family screening of malnutrition by muac · incorporated in cmam (community management of acute...
TRANSCRIPT
Family screening of malnutrition by MUAC
Sonia Girle ALIMA Australia
Cranaplus Conference Cairns 2018
The Alliance for International Medical Action
ALIMA- background bull Created in 2009 in Paris
bull Medical Care - 56 programs in 13 countriesTreated 2 600 000 patients
bull Innovation and research - 10 research projects
bull A unique alliance ndashwith a network of local and national medical organisations
bull ALIMA Australia
The Alliance for International Medical Action
Niger
The Alliance for International Medical Action
ALIMA and BEFEN
Well Being of Mothers and babies
Re
The Alliance for International Medical Action
MUAC (Mid Upper Arm Circumference)
bull Severe Acute Malnutrition (SAM) 0- 116mm
bull Normal 125-265mm
bull In 2011 ALIMA had the idea of
training mothers to measure their
own childrenrsquos MUAC
bull ALIMA was responding to recurring
medical and operational problems
of
1 Late admissions (leading to
complications)
2 Poor program coverage ( often
lt50)
MUAC Motherrsquos Understand And Can do it
The Alliance for International Medical Action
MUAC I Motherrsquos Understand And Can do it
MUAC Pilot study proof of concept
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015
Mothers Understand And Can do it (MUAC) a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Result(n = 103 motherinfant couples)
rarr Perfect agreement
rarrErrors only at limits
rarrNo difference
- Left or right arm
measures
- Estimation vs
measure of the
mid-point of the
arm
MUAC I Mothers can classify MUAC
correctly
The Alliance for International Medical Action
MUAC II Study at scale
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5
Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health
workers results from a large-scale pragmatic trial in rural Niger
Aleacute F Phelan KP Issa H Defourny I Le Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend
A Allafort-Duverger T Shepherd S Blackwell N
(May 2013 ndash April 2014)
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
The Alliance for International Medical Action
ALIMA- background bull Created in 2009 in Paris
bull Medical Care - 56 programs in 13 countriesTreated 2 600 000 patients
bull Innovation and research - 10 research projects
bull A unique alliance ndashwith a network of local and national medical organisations
bull ALIMA Australia
The Alliance for International Medical Action
Niger
The Alliance for International Medical Action
ALIMA and BEFEN
Well Being of Mothers and babies
Re
The Alliance for International Medical Action
MUAC (Mid Upper Arm Circumference)
bull Severe Acute Malnutrition (SAM) 0- 116mm
bull Normal 125-265mm
bull In 2011 ALIMA had the idea of
training mothers to measure their
own childrenrsquos MUAC
bull ALIMA was responding to recurring
medical and operational problems
of
1 Late admissions (leading to
complications)
2 Poor program coverage ( often
lt50)
MUAC Motherrsquos Understand And Can do it
The Alliance for International Medical Action
MUAC I Motherrsquos Understand And Can do it
MUAC Pilot study proof of concept
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015
Mothers Understand And Can do it (MUAC) a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Result(n = 103 motherinfant couples)
rarr Perfect agreement
rarrErrors only at limits
rarrNo difference
- Left or right arm
measures
- Estimation vs
measure of the
mid-point of the
arm
MUAC I Mothers can classify MUAC
correctly
The Alliance for International Medical Action
MUAC II Study at scale
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5
Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health
workers results from a large-scale pragmatic trial in rural Niger
Aleacute F Phelan KP Issa H Defourny I Le Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend
A Allafort-Duverger T Shepherd S Blackwell N
(May 2013 ndash April 2014)
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
The Alliance for International Medical Action
Niger
The Alliance for International Medical Action
ALIMA and BEFEN
Well Being of Mothers and babies
Re
The Alliance for International Medical Action
MUAC (Mid Upper Arm Circumference)
bull Severe Acute Malnutrition (SAM) 0- 116mm
bull Normal 125-265mm
bull In 2011 ALIMA had the idea of
training mothers to measure their
own childrenrsquos MUAC
bull ALIMA was responding to recurring
medical and operational problems
of
1 Late admissions (leading to
complications)
2 Poor program coverage ( often
lt50)
MUAC Motherrsquos Understand And Can do it
The Alliance for International Medical Action
MUAC I Motherrsquos Understand And Can do it
MUAC Pilot study proof of concept
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015
Mothers Understand And Can do it (MUAC) a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Result(n = 103 motherinfant couples)
rarr Perfect agreement
rarrErrors only at limits
rarrNo difference
- Left or right arm
measures
- Estimation vs
measure of the
mid-point of the
arm
MUAC I Mothers can classify MUAC
correctly
The Alliance for International Medical Action
MUAC II Study at scale
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5
Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health
workers results from a large-scale pragmatic trial in rural Niger
Aleacute F Phelan KP Issa H Defourny I Le Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend
A Allafort-Duverger T Shepherd S Blackwell N
(May 2013 ndash April 2014)
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
The Alliance for International Medical Action
ALIMA and BEFEN
Well Being of Mothers and babies
Re
The Alliance for International Medical Action
MUAC (Mid Upper Arm Circumference)
bull Severe Acute Malnutrition (SAM) 0- 116mm
bull Normal 125-265mm
bull In 2011 ALIMA had the idea of
training mothers to measure their
own childrenrsquos MUAC
bull ALIMA was responding to recurring
medical and operational problems
of
1 Late admissions (leading to
complications)
2 Poor program coverage ( often
lt50)
MUAC Motherrsquos Understand And Can do it
The Alliance for International Medical Action
MUAC I Motherrsquos Understand And Can do it
MUAC Pilot study proof of concept
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015
Mothers Understand And Can do it (MUAC) a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Result(n = 103 motherinfant couples)
rarr Perfect agreement
rarrErrors only at limits
rarrNo difference
- Left or right arm
measures
- Estimation vs
measure of the
mid-point of the
arm
MUAC I Mothers can classify MUAC
correctly
The Alliance for International Medical Action
MUAC II Study at scale
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5
Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health
workers results from a large-scale pragmatic trial in rural Niger
Aleacute F Phelan KP Issa H Defourny I Le Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend
A Allafort-Duverger T Shepherd S Blackwell N
(May 2013 ndash April 2014)
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
Re
The Alliance for International Medical Action
MUAC (Mid Upper Arm Circumference)
bull Severe Acute Malnutrition (SAM) 0- 116mm
bull Normal 125-265mm
bull In 2011 ALIMA had the idea of
training mothers to measure their
own childrenrsquos MUAC
bull ALIMA was responding to recurring
medical and operational problems
of
1 Late admissions (leading to
complications)
2 Poor program coverage ( often
lt50)
MUAC Motherrsquos Understand And Can do it
The Alliance for International Medical Action
MUAC I Motherrsquos Understand And Can do it
MUAC Pilot study proof of concept
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015
Mothers Understand And Can do it (MUAC) a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Result(n = 103 motherinfant couples)
rarr Perfect agreement
rarrErrors only at limits
rarrNo difference
- Left or right arm
measures
- Estimation vs
measure of the
mid-point of the
arm
MUAC I Mothers can classify MUAC
correctly
The Alliance for International Medical Action
MUAC II Study at scale
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5
Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health
workers results from a large-scale pragmatic trial in rural Niger
Aleacute F Phelan KP Issa H Defourny I Le Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend
A Allafort-Duverger T Shepherd S Blackwell N
(May 2013 ndash April 2014)
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
bull In 2011 ALIMA had the idea of
training mothers to measure their
own childrenrsquos MUAC
bull ALIMA was responding to recurring
medical and operational problems
of
1 Late admissions (leading to
complications)
2 Poor program coverage ( often
lt50)
MUAC Motherrsquos Understand And Can do it
The Alliance for International Medical Action
MUAC I Motherrsquos Understand And Can do it
MUAC Pilot study proof of concept
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015
Mothers Understand And Can do it (MUAC) a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Result(n = 103 motherinfant couples)
rarr Perfect agreement
rarrErrors only at limits
rarrNo difference
- Left or right arm
measures
- Estimation vs
measure of the
mid-point of the
arm
MUAC I Mothers can classify MUAC
correctly
The Alliance for International Medical Action
MUAC II Study at scale
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5
Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health
workers results from a large-scale pragmatic trial in rural Niger
Aleacute F Phelan KP Issa H Defourny I Le Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend
A Allafort-Duverger T Shepherd S Blackwell N
(May 2013 ndash April 2014)
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
MUAC I Motherrsquos Understand And Can do it
MUAC Pilot study proof of concept
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015
Mothers Understand And Can do it (MUAC) a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Result(n = 103 motherinfant couples)
rarr Perfect agreement
rarrErrors only at limits
rarrNo difference
- Left or right arm
measures
- Estimation vs
measure of the
mid-point of the
arm
MUAC I Mothers can classify MUAC
correctly
The Alliance for International Medical Action
MUAC II Study at scale
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5
Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health
workers results from a large-scale pragmatic trial in rural Niger
Aleacute F Phelan KP Issa H Defourny I Le Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend
A Allafort-Duverger T Shepherd S Blackwell N
(May 2013 ndash April 2014)
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Result(n = 103 motherinfant couples)
rarr Perfect agreement
rarrErrors only at limits
rarrNo difference
- Left or right arm
measures
- Estimation vs
measure of the
mid-point of the
arm
MUAC I Mothers can classify MUAC
correctly
The Alliance for International Medical Action
MUAC II Study at scale
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5
Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health
workers results from a large-scale pragmatic trial in rural Niger
Aleacute F Phelan KP Issa H Defourny I Le Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend
A Allafort-Duverger T Shepherd S Blackwell N
(May 2013 ndash April 2014)
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
MUAC II Study at scale
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5
Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health
workers results from a large-scale pragmatic trial in rural Niger
Aleacute F Phelan KP Issa H Defourny I Le Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend
A Allafort-Duverger T Shepherd S Blackwell N
(May 2013 ndash April 2014)
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
MUAC II
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
MUAC II Results-MUAC distribution at admission
N Mothers = 12893
N CHWs = 36
Median MUAC of mothers
zone vs CHW zone was 16
mm higher (95 CI = 065
187) (p = 0007) for children
admitted by MUAC
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
Zone Megraveres
233 722
070773
754
8 600104
Zone RECOs
9011184
7751332
401
21 980300
MUAC II Results (Hospitalisation Agreement Cost)
Hospitalisations all admissionsAt admission
During treatmentFor admissions with MUAClt115 mm
At admission During treatment
MUAC agreement at health centre
Cost total (en USD)Cost per child lt5 years
p-value
lt0001lt0001
lt00010002
lt0001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
The Alliance for International Medical Action
MUAC II Conclusions
rarrBringing Family MUAC to scaleis feasible and should beincorporated in CMAM (community management of acute malnutrition) programming and training guidelines
rarrFamily MUAC strategy will bemost effective in programs thatintegrate SAMMAM treatment(eg Maust et al in Sierra Leone)
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Changing ALIMArsquos policypractice
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
2015 2016 2017
Number of people trained in Family MUAC by ALIMA and its partners 2015-2017
Niger
Niger Burkina FasoChadMaliNigeriaCameroon
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Niger
rarr Training Guidelines available at
httpalima-ngoorgempowering-mothers-prevent-malnutrition
alima-ngoorg
The Alliance for International Medical Action
alima-ngoorg
The Alliance for International Medical Action