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Yes, they can! – Sahel's mothers detecting malnutrition

Doctor Susan Shepherd collecting data in a hospital in Niger. © Sylvain Cherkaoui/Cosmos for ALIMA

A lot has changed in the Sahel since the 2005 crisis in Niger. The number of children accessing treatment for malnutrition has more than doubled, while health centres providing this type of care have grown threefold. However, the number of malnourished children is increasing steadily every year, and 1.4 million children are currently suffering from severe acute malnutrition in the Sahel according to UN and Commission's figures.

In an attempt to respond to the crisis, humanitarian organisations on the ground are exploring new ways to diagnose kids faster. The European Commission’s Humanitarian Aid and Civil Protection department (ECHO) supports all the innovative efforts that are headed in this direction.

The acronym 'MUAC' stands for 'mid-upper arm circumference', that is the name of the measurement tape that helps assess the nutritional status of a child. Medical NGO ALIMA has given it new life by rebranding the acronym into 'Mothers Understand And Can do it'. It is an empowering approach that puts mothers in charge of the initial detection of the symptoms of malnutrition. Our colleague Isabel Coello spoke with Susan Shepherd, ALIMA’s coordinator for field research, to find out more.

Interviewed by Isabel Coello, Regional Information Officer for West and Central Africa @ECHO_WAfrica

How did the idea of the catchphrase 'Mothers Understand And Can do it' come about?

All over the world, mothers are the experts when it comes to their children. Measuring the arm circumference with a little bracelet is a relatively simple procedure that almost anybody can learn after a few minutes of instructions – as we have demonstrated over and over by training health workers. So we said to ourselves: Why not train mothers? Mothers are with their children every day, and if the overall goal of tackling malnutrition is to start treating kids as soon as possible, who better to identify the first symptoms than their own mothers? This is where the whole project started.  

What were the first steps you took to kick off the project?

We first observed if the mothers who were in the hospitals were as good at using the bracelet as the nurses. However, that was not a real-life situation, so we took the project out into the villages where we carried out our observations on a small scale with a hundred moms. Based on the results we collected, we published a paper in May 2015.

A child in Mali is being measured with a 'MUAC' tape. © European Union/ECHO/Isabel Coello

What were the research conclusions?

The results showed that mothers and community health workers had a similar understanding of how to classify malnutrition levels according to the 'mid-upper arm circumference' tape. When there was discordance, it was usually in small figures and on the threshold of the three categories. The differences were minimal and they showed the same type of discordance that a doctor and a nurse might have in their diagnoses.

Backed by these important results proving that mothers could indeed detect malnutrition in their children, we felt like we had to test this on a larger scale. So we trained 13 000 mothers in Niger to screen their children at least every month. Since then, we have trained another 30 000 mothers in the same area, and we have also started the same training in our projects in Mali.

What are the benefits of your approach?

There are numerous benefits. First of all, we catch malnutrition early. Currently, most community health workers conduct their screenings in each village once a month. Screening a healthy child once a month is probably enough. But a monthly screening of a sick child, or of a child who is in the risk zone, is not enough. If we can get mothers to screen their babies weekly and bring them to the health centres, this will help speed up diagnoses, and it will significantly lessen the number of children who are hospitalised.

Also, training mothers (paying for the initial trainers’ salaries and the 'MUAC' tapes) is cheaper than providing salaries to community health workers who tour the villages to carry out regular malnutrition screenings.

How have mothers reacted to this new initiative?

Mothers felt empowered. They felt they can better take care of their children by themselves. One major difference we observed between the areas where mothers were themselves carrying out the detections and those where the health workers were in charge of these was that empowered mothers would come spontaneously to the health centre to look out for help for their children. The new approach has encouraged mothers to be more proactive. The message we send to them is: "You know your child at best, so if you are concerned, come to the health centre."

What was the role of European Commission in the project?

The Commission's support has been absolutely essential; without the financial support we could have never accomplished this. We could have never experimented new ways of screening for malnutrition without a well-functioning treatment programme, which we do have thanks to the EU funding and the Commission's openness to innovative approaches.

Mortality has declined dramatically in Niger, which is terrific progress. The number of acutely malnourished children yet remains very high, so we need to gain efficiency, simplify procedures as much as possible, and keep looking for new innovative ways. Having mothers screen and detect malnutrition is only one part of the solution but it helps us find new methods to make the management of malnutrition simpler.

A few years down the road, do you think the 'MUAC' measuring tape will be as commonly used as thermometers?

Yes, I believe it will become a useful and widely used tool to identify malnutrition and seek the right help. Mothers in the villages can certainly have 'MUAC' tapes at home just like thermometers: both tools are very easy to use but essential to help figure out if something is wrong.

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