MUAC MOTHER ACTIVITY PRESENTATION BY DR CHRISTIAN MASUDI

MUAC MOTHER ACTIVITY PRESENTATION BY DR CHRISTIAN MASUDI DEP. MEDCO ALIMA MAIDUGURI NUTRITION SECTOR November 2019

Agenda • 1/ BACKGROUND AND JUSTIFICATION • 2/ WHO DOES ALIMA TRAIN? • 3/ WHERE CAN BE CONDUTED THE TRAINING? • 4/ WHO TRAIN MOTHERS AND CAREGIVERS? • 5/WHAT DOES THE TRAINING COVER ? • 6/ MUAC TAPE MEASUREMENT AND OEDEMA DETECTION • 7/ DATA MUAC MOTHER ACTIVITY • 8/ CONCLUSION

In 2011, ALIMA began examining the feasibility of training mothers to be able to identify malnutrition in their children. They wanted to reduce the number of children presenting late for treatment for severe malnutrition (which was resulting in more complications), and improve low program coverage. ALIMA conducted two studies in the Mirriah District of Niger to compare mothers trained by health workers and CHWs muac activity in classifying children’s nutritional status by MUAC. The first pilot study showed that after a short practical demonstration on using MUAC bracelets, there was near-perfect agreement in MUAC classification between 103 mothers and health workers. A larger study followed comparing the MUAC for Mothers and CHW screening strategies in two separate health zones. In the zone where 13 000 mothers were trained to use MUAC malnourished children arrived for treatment earlier and required far fewer hospitalizations than children in the CHW health zone.

• ALIMA has taught tens of thousands of mothers to screen for malnutrition in Niger, Burkina Faso, Mali, Chad, Nigeria. • Our teams have found that opportunities for group and individual trainings exist in all health and nutrition interventions, and that it is relatively straightforward to incorporate into pre-existing programs. Training activities flow like a cascade from the community to the health center to the hospital, reinforcing key messages and actions along the way. Follow-up activities are important to ensure mothers successfully understand the screening techniques and that screening occurs routinely and regularly. • Early evidence of MUAC for Mothers’ impact convinced ALIMA’s operational and country managers to implement the approach in all of ALIMA’s malnutrition treatment programs beginning in 2016. ALIMA has already trained more than a million mothers and caretakers in more than 10 countries. To help other national and international groups implement the strategy in their own programs, ALIMA also created guidelines conducting MUAC trainings.

• WHO DOES ALIMA TRAIN? While mothers with children aged 6 -59 months have been the priority, other caretakers and family members have been included in the training. ALIMA found that training recent mothers or soon-to-be mothers, as well as engaging husbands and fathers, can generate community acceptance.

WHERE HAS ALIMA CONDUCTED TRAININGS? • At the community level: ü Dedicated mass training campaigns with group trainings in villages and individually in households over a period of two weeks ü Trainings attached to seasonal malaria chemoprevention (SMC) campaigns ü Trainings attached coverage surveys, mass screenings or vaccination campaigns identifying mothers who are ü leaders in their community to form small groups • At the health post or health center level ü In the triage waiting area ü After triage for those not needing further treatment ü During ‘cooking groups’ or other health promotion activities ü Upon discharge from SAM or MAM treatment • At the hospital/stabilization center ü During a hospital stay once a child is stabilized ü Individual training at discharge or graduation Video presentations ü Using short demonstration videos can be a good way to reach mothers and caretakers with messages during training sessions.

WHO TRAIN MOTHERS AND CAREGIVERS ? ALIMA has used CHWs, Health Promoters, Nutrition Assistants and nurses to train caregivers on using MUAC tapes and identifying malnutrition. • CHWs continue to play an important role in promoting and delivering health efforts in a community, but utilizing CHWs to train mothers how to screen in the community, rather than screening children themselves, is better suited to their skills. WHAT DOES THE TRAINING COVER? • Trainings are generally a mixture of short presentations and practical demonstrations. Topics covered include: • what is malnutrition, how it is diagnosed and treated (using pictures, videos or drawing in support) and why mothers should screen their children. • Highlighting that early detection can reduce the risk of death or the need for lengthy hospital stay has been noted to be effective. Mothers then have an opportunity to use MUAC tapes and practice measuring their children as well as checking for oedema.

MUAC TAPE MEASUREMENT § Slide the tape around either the left or right arm up to what you estimate to be the midpoint between the shoulder and elbow. § With the arm hanging down relaxed at the side of the body, tighten the tape with enough tension so the tape is held against the skin without pinching. (If the tape is too tight, the skin will be pinched. If the tape is too loose, the tape will not be touching the skin. Both can cause inaccurate measurements. ) § Read the color in the window between the two arrows to identify the nutritional status of your child.

MUAC MOTHER MEASUREMENT

OEDEMA DETECTION • Press your thumbs down on top of your child’s feet for three seconds If there is still an imprint a few seconds after you have removed your thumbs, your child may have severe acute malnutrition so you should go to the health center as soon as possible.

DATA OF MUAC MOTHER ACTIVITY FROM JAN-SEPT 2019 JANUARY 2019 - SEPTEMBER 2019 LOCATIONS Mother trained % Muac mastering % Edema detecting % Admission using one of the method Monguno 53. 299 85% 86% 21% Muna 10. 596 90% 85% 14% TVC 4662 94% 88% NO OTP UMTH 957 93% 92% NOT DIRECT ADMISSION IN UMTH 14603 77% 75% ASKIRA /HAWUL 6%

CONCLUSION • This activity is important because; Ø Sharing information about Malnutrition, feeding and detecting abnormalities nutritional status among children ØImpact the performance indicators of nutrition ( OTP/SC) Ø Commit the mother for monitoring SAM and first management. Ø Reduce morbidity by coming early in the health facility Ø Reduce mortality linked to malnutrition Ø Community commitment in SAM management