RESUMEN
BACKGROUND: A novel approach for improving community case-detection of acute malnutrition involves mothers/caregivers screening their children for acute malnutrition using a mid-upper arm circumference (MUAC) insertion tape. The objective of this study was to test three simple MUAC classification devices to determine whether they improved the sensitivity of mothers/caregivers at detecting acute malnutrition. METHODS: Prospective, non-randomised, partially-blinded, clinical diagnostic trial describing and comparing the performance of three "Click-MUAC" devices and a MUAC insertion tape. The study took place in twenty-one health facilities providing integrated management of acute malnutrition (IMAM) services in Isiolo County, Kenya. Mothers/caregivers classified their child (n=1040), aged 6-59 months, using the "Click-MUAC" devices and a MUAC insertion tape. These classifications were compared to a "gold standard" classification (the mean of three measurements taken by a research assistant using the MUAC insertion tape). RESULTS: The sensitivity of mother/caregiver classifications was high for all devices (>93% for severe acute malnutrition (SAM), defined by MUAC < 115 mm, and > 90% for global acute malnutrition (GAM), defined by MUAC < 125 mm). Mother/caregiver sensitivity for SAM and GAM classification was higher using the MUAC insertion tape (100% sensitivity for SAM and 99% sensitivity for GAM) than using "Click-MUAC" devices. Younden's J for SAM classification, and sensitivity for GAM classification, were significantly higher for the MUAC insertion tape (99% and 99% respectively). Specificity was high for all devices (>96%) with no significant difference between the "Click-MUAC" devices and the MUAC insertion tape. CONCLUSIONS: The results of this study indicate that, although the "Click-MUAC" devices performed well, the MUAC insertion tape performed best. The results for sensitivity are higher than found in previous studies. The high sensitivity for both SAM and GAM classification by mothers/caregivers with the MUAC insertion tape could be due to the use of an improved MUAC tape design which has a number of new design features. The one-on-one demonstration provided to mothers/caregivers on the use of the devices may also have helped improve sensitivity. The results of this study provide evidence that mothers/caregivers can perform sensitive and specific classifications of their child's nutritional status using MUAC. TRIAL REGISTRATIONS: Clinical trials registration number: NCT02833740.
RESUMEN
Twice-yearly child health weeks are an effective way of reaching children with essential child survival services in developing countries. In Kenya, child health weeks, or Malezi Bora, were restructured in 2007 from an outreach-based delivery structure to a health facility-based delivery structure to reduce delivery costs and increase sustainability of the events. Administrative data from 2007 to 2011 have demonstrated a decrease in coverage of Malezi Bora services to targeted children. A post-event coverage (PEC) survey was conducted after the May 2012 Malezi Bora to validate coverage of vitamin A supplementation (VAS) and deworming and to inform program strategy. Nine hundred caregivers with children aged 6-59months were interviewed using a randomized, 30×30 cluster design. For each cluster, one facility-based health worker and one community-based health worker were also interviewed. Coverage of VAS was 31.0% among children aged 6-59months and coverage of deworming was 19.6% among children aged 12-59months. Coverage of VAS was significantly higher for children aged 6-11months (45.7%, n=116) than for children aged 12-59months (28.8%, n=772) (p<0.01). Eighty-five percent (51/60) of health workers reported that Malezi Bora was implemented in their area while 23.6% of primary caregivers reported that Malezi Bora occurred in their area. The results of this PEC survey indicate that the existing Malezi Bora programmatic structure needs to be reviewed and reformed to meet WHO guidelines of 80% coverage with VAS.