Abstract
A stubborn persistence of child severe acute malnutrition (SAM) and continued gaps in program coverage have made identifying methods for expanding detection, diagnosis, and treatment of SAM an urgent public health need. There is growing consensus that making mid-upper arm circumference (MUAC) use more widely accessible among caregivers and community health workers (CHWs) is an important next step in further decentralizing SAM care and increasing program coverage, including the ability of CHWs to treat uncomplicated SAM in community settings. We conducted a systematic review to summarize published and operational evidence published since 2000 describing the use of MUAC for detection and diagnosis of SAM in children aged 6-59 months by caregivers and CHWs, and of management of uncomplicated SAM by CHWs, all outside of formal health care settings. We screened 1,072 records, selected 43 records for full-text screening, and identified 22 studies that met our eligibility criteria. We extracted data on a number of items, including study design, strengths, and weaknesses; intervention and control; and key findings and operational lessons. We then synthesized the qualitative findings to inform our conclusions. The issue of treating children classified as SAM based on low weight-for-height, rather than MUAC, at household level, is not addressed in this review. We found evidence that caregivers are able to use MUAC to detect SAM in their children with minimal risk and many potential benefits to early case detection and coverage. We also found evidence that CHWs are able to correctly use MUAC for SAM detection and diagnosis and to provide a high quality of care in the treatment of uncomplicated SAM when training, supervision, and motivation are adequate. However, the number of published research studies was small, their geographic scope was narrow, and most described intensive, small-scale interventions; thus, findings are not currently generalizable to public-sector health care systems. Scaling up the use of MUAC by caregivers and CHWs to detect SAM in household and community settings is a promising step toward improving the coverage of SAM detection, diagnosis, and treatment. Further research on scalability, applicability across a wider range of contexts, coverage impact, and cost is needed. The primary use of MUAC for SAM detection should also be explored where appropriate.
Highlights
Scaling up the use of mid-upper arm circumference (MUAC) by caregivers and community health worker (CHW) to detect severe acute malnutrition (SAM) in household and community settings is a promising step toward improving the coverage of SAM detection, diagnosis, and treatment
The use of mid-upper arm circumference (MUAC) by health care providers to detect SAM was inextricably linked to the initial success of community-based management of acute malnutrition (CMAM) and is likely to remain an accurate, simple, affordable, and acceptable tool to facilitate further scale up of SAM detection and management
We found evidence supporting high CHW capacity to accurately diagnose SAM using MUAC in 3 studies of 2 interventions in Bangladesh and Mali19–21 Two studies presented mixed evidence from Niger and Pakistan,11,13 and two from www.ghspjournal.org
Summary
Of the approximately 16.4 million children aged 6–59 months worldwide estimated to experience severe acute malnutrition (SAM), roughly 7% to 13% receive treatment each year. While the growth of community-based management of acute malnutrition (CMAM) programs has considerably increased coverage of treatment for SAM over the past decade, continued gaps in coverage and a persistence of SAM have made identifying strategic methods for expanding access to care, and finding the means to leverage these methods at scale, an urgent public health need.3MUAC Use for SAM Detection in Communities www.ghspjournal.orgThe use of mid-upper arm circumference (MUAC) by health care providers to detect SAM was inextricably linked to the initial success of CMAM and is likely to remain an accurate, simple, affordable, and acceptable tool to facilitate further scale up of SAM detection and management. While the growth of community-based management of acute malnutrition (CMAM) programs has considerably increased coverage of treatment for SAM over the past decade, continued gaps in coverage and a persistence of SAM have made identifying strategic methods for expanding access to care, and finding the means to leverage these methods at scale, an urgent public health need.. A stubborn persistence of child severe acute malnutrition (SAM) and continued gaps in program coverage have made identifying methods for expanding detection, diagnosis, and treatment of SAM an urgent public health need. There is growing consensus that making mid-upper arm circumference (MUAC) use more widely accessible among caregivers and community health workers (CHWs) is an important step in further decentralizing SAM care and increasing program coverage, including the ability of CHWs to treat uncomplicated SAM in community settings
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