P3.113: Using Mid-Upper Arm Circumference (MUAC) Z-Score Tape for Community Pediatric Nutrition Risk Assessment and Monitoring: Experiences and Lessons from Southwestern Kenya

Background: In 2023, Community Health Volunteers (CHVs) and the Ministry of Health (MoH) staff were trained to use the novel MUAC z-score tape for household anthropometric measurements in southwestern Kenya as part of a randomized controlled trial titled ALIMUS-We are Feeding! In this qualitative sub-study, we aimed to understand the experiences and lessons learned from using the MUAC z-score tape for screening and monitoring.

Methods: Focus Group Discussions (FGDs) were used to explore the experiences of CHVs and MoH staff, who used the MUAC z-score tape for the nutrition screening of 617 children aged between 23 and 59 months. Two FGDs were conducted with CHVs (n=14) and one with MoH staff (n=7). Trained facilitators led discussions using a semi-structured interview guide in Luo and Swahili. FGDs were recorded, transcribed, translated, and analyzed using thematic analysis.

Results: Broad emerging themes included the acceptability of the MUAC z-score tape, perceived areas of improvement, and barriers to using the new tool for household nutrition screening. Participants had a positive opinion of using the MUAC z-score tapes emphasizing the expanded age categories, the inclusion of the age-specific z-scores, and additional color-coding for nutritional status. Barriers to using the MUAC z-score tape included the tape's durability and the font size of the markings on the tape. Acceptability for use at health posts by MoH staff was impacted by a lack of awareness and understanding of the novel information provided by the tape. Buy-in from community members proved essential to the screening process.

Conclusion: The findings highlight how enhancements to the MUAC z-score tape could facilitate community-based nutrition screening and monitoring. They also underscore the critical role of frontline community health workers in shaping the implementation of public health programs and the importance of providing proper training to such staff before community-level program implementation.