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Table 2 Content and instructions for training mothers or community health workers to screen children for malnutrition in separate health zones of Mirriah District, Niger between May 2013 and April 2014

From: 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

  Mothers Zone Community Health Workers Zone
Training received - 30 min group (20–30 participants) session with practical demonstration;
- 2–3 min individual home-based session
- Further individual training if needed following evaluation
- Check for MUAC and edema whenever you feel necessary or at least once a month on market day.
- Individual trainings at the health center waiting area
- 6 h group theoretical training and 2 h practical training (per current CHW training modules recommended by the WHO and UNICEF.)a
- Check MUAC and edema monthly or as needed
- Each CHW records in notebook the children he or she has recorded with a red MUAC/edema.
- One supervisor for the 36 CHWs throughout the study.
Total number trained 12,893 36
Instructions for using MUAC bracelets - Perform the MUAC on children who are at least 6 months of age OR 67 cmb or taller in height (For mothers: measure a mark at 67 cm on the wall in your home, or cut a piece of cloth/wood to 67 cm)
- Slide the MUAC bracelet on the left arm to what you estimate is the mid-point.
- Make sure the arm is hanging down straight, and is not bent
- Make sure the tape is snug – not too tight or too loose on the arm
Instructions for reading the MUAC color-codes Look at the color in the window. If it is:
RED – Your child may be sick and have severe acute malnutrition. You should go to the health center/health post within 48 h.
YELLOW – Your child needs to eat nutritious food like beans, carrots, meat, and eggs. You should go to the MAM treatment center at the earliest opportunity but we cannot guarantee that food will be available every day there. (For mothers only: You should take regular MUAC readings to make sure your child does not become more malnourished.)
GREEN – Your child is properly nourished. Continue to feed him or her well. (For mothers only: take a MUAC regularly and watch for signs discussed during group sessions.)
Mothers could always visit the health center/health post if they thought their child was sick, regardless of MUAC status (and without a referral slip in the CHWs’ Zone.)
Instructions for checking for edema - Press your thumbs down on top of your child’s feet for three seconds
- If there is still an imprint a few seconds after you have removed your thumbs, your child may have edematous malnutrition, or kwashiorkor, so you should go to the health center as soon as possible.
  1. MUAC mid-upper arm circumference, CHW Community Health Worker
  2. aUnited Nations Department of Technical Co-operation for Development and Statistical Office. Annex 1: “Summary Procedures” in How to weigh and measure children: assessing the nutritional status of young children in household surveys. New York: United Nations; 1986
  3. bAt the beginning of the study in May 2013, the national protocols called for a 65 cm height cut-off for MUAC use. The protocols were revised to 67 cm during the course of the study