Programmatic adaptations to acute malnutrition screening and treatment during the COVID‐19 pandemic
Open Access
- 5 August 2022
- journal article
- research article
- Published by Wiley in Maternal & Child Nutrition
- Vol. 18 (4), e13406
- https://doi.org/10.1111/mcn.13406
Abstract
The COVID-19 pandemic presented numerous challenges to acute malnutrition screening and treatment. To enable continued case identification and service delivery while minimising transmission risks, many organisations and governments implemented adaptations to community-based management of acute malnutrition (CMAM) programmes for children under 5. These included: Family mid-upper arm circumference (MUAC); modified admission and discharge criteria; modified dosage of therapeutic foods; and reduced frequency of follow-up visits. This paper presents qualitative findings from a larger mixed methods study to document practitioners' operational experiences and lessons learned from these adaptations. Findings reflect insights from 37 interviews representing 15 organisations in 17 countries, conducted between July 2020 and January 2021. Overall, interviewees indicated that adaptations were mostly well-accepted by staff, caregivers and communities. Family MUAC filled screening gaps linked to COVID-19 disruptions; however, challenges included long-term accuracy of caregiver measurements; implementing an intervention that could increase demand for inconsistent services; and limited guidance to monitor programme quality and impact. Modified admission and discharge criteria and modified dosage streamlined logistics and implementation with positive impacts on staff workload and caregiver understanding of the programme. Reduced frequency of visits enabled social distancing by minimising crowding at facilities and lessened caregivers' need to travel. Concerns remained about how adaptations impacted children's identification for and progress through treatment and programme outcomes. Most respondents anticipated reverting to standard protocols once transmission risks were mitigated. Further evidence, including multi-year programmatic data analysis and rigorous research, is needed in diverse contexts to understand adaptations' impacts, including how to ensure equity and mitigate unintended consequences.Funding Information
- United States Agency for International Development
This publication has 40 references indexed in Scilit:
- Mothers Understand And Can do it (MUAC): a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 yearsArchives of Public Health, 2015
- Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?Public Health Nutrition, 2015
- Self-Screening and Non-Physician Screening for Hypertension in Communities: A Systematic ReviewAmerican Journal of Hypertension, 2015
- Mid upper-arm circumference is an effective tool to identify infants and young children with severe acute malnutrition in IndiaPublic Health Nutrition, 2015
- Optimal Screening of Children with Acute Malnutrition Requires a Change in Current WHO Guidelines as MUAC and WHZ Identify Different Patient GroupsPLOS ONE, 2014
- Mid-upper-arm-circumference and mid-upper-arm circumference z-score: the best predictor of mortality?European Journal of Clinical Nutrition, 2012
- Mid‐upper arm circumference and weight‐for‐height to identify high‐risk malnourished under‐five childrenMaternal & Child Nutrition, 2011
- Maternal and child undernutrition: global and regional exposures and health consequencesThe Lancet, 2008
- Using thematic analysis in psychologyQualitative Research in Psychology, 2006
- Cancer Prevention in Primary Care: Screening and self examination for breast cancerBMJ, 1994