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Phone-based screening/ early detection of wasting (escalated question to the Wasting TWG)

This question was posted the COVID-19 and nutrition programming forum area and has 1 replies.

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GTAM Wasting TWG

Emergency Nutrition Network

Frequent user

19 Jun 2020, 10:48

Phone-based screening/ early detection - where family/ mothers’ MUAC is not possible, can mobile-phone based SAM/MAM screening questions be used to identify malnourished children based on predictors of wasting? (e.g. to integrate into CHW phone calls with households) If so, what simple questions are advised?
What apps can be used for phone based screening?

GTAM Wasting TWG

Emergency Nutrition Network

Frequent user

19 Jun 2020, 11:43

The following answer was compiled through consultation withing the Wasting TWG. An information note on this type of programme adaptation can also be found here:

https://www.nutritioncluster.net/Resources_Wasting_COVID-19_Programme_Adaptations_Information_Note_2


In situations where there is no alternative, then this approach could be considered. This type of screening has not yet been trialled by the sector, but there are a number of examples of where use of mobile phones/mhealth can support decision-making by CHWs. Mhealth programmes have shown success when used for disease surveillance, supporting CHWs in ICCM programmes as well as guiding health workers in the process to screen and treat SAM.


Mhealth can range from simple (e.g. SMS messaging) to more complex platforms using smart phones or tablets. Mhealth applications have and can be used by CHWs as a job-aid, and also as a tool to share information directly with households.
Use of mhealth in context of COVID-19 will be advantageous in allowing CHWs to follow up with families where person-to-person contact is not possible.
It would be feasible to use mhealth as a tool to screen HHs remotely for wasting, using a series of questions

Questions that could be used

Remote identification of at risk wasted children that require intervention
We have suggested nine screening questions. We suggest that where three of the screening criteria for risk are met, this should prompt advice to the caregiver to access a health/nutrition service. The exception are questions 3, 4 and 5 which should prompt immediate advice to access urgent medical attention.
Screening questions:
How old are your children?
Are you worried about the health of your child/any of your children?
Is your child unusually sleepy, not feeling well, vomiting everything, or had any loss of consciousness or seizures?
If your child is currently sick or has a fever, has it been going on for more than 7 days?
Do you think your child is too thin or is becoming thinner than before?
Is your child still feeding or eating normally?
If answer is no, has this been for 2 days or more?
[If child is under 2]:
Have you ever breastfed your child?
If no longer breastfeeding, when and why did you stop?
Does your family struggle to have enough food every day for all the household?
Has your child previously been identified as malnourished or admitted to a nutrition treatment programme?

Aid to interpret answers to identify risks:
How old are your children? Children under 2 years are more at risk. However irrespective of age of the child, if they are 0-59 months, please continue with the screening questions.
Are you worried about the health of your child/any of your children? If a mother or primary caregiver is concerned about her child, this is an important alert to a problem and helps to interpret the responses to the rest of the questions.
Is your child unusually sleepy, not feeling well, vomiting everything, or had any loss of consciousness or seizures? These are IMCI danger signs that are an immediate alert for a caregiver to seek urgent medical attention.
IF ANSWER IS YES -> ADVISE TO IMMEDIATELY GO TO A HEALTH FACILITY
If your child is currently sick or has a fever, has it been going on for more than 7 days? A child who is or has been very recently sick is at greater risk. If the child is currently sick and the caregiver is worried about the child, advise that she access health services. If a child has been sick for more than 7 days then should be referred to a health facility.
IF ANSWER IS YES -> ADVISE TO IMMEDIATELY GO TO A HEALTH FACILITY
Do you think your child is too thin or is becoming thinner than before? A child who has recently lost weight or has faltered in growth is at increased risk
IF ANSWER IS YES -> ADVISE TO IMMEDIATELY GO TO A HEALTH FACILITY
Is your child still feeding or eating normally? Poor appetite for food puts a child at increased risk of wasting and can indicate a child who is sick.
IF CHILD HAS NOT BEEN EATING NORMALLY FOR MORE THAN 2 DAYS -> ADVISE TO IMMEDIATELY GO TO A HEALTH FACILITY
[If child is under 2]:
Have you ever breastfed your child? A child not breastfeeding is at higher risk, especially if under 1 year of age. If not breastfed aged under six months of age, requires immediate further investigation as to how this infant is being fed.
If no longer breastfeeding, when and why did you stop? It is important to identify children who have stopped breastfeeding due to reduced appetite/ willingness or ability to breastfeed.
Does your family struggle to have enough food every day for all the household? If a family is struggling to have enough food, this will compromise food intake of the children.
Has your child previously been identified as malnourished or admitted to a nutrition treatment programme? A child who previously was wasted is at higher risk.

Considerations
The type of mhealth intervention selected should be based on an assessment of network coverage and the types of phones available to the target audience;
This type of screening should only be used in contexts where treatment services are available with clear instructions for the referral of cases;
Partners should agree on a common approach and single platform;
Open source platforms should be used;
Combining the use of mhealth with other platforms, such as mass media messaging on danger signs for malnutrition could be considered.

Resources:

ACF has conducted a mapping of mhealth apps for nutrition. The report can be found here: https://knowledgeagainsthunger.org/key-documents/nutrition-information-systems-review/ Other related resources include: https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-019-0803-2 https://opendocs.ids.ac.uk/opendocs/bitstream/handle/20.500.12413/2602/AGER1.pdf?sequence=1&utm_source=idswebsite&utm_medium=download&utm_campaign=opendocs http://www.transformnutrition.org/wp-content/uploads/sites/3/2017/04/TN_WorkingPaper1_MobileApp_Online.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594719/

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