Project Details
E.W. "Al" Thrasher
Status: Funded - Closed
Developing low-cost universal malnutrition screening for low income countries
Summary
BACKGROUND: Family MUAC programs train caregivers to use mid-upper arm circumference (MUAC) tapes to screen their child for wasting. We assessed the effect of a Family MUAC program supported by a two-way short message service (SMS) platform on childhood wasting outcomes in western Kenya. METHODS: Children aged 5-12 months were recruited at health clinics and randomized to standard care (SOC) or the Maternally Administered Malnutrition Monitoring System (MAMMS). The MAMMS arm received two MUAC tapes and weekly SMS reminders to screen their child’s MUAC. The SOC arm received routine community health worker services and additional quarterly visits from the study team. Children were followed for 6-months, and outcomes included the incidence of wasting (MUAC <12.5cm), days from enrollment to treatment initiation, proportion of children with wasting identified by the two approaches and enrolled into care (treatment coverage), mean MUAC at treatment initiation, and duration of treatment among children with wasting. RESULTS: Among 599 children randomized to MAMMS and 601 to the SOC arm, the incidence of wasting was 37% lower in the MAMMS arm (hazard ratio: 0.63, 95%CI: 0.42-0.94, p=0.002). However, among wasting cases the arms were comparable in the median number of days-to-diagnosis (MAMMS: 63 days [95%CI: 23-92], SOC: 58 days [95%CI: 22-94]). There was some evidence of higher treatment coverage in the MAMMS (83.3%, 95%CI: 39.9-100.0) versus SOC arm (55.6%, 95%CI: 22.3-88.9%, p=0.300). The two arms had a similar mean treatment duration (MAMMS: 8.8 weeks [95%CI: 8.4-9.2], SOC: 9.1 weeks [95%CI: 8.8-9.5]), and mean MUAC at treatment initiation (MAMMS: 12.2 cm [95%CI: 12.1-12.3], SOC: 12.1 cm [95%CI: 12.0-12.2]). IMPACT: Family MUAC supported by SMS was comparable to SOC approaches across many measures of wasting management, but empowering caregivers to monitor their child’s nutritional status may prevent wasting in some low-resource households.