### How can severe malnutrition be determined locally?
Severe malnutrition can readily be determined without scales, with minimal training and with objective accuracy. The mid-upper arm circumference (MUAC) has been endorsed and recommended as a reliable screening tool for acute malnutrition. It is an easy and objective measurement that can be followed over time. An important update to this MUAC approach is a recent study that proves even minimally trained persons can use the inexpensive color coded bands to measure a small child or infant’s arm circumference.
This home-based approach allows much easier screening for severe malnutrition in areas with little access to trained medical personnel. Since the results have been determined to be reliable, Mid Upper Arm Circumference can be used by a mother to monitor the nutritional progress of her child, thereby she can play an even greater and proactive role in the complete care of her child.
This band with graduation in millimeters has an easy to read color code: green, yellow and red indicating the risk/severity of indicate the nutritional status of a child or adult. The color coded bands can be used by a minimally trained person to measure the diameter of the upper arm of a 6 – 60 month old. Severe acute malnutrition (SAM) is indicated by a red reading.
This study, published in the Archives of Public Health, demonstrated that there is no difference between measuring the dominant vs. non-dominant arm as was previous recommended AND it was determined that a mother could readily determine the mid-point of the upper arm without any extra measurements. The child’s arm needs only to be relaxed and at his side to be measured accurately.
### Does this method work for pregnant women?
MUAC is clinically accurate for children and adults too! There are four sizes of bands available.
Of particular interest to us is the size that is suitable for adults including **pregnant and postpartum women**. The importance of nutrition of pregnant and postpartum woman as it so directly affects not just her health but that of her baby.
Accurately assessing these women for moderate acute malnutrition (MAM), helps them to receive assistance and to gain entry into available feeding programs before the issue becomes critical. Severe acute malnutrition (SAM) drastically increases the risk of LBW (low birth weight). This simple assessment tool can help women (and babies) at risk get the help they need. In general, the cutoff point used for pregnant women
[MSF appears to be leading research on using the MUAC for pregnant women] (http://www.ennonline.net/fex/47/anthropometric). Their literature notes that "some nutritional protocols enroll pregnant women based on gestational age (mostly only in the third trimester) regardless of any anthropometric measurement. Different sections of Médecins Sans Frontiéres (MSF) are currently using MUAC <18.5 or <21.0 cm to include pregnant women in Supplementary Feeding Programmes (SFPs)."
Across a series of studies, a literature review found that cutoffs for pregnant women (meaning a MUAC measurement below the cutoff number) could be as high as 23 cm or as low as 18.5 cm.
Though there is a call for additional studies the important point here is that the MUAC tape may be used to screen pregnant women in humanitarian (and other) settings for dangerous levels of malnutrition which affect both other and fetus.
Sizes of MUAC bands available include the following:
-Infants from 6 months and children up to 6 years -Children 6 years up to 10 years -Children 10 years up to 18 years -Adults older than 18 years, pregnant and postpartum women
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.