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Where is MUAC used as the only admission criteria for SAM treatment programmes?

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 3 replies. You can also reply via email – be sure to leave the subject unchanged.

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Natalie Sessions

CMAM Forum Coordinator

Normal user

24 Nov 2016, 16:32

The CMAM Forum is currently mapping out all programmes where MUAC is used as the only admission criteria for SAM treatment, along with bilateral pitting oedema (as opposed to using both MUAC and WHZ or only WHZ admission criteria).

If you know of programmes using this admission criteria, we would love to hear from you!

We would really like to know where it is being used, the type of context (emergency/ non emergency), who conducts the measurements (mothers/community health workers/ health facility workers), how children continue to be monitored once in the programme and what discharge criteria are used.

Thank you!

Mark Myatt

Consultant Epidemiologist, Brixton Health

Frequent user

27 Nov 2016, 06:02

From my own observations in recent years ...

The Nigerian nation CMAM program operates in eleven states elected because of high prevalence of SAM by MUAC (MUAC < 115 mm or bilateral pitting oedema). The program properly implements WHO recommendations using MUAC as the primary admitting criteria and W/H where feasible (i.e. almost nowhere in a PHC delivered program).

The program operates in emergency (northerm Nigeria) and non-emergency contexts (elsewhere). Case-finding is by screening (MUAC) at health facilities and by a mix of CBVs, CHWs, and HEWs in the community. Monitoring is by weight gain (plans to use MUAC in the future). Discharge is on MUAC > 115 mm for two visits with consistent weight gain and / or loss of oedema for two visits. Visits are weekly.

A recent review in two high admissions states (article in preparation) found 95.1% of cases were admitted by MUAC, 1.4% by MUAC with oedema, and 0.18% by oedema alone. About 3.3% of admissions were by other criteria such as WHZ < -3, visible severe wasting, transfers from inpatient stabilisation facilities, and discretionary criteria.

The programs, in recent years, has met SPHERE minimum standards for treatment outcomes. As with many programs, deaths may me under-reported but mortality would need to be very high for the program to have failed to meet SPHERE minimum standards. Repeated coverage assessments found coverage to be stable at about 38%. Median length of stay in the program is 7 weeks for cases discharged as cured.

ACF programs in Pakistan and Kenya use similar admitting criteria with most admissions and discharges by MUAC. In Pakistan the situation is a little confused by inpatient care using WHZ < -3 or oedema +++ as the local WHO office refuses to "allow" the use of MUAC. Both programs have achieved moderate to good coverage. Coverage has dropped in Kenya due to issue with the RUSF pipeline and cuts in community activities due to squeezed budgets following decentralisation following the adoption of the new constitution.

The Sudan national CMAM program is MUAc only. MSF have run a MUAC only program (MUAC < 120 mm) in Gedaref state.

ALIMA have MUAC only programs in Burkina Faso and Niger. Mothers using MUAC.

MSF has a MUAC only program in Cameroon. Mothers using MUAC.

IRC is working on CCM for SAM (and other conditions) delivered by semi-literate / semi-numerate community workers. These programs (still piloting instruments in pilots) are MUAc only in the sense that admission, monitoring, and discharge are by MUAC. case-findings is by CHWs.

SC-US ran a MUAC only CHW delivered program using MUAC only for admission and discharge.

The COMPAS project (fully integrated MAM an SAM programs) are, AFAIK, using a MUAC only programming model. I think that program have been in place or ar planned for Sierra Leone, South Sudan, and Kenya (maybe elsewhere).

There are more tat I cannot rightly recall (that is ageing for you!).

I hope this is of some use.

Natalie Sessions

CMAM Forum Coordinator

Normal user

29 Nov 2016, 08:53

Thanks so much for the information Mark, I had tried to email you personally but for some reason the email bounced back. Anyways, thanks for reply, much appreciated!

Mark Myatt

Consultant Epidemiologist, Brixton Health

Frequent user

29 Nov 2016, 15:31

Natalie,

Thank you for your kind comments.

Try:

mark@NOSPAM.brixtonhealth.com

removing "NOSPAM." from the address.

You may get an out-os-office reply because I am in the field until the start of next week (5th December 2016).

Mark

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