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Families screening for malnutrition by MUAC and edema
Kevin PQ Phelan Nutrition Referent
ALIMA ndash the Alliance for International Medical Action
APRIL 2017
The Alliance for International Medical Action
-In 2011 ALIMA began studying the feasibility of trainingmothers to use mid-upper arm circumference (MUAC)
-We were responding to two recurring operationalmedical issues
1 Late presentation (resulting in more complications) 2 Low program coverage (often lt50)
Family MUAC Why ALIMA began this researchhellip
The Alliance for International Medical Action
MUAC I Pilot Study proof of conceptSeptember 2011 ndash April 2012
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015Mothers 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 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Results(n = 103 mother-child pairs)
Excellent agreement
Errors only at boundaries
No difference in- left vs right arm
measures- Estimating vs
measuring mid point
MUAC I Mothers can reliably measure MUAC
The Alliance for International Medical Action
MUAC II Large-scale trialMay 2013 ndash April 2014
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5 Mothers screening
for malnutrition by mid-upper arm circumference is non-inferior to community health workers
results from a large-scale pragmatic trial in rural Niger Aleacute F Phelan KP Issa H Defourny I Le
Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend A Allafort-Duverger T
Shepherd S Blackwell N
The Alliance for International Medical Action
MUAC II Results (Distribution of MUAC at admission)
Median MUAC in Mothers vs
CHWs zone was 16 mm greater
(95 CI = 065 187) (p = 0007)
for children admitted by MUAC
The Alliance for International Medical Action
MothersZone
233 722
070773
754
8 600104
CHWsZone
9011184
7751332
401
21 980300
MUAC II Results (Hospitalization Agreement Costs)
Hospitalizations for all admissionsAt admission
During course of treatmentfor admissions by MUAC lt115 mm
At admission During course of treatment
Agreement with MUAC at health center
Overall costs (in USD)Cost per child lt5 yo
p-value
lt00001lt00001
lt0000100021
lt00001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
MUAC II Conclusions
Making mothers the focal point of MUAC screening strategies is feasible at scaleand should be included in regular CMAM programming
Family MUAC screening strategies will be most efficient in MUAC-based programs integrating SAMMAM (eg better coverage Maust et al in Sierra Leone)
The Alliance for International Medical Action
Integrating SAMMAM Key messages
SEVERE Go to health center within 2 days
MODERATE
NORMAL Continue to feed your child well
The Alliance for International Medical Action
What do we say to mothers whenthere is no MAM programming
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
-In 2011 ALIMA began studying the feasibility of trainingmothers to use mid-upper arm circumference (MUAC)
-We were responding to two recurring operationalmedical issues
1 Late presentation (resulting in more complications) 2 Low program coverage (often lt50)
Family MUAC Why ALIMA began this researchhellip
The Alliance for International Medical Action
MUAC I Pilot Study proof of conceptSeptember 2011 ndash April 2012
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015Mothers 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 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Results(n = 103 mother-child pairs)
Excellent agreement
Errors only at boundaries
No difference in- left vs right arm
measures- Estimating vs
measuring mid point
MUAC I Mothers can reliably measure MUAC
The Alliance for International Medical Action
MUAC II Large-scale trialMay 2013 ndash April 2014
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5 Mothers screening
for malnutrition by mid-upper arm circumference is non-inferior to community health workers
results from a large-scale pragmatic trial in rural Niger Aleacute F Phelan KP Issa H Defourny I Le
Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend A Allafort-Duverger T
Shepherd S Blackwell N
The Alliance for International Medical Action
MUAC II Results (Distribution of MUAC at admission)
Median MUAC in Mothers vs
CHWs zone was 16 mm greater
(95 CI = 065 187) (p = 0007)
for children admitted by MUAC
The Alliance for International Medical Action
MothersZone
233 722
070773
754
8 600104
CHWsZone
9011184
7751332
401
21 980300
MUAC II Results (Hospitalization Agreement Costs)
Hospitalizations for all admissionsAt admission
During course of treatmentfor admissions by MUAC lt115 mm
At admission During course of treatment
Agreement with MUAC at health center
Overall costs (in USD)Cost per child lt5 yo
p-value
lt00001lt00001
lt0000100021
lt00001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
MUAC II Conclusions
Making mothers the focal point of MUAC screening strategies is feasible at scaleand should be included in regular CMAM programming
Family MUAC screening strategies will be most efficient in MUAC-based programs integrating SAMMAM (eg better coverage Maust et al in Sierra Leone)
The Alliance for International Medical Action
Integrating SAMMAM Key messages
SEVERE Go to health center within 2 days
MODERATE
NORMAL Continue to feed your child well
The Alliance for International Medical Action
What do we say to mothers whenthere is no MAM programming
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
MUAC I Pilot Study proof of conceptSeptember 2011 ndash April 2012
