Mid-upper arm circumference z-score tapes for childhood malnutrition screening: an implementation study from rural Kenya

Abstract Background In many remote and low-resource regions, standard methods for assessing the nutritional status of children are hindered by inadequate access to equipment, inaccurate equipment, high costs of screening, and under-resourced health facilities for malnutrition risk screening. Mid-upper arm circumference (MUAC) is a relatively simple, inexpensive, and established method for malnutrition risk screening in children, but monitoring of nutritional risk status over time can be challenging. MUAC tapes that instantly display age-specific MUAC z-scores in addition to absolute MUAC have become available. However, there are limited studies exploring the penetration and adoption of MUAC z-score tapes’ use and implementation by community health volunteers (CHVs) in community settings. Methods As part of the ALIMUS cluster-randomized controlled trial, 15 CHVs were trained on the use of MUAC z-score tapes. The CHVs then applied the tapes during routine home visits to screen for malnutrition risk among children < 5 years of age living in Siaya County, Kenya. The study comprised 4 screenings over 1 year at 2–3 month intervals. The proportions of executed MUAC z-score screenings and nutritional risk status at each home visit were determined. Results Of the 575 children (mean age, 15 months; SD, 5.08 months at enrollment) from 575 households, at least 85% (488/575) were screened using the MUAC z-score tape during each of the 4 screening periods. The overall proportion of malnutrition risk (overnutrition and undernutrition) declined from 18.2% in the first round to 14.1% in the fourth round of screening, increasing the proportion with normal nutritional status from 82% to 86%. Among the 451 children who completed all four screenings, 12% improved their nutritional risk status, while 7% experienced a deterioration in nutritional risk status. Conclusions MUAC z-score tapes were repeatedly applied for nutrition risk screening in the ALIMUS study, supporting the penetration and adoption of their use by CHVs working in remote and low-resource community settings. Trial registration German Clinical Trials Register (DRKS) DRKS00019076. Registered on 27 July 2021.