded their MUAC tape for use in the care of their children if we are serious about tackling global child malnutrition, then involving mothers and allowing them access to this simple tool with minimal (cheap) training is one of the key steps in allowing children that need treatment to be identified and have access to care it's a no-brainer really isn't it?

For Alfred Zerfas: are you related to Dr. Fred Zerfas who worked for the IUCW just after the Biafan war/Nigeria where he developed the arm-measuring idea for malnutrition?? I met some people recently [in Spain, where I now live] who also knew him and we wondered what had happened to him!? I worked for the IUCW in Geneva and visited the Nigeria project a couple of times.