Development of a Simplified MUAC Bracelet: the Click-MUAC Project Development of Simplified MUAC Bracelet: the Click-MUAC Project Development of a Simplified MUAC Bracelet: the Click-MUAC Project

Background Over 17 M children affected by SAM globally, estimated 85% of cases still lack access to treatment Key component of SAM management is establishing sufficient community mobilisation to ensure regular case detection and screening at community level Over-reliance on CVs & CHWs to conduct SAM screening  large number of health activities, competing priorities, low motivation Additional leading barrier to access: lack of knowledge of malnutrition on behalf of primary caregivers

New Approaches, Gaps and Challenges Mothers Understand and Can Do It, Blackwell et al. Mother MUAC alternative screening strategy during the no-touch policy in EVD ALIMA-BEFEN study 2013-2014: improvement in median MUAC at OTP admission + OTP performance indicators with mother MUAC compared to CHW screening Potential benefits: earlier case detection, reduce programme costs, lower proportion of cases requiring in-patient care  Mother MUAC promising programme approach for community-level screening However conventional MUAC tapes subject to measurement error Potential rejection at health centre level  negative impact on future health-seeking behaviour - Golden review of SMART standardization test data: MUAC measurements show high error as compared to other anthropometric measurements - Potential rejection at health centre level also cited in top five barriers to access: Access for All, Volume 2

Project Objective  Develop & test a simplified, standardized MUAC bracelet (“Click-MUAC”) for use by mothers & caregivers for SAM (or MAM) screening Easy to use with minimal training and high sensitivity and specificity Standard circumference of 115 mm (or both 115mm & 125mm), expected to be made out of plastic, opening laterally or expandable Key message: “If the bracelet fits the child is sick” No need to adjust the placement and tension of the Click-MUAC as compared to a conventional MUAC tape Previous continuous MUAC measurement replaced by binary classification (acute malnutrition/no acute malnutrition)

Stage 1: Two Click-MUAC prototypes are identified for field testing Stage 2: A conclusion is reached on the added value of Click-MUAC versus conventional MUAC Map plastics specialists for development of specimens. Consult with mothers/caregivers/CHWs/FS on design Identification of villages targeted for study and sensitisation of participating communities (DRC & Kenya) Select two appropriate prototypes with academic & technical partners, based on field feedback Obtain research permit, recruit data collection team, carry out data collection Establish partnership with producer(s) for the production of prototypes. Follow-up survey on utilisation, durability and preference of prototypes Production of prototypes for field testing Analyse results with academic partners & produce peer-reviewed article

Methodology and Key Indicators Non-randomised, non-blinded evaluation of performance of new prototypes versus conventional MUAC tape Primary outcomes: Weighted Kappa (agreement) Sensitivity Specificity Secondary outcomes: durability, perceived ease of use, preference, cost-effectiveness Staggered trial to run in DRC and Kenya, opportunistic selection of villages Data analysis in collaboration with University of Tampere and Brixton Health

Models Under Development and Appraisal