With WFP Nepal i developed a mobile phone app to record SAM/MAM screening in the flood response in 2017-8 in Nepal. However this depended on FCHVs and/or NGO staff measuring MUAC and recording the colour code. I am struggling to see how MUAC screening can be done by families unless there is a massive training programme and the training programme would not be possible if social distancing is being kept up. I think the best we can do in Nepal is look for predictors of wasting from our datasets - Suaahara's, UCL's, Nepal Innovation Lab's, DHS and then ask questions about the indicators we see as predictive of SAM/MAM. Then we can presumptively treat for wasting by some kind of controlled (crowd-free) RUSF/RUTF collection system. It will be very challenging, but this might be a way forward?

Dear Namoi, thank you for the info' on your mobile app'. With regards to your comment, 'am struggling to see how MUAC screening can be done by families unless there is a massive training programme and the training programme would not be possible if social distancing is being kept up'. I would like to share GOAL's experiences from managing community engagement during the Ebola crisis in 2016 where, despite us dealing with a highly contangeous virus (similar in this respect to CV-19), we were able to maintain community contact using what was termed Community Led Ebola Action - as part of the package of lifesaving/life sustaining interventions that were prioritised. We have adapted this approach for the CV-19 context - Community Led Action (CLA) and are planning to use this approach where large swathes of our target populations have very limited access to media, text, social media, TV or in some contexts even radio. As such, face-to-face interactions are going to be necessary to support much of the RCCE work that will need to happen. Training for families to undertake their own screening using a MUAC + checks for kwash' can be included in the RCCE plans and cascaded using a CLA approach where social distancing and wider IPC measures are respected. It could either be done door to door, where demonstrations are done by a network of community workers/volunteers that may already be inexistence, whilst respecting social distancing and using whatever PPE is deemed appropriate. Or, it can be done in small groups through a trained facilitator, village by village, for a collection of HHs with U5s/PLWs, marking out areas to ensure social distancing is maintained. Demonstrations can be done physically with the facilitator using their own arm as an example + kwash' demo', or phones/tablets could be used (without touching) showcasing a short i.e. 2min video. We were discussing, just yesterday, options for how this could be achieved in refugee camps whilst ensuring staff safety. If there are existing mechanisms being used with face-to-face contact i.e. through food/NFI distributions, where crowd control, spacing and other IPC measures are already in place, families with U5s/PLWs could be directed to one additional 'station' where they're shown a video or provided with a demonstration of how to take a MUAC measure and check for kwash'. Tapes can be distributed at this point for ongoing home based screening. Given the impact that CV-19 will likely have on families abilities to income generate and maintain food-nutrition security, it is going to be an incredibly useful tool to use.

Dear Hatty, Thanks for the information about your programme which sounds very sensible in your context. We will look to see what aspects of your approach might be adopted in Nepal as the situation unfolds here. Best wishes, Naomi

In situations where there is no alternative, then this approach could be considered. As far as we're aware, this approach has not yet been trialled by the sector. However, there are a number of examples of where use of mobile phones/mhealth can support decision-making by CHWs. Mhealth programmes have shown success when used for disease surveillance, supporting CHWs in ICCM programmes as well as guiding health workers in the process to screen and treat SAM.

The Wasting and Risk workstream of the GTAM has compiled an information note with suggestions for potential methods, questions and considerations to use this approach. Questions are adapted from existing tools such as IMCI guidance and IFE module 2.  Wasting and COVID 19 Programme Adaptations Information Note 2 

We would be very keen to document any use of this method and have feedback on the questions so please do share your experiences.