Peer-reviewed article
Using Mid-Upper Arm Circumference z-score (MUACz) tapes for community-based assessment and monitoring of nutrition risks among young children: a qualitative analysis of experiences and lessons from southwest Kenya.
Bassah D, McClintic E, Danquah I, Sharn AR, Sulo S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study explored how Community Health Volunteers and Ministry of Health staff in southwest Kenya experienced using a new MUAC z-score tape to screen and monitor nutrition risks in young children aged 23-59 months. Researchers conducted focus group discussions with 21 health workers to understand what worked well and what challenges they faced. The findings showed that intensive, hands-on training is essential, the color-coding and expanded age categories were appreciated, but the tape's durability and small font size needed improvement.
Key points
- Intensive training in an open learning environment with simple language and hands-on practice is essential for health workers to effectively use the MUACz tape
- Health workers appreciated the expanded age, risk and color-coding categories provided by the MUACz tape
- Durability of the tape and small font size of markings were identified as practical challenges in the field
- Integration of the MUACz tape into existing Community Health Volunteer tool kits and health care databases is important for sustainability
- Community health workers play a critical role in shaping how public health screening tools are implemented
Limitations
This is a qualitative study based on focus group discussions with a small number of health workers in one region of Kenya, so findings may not generalize to other settings or represent the experiences of individual workers or their clients. The study captures implementation experiences but cannot measure the effectiveness of the MUACz tape in detecting malnutrition or improving child health outcomes.
Abstract
OBJECTIVES AND STUDY: In 2023, Community Health Volunteers (CHVs) and the Ministry of Health (MOH) staff were trained to use the novel MUAC z-score (MUACz) tape for household anthropometric measurements in southwestern Kenya as part of a randomized controlled trial titled ALIMUS-We are Feeding! In this qualitative study, we aimed to understand the experiences and lessons learned from using the MUACz tape for screening and monitoring among health professionals. METHODS: In this qualitative study, Focus Group Discussions (FGDs) were used to explore the experiences of CHVs and MOH staff, who were trained on using the MUACz tape and applied the device for nutrition screening among 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 Dholuo and Swahili. FGDs were recorded, transcribed, translated, and analyzed using thematic analysis. RESULTS: Broad emerging themes showed that intensive training is essential for learning to use the MUACz tape. Trainings should be in an open learning environment, using simple language and incorporating hands-on practice. Participants had positive experiences using the MUACz tape, appreciating the expanded age, risk and color-coding categories. Challenges in using the tape included durability and the font size of tape markings. Participants emphasized the importance of integrating MUACz tape in existing CHV tool kits and data collection, in addition to adding z-score as an indicator in the health care database and services to ensure consistency and sustainability. CONCLUSIONS: The findings highlight that a few improvements of MUACz tapes could facilitate community-based nutrition screening and monitoring. Frontline community health workers play a critical role in shaping the implementation of public health programs. Accessible training is important for their buy-in.