Arch Public Health 2015 May 1873(1)26 doi 101186s13690-015-0074-z eCollection 2015Mothers 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 years
Blackwell N Myatt M Allafort-Duverger T Balogoun A Ibrahim A Briend A
The Alliance for International Medical Action
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Results(n = 103 mother-child pairs)
Excellent agreement
Errors only at boundaries
No difference in- left vs right arm
measures- Estimating vs
measuring mid point
MUAC I Mothers can reliably measure MUAC
The Alliance for International Medical Action
MUAC II Large-scale trialMay 2013 ndash April 2014
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5 Mothers screening
for malnutrition by mid-upper arm circumference is non-inferior to community health workers
results from a large-scale pragmatic trial in rural Niger Aleacute F Phelan KP Issa H Defourny I Le
Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend A Allafort-Duverger T
Shepherd S Blackwell N
The Alliance for International Medical Action
MUAC II Results (Distribution of MUAC at admission)
Median MUAC in Mothers vs
CHWs zone was 16 mm greater
(95 CI = 065 187) (p = 0007)
for children admitted by MUAC
The Alliance for International Medical Action
MothersZone
233 722
070773
754
8 600104
CHWsZone
9011184
7751332
401
21 980300
MUAC II Results (Hospitalization Agreement Costs)
Hospitalizations for all admissionsAt admission
During course of treatmentfor admissions by MUAC lt115 mm
At admission During course of treatment
Agreement with MUAC at health center
Overall costs (in USD)Cost per child lt5 yo
p-value
lt00001lt00001
lt0000100021
lt00001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
MUAC II Conclusions
Making mothers the focal point of MUAC screening strategies is feasible at scaleand should be included in regular CMAM programming
Family MUAC screening strategies will be most efficient in MUAC-based programs integrating SAMMAM (eg better coverage Maust et al in Sierra Leone)
The Alliance for International Medical Action
Integrating SAMMAM Key messages
SEVERE Go to health center within 2 days
MODERATE
NORMAL Continue to feed your child well
The Alliance for International Medical Action
What do we say to mothers whenthere is no MAM programming
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
Source Blackwell et al Archives of Public Health 2015 7326 doi101186s13690-015-0074-z
Results(n = 103 mother-child pairs)
Excellent agreement
Errors only at boundaries
No difference in- left vs right arm
measures- Estimating vs
measuring mid point
MUAC I Mothers can reliably measure MUAC
The Alliance for International Medical Action
MUAC II Large-scale trialMay 2013 ndash April 2014
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5 Mothers screening
for malnutrition by mid-upper arm circumference is non-inferior to community health workers
results from a large-scale pragmatic trial in rural Niger Aleacute F Phelan KP Issa H Defourny I Le
Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend A Allafort-Duverger T
Shepherd S Blackwell N
The Alliance for International Medical Action
MUAC II Results (Distribution of MUAC at admission)
Median MUAC in Mothers vs
CHWs zone was 16 mm greater
(95 CI = 065 187) (p = 0007)
for children admitted by MUAC
The Alliance for International Medical Action
MothersZone
233 722
070773
754
8 600104
CHWsZone
9011184
7751332
401
21 980300
MUAC II Results (Hospitalization Agreement Costs)
Hospitalizations for all admissionsAt admission
During course of treatmentfor admissions by MUAC lt115 mm
At admission During course of treatment
Agreement with MUAC at health center
Overall costs (in USD)Cost per child lt5 yo
p-value
lt00001lt00001
lt0000100021
lt00001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
MUAC II Conclusions
Making mothers the focal point of MUAC screening strategies is feasible at scaleand should be included in regular CMAM programming
Family MUAC screening strategies will be most efficient in MUAC-based programs integrating SAMMAM (eg better coverage Maust et al in Sierra Leone)
The Alliance for International Medical Action
Integrating SAMMAM Key messages
SEVERE Go to health center within 2 days
MODERATE
NORMAL Continue to feed your child well
The Alliance for International Medical Action
What do we say to mothers whenthere is no MAM programming
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
MUAC II Large-scale trialMay 2013 ndash April 2014
Arch Public Health 2016 September (7438) doi 101186s13690-016-0149-5 Mothers screening
for malnutrition by mid-upper arm circumference is non-inferior to community health workers
results from a large-scale pragmatic trial in rural Niger Aleacute F Phelan KP Issa H Defourny I Le
Duc G Harczi G Issaley K Sayadi S Ousmane N Yahaya I Myatt M Briend A Allafort-Duverger T
Shepherd S Blackwell N
The Alliance for International Medical Action
MUAC II Results (Distribution of MUAC at admission)
Median MUAC in Mothers vs
CHWs zone was 16 mm greater
(95 CI = 065 187) (p = 0007)
for children admitted by MUAC
The Alliance for International Medical Action
MothersZone
233 722
070773
754
8 600104
CHWsZone
9011184
7751332
401
21 980300
MUAC II Results (Hospitalization Agreement Costs)
Hospitalizations for all admissionsAt admission
During course of treatmentfor admissions by MUAC lt115 mm
At admission During course of treatment
Agreement with MUAC at health center
Overall costs (in USD)Cost per child lt5 yo
p-value
lt00001lt00001
lt0000100021
lt00001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
MUAC II Conclusions
