By Isabelle Mayault
Mothers can do it: They can now test their children for malnutrition themselves.
This simple enough idea emerged from a vast study carried out in Niger in 2015 by Alima, a Dakar-based medical NGO, and has given birth to a groundbreaking new method of treating malnutrition.
Hadiza Kanta, a 30-year-old mother of six, hangs her MUAC bracelet on a nail so that it doesn’t bend. (Photo credit: Sylvain Cherkaoui/Cosmos)
For the past decade or so, MUAC, which stands for Mid-Upper Arm Circumference, has been used for detecting malnutrition. This innovative tool is, in fact, a four-color bracelet. Simple and cheap—just 13 cents per tape—it requires little equipment, can be taught to minimally trained people, and has proven more reliable than any other anthropometric indicator, including Weight-for-Height.
Alima, however, gave this tool a new life when it came up with the idea of involving mothers, too.
“MUAC is very easy to use. Mothers have fully understood it and have been doing the testing very dutifully,” says Dr. Nafissa Dan Bouzoua, who recently returned from a six-month mission in Chad where Alima has recently started to implement this new method. A doctor for almost 15 years, she has worked on nutrition programs for most of her career—first as a referring doctor for Doctors Without Borders (MSF) and, since 2013, for Alima.
Maria Ousmane, 52, measures her granddaughter, 5-year-old Farida Nassirou. (Photo credit: Sylvain Cherkaoui/Cosmos)
According to the 2015 study carried out by Alima and the Niger-based NGO Befen, entitled “MUAC – Mothers Understand And Can do it,” it appears that mothers are able to identify which kind of malnutrition their children suffer from (if any at all) by using the ribbon.
Dr. Nafissa Dan Bouzoua, who was born and educated in Niger, explains how the mothers’ training works: “We offer theoretical and practical courses. First, we show them short educational video clips. Then, either at the health center or in the villages, we practice with the tape.”
“Moms understand quickly; they will be able to do at home,” says Alimatou Daouda, 42, a social worker employed by BEFEN / ALIMA. (Photo credit: Sylvain Cherkaoui/Cosmos)
The bracelet is rolled over the child’s upper-arm. If it measures over 13.5 cm (or green), it means that the child is well nourished; if it’s between 12.5 cm and 13.5 cm (yellow), the child is at risk for acute malnutrition; if it’s between 11 cm and 12.5 cm (orange), the child suffers from Moderate Acute Malnutrition (MAM); and if the result is below 11 cm (red), then it is a case of Severe Acute Malnutrition (SAM).
“Mothers understand that, if the testing is done in time, it can help prevent their child from staying for a long time in the hospital,” says Dr. Bouzoua. “If the tape is red or orange, they know they must immediately go to the nearest health center.”
Barra Hatou, 20, measures her 2-year-old son, Umar. (Photo credit: Sylvain Cherkaoui/Cosmos)
It is perhaps no surprise that Alima’s pilot project initially took place in Niger—the country with one of the highest rates of child malnutrition in the world—and is now being implemented in Chad and Mali. Indeed, the Sahel has some of the highest child mortality rates in the world, as well as the highest acute malnutrition rates in children.
According to UNICEF, an estimated 3.4 million people will be food insecure in Chad in 2016 and 728,000 children under 5 years of age will suffer from malnutrition.
Located within the Sudano-Sahelian belt, Chad ranks 185 out of 188 in the Human Development Index. The country is currently facing a context of growing vulnerability, having to deal with both increasing droughts and the seventh largest refugee population in the world. Twenty percent of its population is under 5 years old.
Alarmingly, child malnutrition has also developed in Chad’s capital city of N’Djamena, confirming that malnutrition is not just a rural issue.
“It can seem odd in an oil-producing country, but it’s real,” says Dr. Bouzoua. “The main issue in N’Djamena is not so much the refugee crisis than access to healthcare. There simply isn’t enough medical help on the ground.”
The Nutrition Therapy Unit (UNT) in N’Djamena, supported by Alima/Health Alert. (Photo credit: Sylvain Cherkaoui/Cosmos)
Although progress has been made in this area (The country currently has 500 nutrition centers, versus just half of that figure less than five years ago), efforts remain to be made.
Alima’s team only recently became aware of N’Djamena’s malnutrition problem while in Chad but the results so far have been encouraging. “In just a few weeks after we started working with the ‘Mothers Can Do It’ approach, the number of admissions at the health centers in the capital increased by 45 to 50 percent,” adds Dr. Bouzoua.
Now other NGOs have started to use this method in Chad, including Action Contre la Faim (ACF) and Doctors Without Borders (MSF).
“It enables an early diagnosis because mothers are able to do the test often. Usually not just on their own children, but on the children dependent on them—nephews, brothers—and also on their neighbors’ children,” says Dr. Bouzoua. “In this simple, low-cost way, the entire community profits.”
