Dear Fe, Unfortunately, I am not sure there are any mainly because there is no data to inform its interpretation in this age group. Surveys and other data sources do not collect MUAC measures at this age hence no way to estimate cut-offs. This I would say is a gapping opportunity for research and would encourage you to start collecting MUAC data for this age and start comparing its performance against routinely used anthropometric criteria like BMI or WFH even on simple estimates like prevalence, reliability, accuracy and validity. This will begin to give us a glimpse on the usability of MUAC in this age group. Later longitudinal studies can be designed to collect data on predictive values and risk analysis.

MUAC cut-offs in children below 5 years are decided by mortality risk. Mortality in older children is very much lower than in under five years children. This means that the older age-group has received little attention and that a large cohort sample size (very expensive) is required to estimate mortality at different cut-points. This means that we are limited to anthropometry. You could use MUAC/A z-scores or MUAC/H z-scores (from an international reference or from a local survey). My preference would be for MUAC/H as (a) age may be subject to considerable error, and (b) A QUAC stick could be used. I hope this is of some use.

COOPI is looking for a Nutrition Consultant in the DRC

Present in the DRC since 1977, COOPI has greatly developed its interventions there over the past 20 years in response to the multiple crises that have destabilized the country. The organization now operates in 5 provinces with national coordination in Kinshasa. From Kivu, where there was the first intervention, COOPI's response gradually extended to other areas, for the implementation of emergency programs in favor of displaced populations and victims of conflicts. Nutrition, food security and protection are our three main areas of activity in the DRC. COOPI is currently co-facilitating the Nutrition cluster at the national level, alongside the UNICEF lead. Furthermore, the organization develops an active policy of partnership with International and National NGOs.

In post-crisis provinces, COOPI develops multi-year projects that lay the foundations for harmonious and sustainable development. This is particularly the case in Haut-Katanga and Bas Uélé where we are implementing a project to combat food insecurity and malnutrition in the populations living near two national parks, which also aims to reduce poaching and pressure on the resources of these protected areas. A complementary project is in preparation for the same areas, which will support citizen participation in the management of the common good. Finally, COOPI also implements several multi-year projects for the socio-economic reintegration of victims and vulnerable children, in particular with the support of the Fund for the Benefit of Victims of the CPI.

Objective of the consultancy

The goal is to present a cost-effectiveness analysis of the simplified CMAM protocol to face the challenges related to the coverage of nutritional care in the DRC. This cost-effectiveness analysis will focus on the implementation of the simplified CMAM protocol validated in 2020 implemented in health facilities and at community level. The treatment of cases of severe acute malnutrition with medical complications is done in UNTI* (HGR* or CSR)* with the standard protocol.

The consultant will work according to the tasks described below and must submit these deliverables in accordance with the plan provided for in these terms of reference.

* UNTI: Intensive Therapeutic Nutritional Unit. HGR General Reference Hospital. CSR Reference Health Center.

Responsibilities and tasks of the consultant

Under the responsibility of the Nutrition Coordinator, the Consultant will have the following specific tasks and responsibilities:

• Ensure the quality of data collection and analysis.
• Analyze and interpret the data with the members of the simplified approaches steering committee.
• Analyze the financial costs of the goods and services needed to implement each of the adaptations to the CMAM protocol.
• Do the cost-effectiveness analysis of the family MUAC strategy.
• Carry out the cost-effectiveness analysis of the use of a single product.
• Analyze the cost-effectiveness of decentralizing care to the community level.
• Identify the strengths and weaknesses of the implementation of this simplified CMAM protocol.
• Present the results of the analysis to the steering committee (power point).
• Ensure the drafting of the final report.

Expected deliverables

The desired start date of the mission is 20/07/2022 and under the terms of the mission, the following deliverables will be produced and presented by the consultant:

• A presentation of the results of the analyses to the steering committee for simplified approaches and to the DRC nutrition cluster.
• A final report integrating all the cost-effectiveness analyses of the different adaptations and of the family MUAC strategy allowing comparisons to be made between the simplified protocol and the standard CMAM.

Methodological approach

The cost-effectiveness analysis will focus on the implementation of the simplified CMAM protocol in health facilities and at the community level in the health zones of Bambu and Nundu.

Consultant profile

• Master (Bac+5) in nutrition, epidemiology or public health.
• At least five (5) years of experience in the field of nutritional data management and analysis.
• Experience in implementing malnutrition management projects in at least three countries.
• Have a deep knowledge of the Integrated Management of Acute Malnutrition of children from 0 – 59 months.
• Have a good experience on the cost-effectiveness analysis of CMAM projects.
• Have strong analytical skills.
• Master the computer tool and its applications.
• Fluency in French and knowledge of English is an asset.
• A mastery of the computer tool (Nutrisurvey ENA for SMART, SPSS and Epi Info).

Are you interested? If so, send your application and CV to: nutrition.rdc@coopi.org

Deadline to apply: June 28, 2022.

COOPI reserves the right to close a recruitment before the expiry date of the announcement. Thank you for your understanding.

Dear Fe, As mentioned already by Mark, the mortality based approach used to determine MUAC cut-off in under-5 children cannot be used for older children. Follow-up of untreated malnourished children, as was done 30 y. ago for the under-5, is no more possible now that we have an effective home based approach to treat them. And the low mortality observed in this age group would in any case make these studies very difficult. The idea of assessing which combination of MUAC and height fits best with the clinical diagnosis of malnutrition done by an expert clinician, as suggested by Pascale, is a good one. A similar approach was proposed almost 30 y ago to see which anthropometric indices fitted best with the clinical diagnosis of marasmus inunder-5. See: http://www.ncbi.nlm.nih.gov/pubmed/3101482 This could be adapted to older children. Maybe a more modern method of analysis, leaving MUAC and height combine each other in an optimal way to fit with clinical wasting as was done for weight and height by Prudhon et al to assess the risk of death (http://www.ncbi.nlm.nih.gov/pubmed/8678042) would be better than using a QUAC stick index derived from standards. (by the way, no K for QUAC). Studies examining the link between different anthropometric indices and other unfavourable outcome, apart from mortality, as suggested by Martha when she mentions risk assessment, would be most welcome, but much more complex to carry out. In any case, this is an area deserving investigation