Contextually Adapted Family MUAC

While the use of Middle-Upper-Arm Circumference (MUAC) tapes can effectively be used to screen children for malnutrition at home, low uptake of the tapes by caregivers presents a barrier to early detection. In Mali, in a district where 90% of women had been trained, only 20% of admissions for treatment were due to family-referrals using the MUAC tape.

Understanding and addressing this gap is critical for improving early detection of malnutrition. Early identification through family-led MUAC screening allows children to receive timely treatment before their condition worsens, reducing the risk of complications, hospitalizations, and mortality.

From 2021 to 2023, the IRC applied a human-centered, behavioral science-informed, problem-solving approach to understand why trained caregivers may not be regularly using MUAC tapes to screen their young children in the Nara region of Mali, with the aim of developing a set of proposed solutions that are both desirable to caregivers and feasible to implement. Through in-depth interviews, focus groups, and human-centered design tools, we found that stigma around malnutrition and the overwhelming family demands on caregivers were key obstacles.

To address these barriers, we implemented a pilot study that included behavioral interventions such as a stigma-reducing video testimonials, regular reminders to and from husbands, and communal screening at existing women’s lending groups. Within two months, the intervention led to a 33% increase in female participants’ confidence to use MUAC tapes and an 11% increase in their motivation for routine screening. The video testimonial resonated strongly with female and male participants, fostering emotional engagement and clearer understanding of the utility of screening their children.

This study underscored the importance of ensuring all women have the support structures and confidence to screen their children independently. Next steps include:

• Adapting the model for places where existing women’s lending groups may not exist
• Adapting the model to peri-urban or other locations less reliant on community health agents
• A large-scale pilot to test how well the model increases early detection of malnourished children, how well these children are then enrolled in treatment for malnutrition, and the viability of the model at scale.

Video: Evidence to Action Change Stories Initiative: Health Family MUAC