Dear Kirk

Thanks for your question

Am writing from Kenya where Community Health Volunteers the equivalent of CHWs assist the nutrition personnel to identify and reffer malnutrition cases at community level to the facilities...I have worked in 3 counties and this is very possible when the following is done. In Lamu and Kilifi counties muac is one of the measurements used in early warning systems and it's done by CHWs

1. Training on correct use of muac tapes by CHWs.

2. Follow up to determine quality of data given

3. Measures of height and weight to determine WHZ scores for interventions. Though interventions can be done by muac.

I am writing from Nigeria where I work in humanitarian context.  Our organization is one of the few INGO implementing GMP consistently over the past 3 years.  The skilled community volunteers also called CHWs are trained in both facility and community based GMP, how to record and  chart the child health card and interpret the growth to caregivers and offer nutrition counselling. Our experience has been that GMP could be a veritable platform for early identification and referral of severe acute malnutrition to either SAM or MAM treatment centres. In addition, we have used this platform for the promotion of MIYCF pratcices, micronutrient supplementation for eligible children.

Our GMP activities are carried out within health facilities and our established community IYCF corners outside the hospital premises.  A caregiver does not need to visit health centre if there is no need for medical attention to receive GMP services in our sites.

Trained CHWs have been found to be capable of doing GMP  and identify wasting using MUAC tape as accurate as the quality of their training, able to record and document the process with minimal supervision 

Child Growth Card design is country specific and our organization uses the National Child Health Card and links the GPM data to national HIMS through the corresponding Local Government health system.

I think that any organization intending to use CHW to carry out GMP and use MUAC to screen for malnutrition must invest in quality selection and training of the CHW through community participation.

This is really encouraging to hear of your experience, Dr. Oloyede! I'm encouraged by the extensive training you provide, the IYCF corners, and close links between the community and health facilities. Do you have a powerpoint presentation or report that provides more detail about your program? You can email me what you think is relevant: kdearden@momentumihr.org.

Nancy, this is very encouraging to hear. I'm impressed by your work on referrals, the focus on data quality, and the use of height and weight. In your experience, is the use of height and weight expensive--both in terms of time and human resources? I'd love to hear more about your program. If you have a few documents, you'd like to share, you can reach out to me: kdearden@momentumihr.org. Thanks!

Hallo Kirk

Height and weight is only possible for us at facility level, since it's complex in taking and interpretation at community level. As these are routine services in our setting (done by nurses and nutritionist or any other trained personnel ), since all children who come for immunization have their height and weight taken and plotted. Any child who has WHZ score of less than -2 s refered to a nutritionist who checks WHZ score and intervenes as required..

It's therefore not expensive to carry out this GMP services.

BUT if it's not routine in your setting then this makes GMP expensive since you have to procure the anthropometric equipment and train staff on MIYCN and IMAM. These two trainings help staff intervention strategies for the various GMP outcomes. CHVs also need training.

Thanks, Nancy. That is what I expected. It's too expensive to collect height/length and weight in the comunity!

Hi! I am Sweta Banerjee, working as Nutritionist for Welthungerhilfe, India & Bangladesh country office. Welthungerhilfe has developed a Child Growth Monitoring Application. It is a open source applivation and can be dowloaded on the smart phone. Currently work is in progress and 80% accuracy has been acheived. The application  scans the children, 6 month to 59 months, and gives the nutritional status of Stunting and Wasting. The scans can be taken off line also and connect to network as and when available. There is a dash board for overall status. At the service provider level a growth chart will be visible to show individual status of the child.

For further information contact

Shivangi Kaushik

Nutrition - Welthungerhilfe (welthungerhilfeindia.org) Digital innovation to fight hunger

For further details please connect to  shivangi.kaushik@welthungerhilfe.de

Many thanks, Shivangi. This sounds really interesting! I've contacted you separately by email.

Would also be good to know of innovative approaches that have been used in a context where availability of anthropometric equipemnts is a challenge ?