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Community-based management and use of MUAC for infants <6months

This question was posted the COVID-19 and nutrition programming forum area and has 2 replies.

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Alice Burrell

Emergency Nutrition Advisor - Save the Children

Normal user

1 Apr 2020, 11:48

Hello Colleagues,

Given the following programme adaptation recommendations for managment of wasting in the recent technical brief issued, are we considering to expand use of MUAC and community-based care for uncomplicated cases to the u6m age group?

  • Reduce exposure by shifting to MUAC only for anthropometric measurements in children and encouraging caregivers to carry out MUAC and oedema assessments under the supervision of a health practitioner.
  • Whenever possible, deliver all treatment for uncomplicated wasting in the community via Community Health Workers (CHWs) or other community-based platforms using a limited/no touch simplified treatment approach. Programmatic modifications should consider:
    • Using simplified admission criteria (e.g. MUAC and oedema only)

Despite MUAC for infants <6 months not being in recommendations given no validated threshold as of yet, MUAC is being used for this age group in certain contexts and there is a growing evidence base, although predominantly from the African context showing 11.0cm to be a suitable threshold for predicting increased mortality risk in this age group.  Given the situation we are faced with and the need to reduce contact and reduce health facility caseloads, do we want to consider the use of MUAC for infants <6 months to help identify infants most at risk and so help prioritise which infants require support? Taking in to consideration of course the impact this would have on caseloads and the need for clear guidance on how to manage such cases within the community to ensure we are not putting additional strain on health facilities. 

Given the likelihood of sub-optimal feeding and care practices due to the spread of covid and related myths and misconceptions, it is crucial that infants <6 months are visible in our nutrition programming adapations and being regularly screened and managed for risk. 

On the ENN C-MAMI webpage, there are links to numerous publications that could inform this discussion: https://www.ennonline.net/c-mami

Look forward to this discussion.

Kristine Jane Atienza

IYCF Coordinator

Normal user

2 Apr 2020, 07:39

Should we have additional guidelines for disinfecting MUAC tapes when using MUAC for anthro assessment? 

Wasting TWG

Emergency Nutrition Network

Frequent user

25 May 2020, 10:14

In the current context, where weight for length (WFL) and weight for age (WFA) assessment is not possible, MUAC criteria may also be expanded to infants under 6 months of age to monitor growth at home and to identify at risk infants. A threshold of <110mm may be used for infants 0-6 weeks (i.e. before first vaccination) and < 115mm for infants 6 weeks- 6 months. MUAC should only be expanded to this age group where there is a clear and appropriate pathway of care in the community to manage cases identified. A pathway of care requires clinical, feeding and maternal assessment and support (see C-MAMI Tool). Feeding support options to explore include breastfeeding peer support counsellors, IYCF programmes, phone counselling and use of video content (see Global Media Health Tools). It is unlikely that existing CMAM programmes targeting children 6 months of age and older have the required capacity and skill set to manage at risk infants under 6 months. RUTF is not recommended for use in infants under 6 months of age. Inpatient care should generally be reserved for complicated cases as per national guidelines. Low birth weight infants are at higher risk. It is important to note there are currently no validated thresholds for MUAC to identify at risk infants under six 6 months of age. These recommendations are based on research in Africa of MUAC thresholds associated with mortality risk and programming experiences.The thresholds suggested above assume a low risk intervention (i.e. breastfeeding support and implementing Integrated Management of Neonatal and Childhood Illness (IMNCI).

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