Thanks for putting this as a discussion topic on ENN

We have teamed up in Kenya as a small COP to use family MUAC approach to improve the facility - community linkage.

We're excited to receive a lot of interest in the new Family MUAC Community of Practice

We've been asked if there are any programmes in Zambia using this approach. Do you have information you can share? Let us know by replying to this post.

Hi all, in the Family MUAC guidelines developed by ALIMA, it is recommended to assess on a sample of trained mothers the need for refresher training sessions, some time after the initial training sessions are conducted. I would like to know if there are specific recommendations for the estimation of the sample size and a recommended timeline after the initial training to assess the mothers’ need for refresher training?
Any feedback from field experience will also be welcome.

Hello everyone

The need for post-training follow-up or refresher training should be systematic. The approach or strategy may be discussed but not the need.

In the ALIMA approach in Niger, it was essential during implementation, despite the fact that in Niger women were very familiar with the MUAC tape after several years of nutritional crisis and community capacity building.

Regarding your question of whether there is a specific sample, I will say no the samples should be derived from convenience and using a reasoned approach (you could discuss on the return of the training team to locate the places where the training did not go well).

One of the ways to account for the time needed to do a second training or retraining is monitoring at the centre level:

1- IF at the health center and following the interviews that should systematically include the MUAC component with the mother, health workers are meeting a lot of mothers or caregivers who have not been trained in the community, then you have new target mothers in the community that you need to train. Maybe they were not eligible during your visit but have since become eligible (I think that if there are less than 50% of mothers trained among the mothers of patients under 5 years at the health center, you can organize a new training and retraining for old ones). You have to define your own strategy; with ALIMA in Niger we have based it on the old venues/routes and training focal points to do the retraining and training. In Cameroon MSF has conducted retraining with community volunteers including former ReCo.
2- if, during the follow-up of the training at the health center, several mothers are mistaken about the classification of their children (concordance rate <75% for example as a suggestion based on the experience of Niger) you should know that the training should be repeated or retraining is necessary. There is no standard; these are recommendations.

Retraining is also a good opportunity to discuss with mothers the problems they encounter in using MUAC. For example, in Niger, it provided an opportunity for the mothers to talk to us about the reception at the health center and the sigmatization they had endured once it was confirmed that their children were malnourished. So for me, to make contact with mothers or families would not solely be for retraining but a big opportunity to encourage them in this new adventure. Obviously this must be based on a simple and less cumbersome strategy.

I hope this helps

thank you

Very useful indeed!

The journal Maternal and Child Nutrition calls for manuscripts for a special issue entitled "Family Approaches to Improve Maternal and Child Nutrition”. Papers will be considered that present any new qualitative or quantitative research or systematic review on the topic. Prior to submission, please send your abstract to MCN.editorialoffice@wiley.com, typing Family Approaches to Improve MCN in the subject box. The deadline for abstract submission is 15 February 2020.

We are piloting the Family MUAC Approach in Nepal as well. It seems it is a good approach. My only question lies in how do we get the data from mothers/ caregivers after they assess their children using MUAC tape? Please share your experience if you are familiar with the process or how it is being done in other countries. Thanks you  

How are data collected from mothers/caregivers in this Family MUAC approach?

We recently used it during COVID-19 and the mothers took the measurements and communicated the readings to the community health volunteers who did the tallying for us. 

We are piloting the Family MUAC Approach in Nepal as well. It seems it is a good approach. My only question lies in how do we get the data from mothers/ caregivers after they assess their children using MUAC tape? Please share your experience if you are familiar with the process or how it is being done in other countries. Thanks you  

In most cases you might use the "family MUAC" for case-finding and self-referral (i.e. mother measures MUAC and takes the child with MUAC "in the red" to a clinic delivering OTP services of to a CHW delivering CCM of SAM services). What you want is for the child to be brought o service and you can monitor that through admissions. I have seen work on CCM of SAM in which MUAC is recorded at each screening using a longitudinal MUAC tape and using a colour-coded monitoring sheet. See this FEX article.