Making mothers the focal point of MUAC screening strategies is feasible at scaleand should be included in regular CMAM programming
Family MUAC screening strategies will be most efficient in MUAC-based programs integrating SAMMAM (eg better coverage Maust et al in Sierra Leone)
The Alliance for International Medical Action
Integrating SAMMAM Key messages
SEVERE Go to health center within 2 days
MODERATE
NORMAL Continue to feed your child well
The Alliance for International Medical Action
What do we say to mothers whenthere is no MAM programming
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
MUAC II Results (Distribution of MUAC at admission)
Median MUAC in Mothers vs
CHWs zone was 16 mm greater
(95 CI = 065 187) (p = 0007)
for children admitted by MUAC
The Alliance for International Medical Action
MothersZone
233 722
070773
754
8 600104
CHWsZone
9011184
7751332
401
21 980300
MUAC II Results (Hospitalization Agreement Costs)
Hospitalizations for all admissionsAt admission
During course of treatmentfor admissions by MUAC lt115 mm
At admission During course of treatment
Agreement with MUAC at health center
Overall costs (in USD)Cost per child lt5 yo
p-value
lt00001lt00001
lt0000100021
lt00001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
MUAC II Conclusions
Making mothers the focal point of MUAC screening strategies is feasible at scaleand should be included in regular CMAM programming
Family MUAC screening strategies will be most efficient in MUAC-based programs integrating SAMMAM (eg better coverage Maust et al in Sierra Leone)
The Alliance for International Medical Action
Integrating SAMMAM Key messages
SEVERE Go to health center within 2 days
MODERATE
NORMAL Continue to feed your child well
The Alliance for International Medical Action
What do we say to mothers whenthere is no MAM programming
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
MothersZone
233 722
070773
754
8 600104
CHWsZone
9011184
7751332
401
21 980300
MUAC II Results (Hospitalization Agreement Costs)
Hospitalizations for all admissionsAt admission
During course of treatmentfor admissions by MUAC lt115 mm
At admission During course of treatment
Agreement with MUAC at health center
Overall costs (in USD)Cost per child lt5 yo
p-value
lt00001lt00001
lt0000100021
lt00001
------
Risk Ratio[95CI]
026 [017038]061[047079]
009 [003025]058 [040085]
188 [169 210]
------
The Alliance for International Medical Action
MUAC II Conclusions
Making mothers the focal point of MUAC screening strategies is feasible at scaleand should be included in regular CMAM programming
Family MUAC screening strategies will be most efficient in MUAC-based programs integrating SAMMAM (eg better coverage Maust et al in Sierra Leone)
The Alliance for International Medical Action
Integrating SAMMAM Key messages
SEVERE Go to health center within 2 days
MODERATE
NORMAL Continue to feed your child well
The Alliance for International Medical Action
What do we say to mothers whenthere is no MAM programming
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
MUAC II Conclusions
Making mothers the focal point of MUAC screening strategies is feasible at scaleand should be included in regular CMAM programming
Family MUAC screening strategies will be most efficient in MUAC-based programs integrating SAMMAM (eg better coverage Maust et al in Sierra Leone)
The Alliance for International Medical Action
Integrating SAMMAM Key messages
SEVERE Go to health center within 2 days
MODERATE
NORMAL Continue to feed your child well
The Alliance for International Medical Action
What do we say to mothers whenthere is no MAM programming
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
Integrating SAMMAM Key messages
SEVERE Go to health center within 2 days
MODERATE
NORMAL Continue to feed your child well
The Alliance for International Medical Action
What do we say to mothers whenthere is no MAM programming
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
Family MUAC The Journey to Scale-Up2015 ndash today
The Alliance for International Medical Action
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
The Alliance for International Medical Action
Family MUAC Internal changes to policy and practice
gt250000 mothers trained 2015-2016 (Burkina Faso Niger Mali Chad etc) Part of the laquo MUAC only raquo study in Burkina Faso 1000 Days in Niger etc
Mirriah Niger since the study
- ~170000 mothers trained with 600 coverage- 71 of all admissions are referred by mothers- Median MUAC 1129 mm Hospitalizations reduced by ~ 35
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
The Alliance for International Medical Action
Family MUAC External advocacy for scaling-up
Released training guidelines and FAQ to facilitate journey to scaleVery well received by policymakers funders and practitioners (eg Part of Nigerrsquos new protocol)
Remaining gaps - Emergencies - Availability of MUAC bracelets- Edema - Integrating SAMMAM programming
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
Thanks for listening
Special thanks to The Ministry of Public Health in Niger UNICEF ECHO and OFDA
The ALIMA and BEFEN teams All the mothers and children in Dogo and Takieta
The Alliance for International Medical Action
PS Guidelines available at httpalima-ngoorgempowering-mothers-prevent-malnutrition
![Uveitic macular edema: a stepladder treatment paradigm€¦ · of macular edema [1,3–4], this review will focus on uveitic macular edema specifically. Uveitic macular edema Macular](https://img.pdfslide.us/doc/110x75/5ed770e44d676a3f4a7efe51/uveitic-macular-edema-a-stepladder-treatment-paradigm-of-macular-edema-13a4.jpg)
