Two-Pronged Screening Approach to Increase Coverage A Case-Study in Dollo Ado Camps, Ethiopia From Relief to Self-Reliance Nutrition and Food Security Department Daniel Takea, Alexandra Rutishauser-Perera, Caroline Abla All content in this document is the property of International Medical Corps and should not be reproduced without prior written consent.

IMC program in Dollo Addo CMAM in 2 camps: 4 Community Nutrition Centers in both Melkadida and Kobe (8 in total) OTP: 608 Admissions of SAM U5 (Jan-Aug 2013) Point Coverage in August 2013: 88.7% TSFP : 1,904 Admissions of MAM U5 (Jan-Aug 2013) Point Coverage in August 2013: 92.5% BSFP : Enrolled 8,043 U5 and 3,184 PLW (Jan-Aug 2013) SC : Referral to Government health center + IYCF/ECD Preventive activities

Screening Methodology MUAC Screening only Monthly 2 pronged screening approach Quarterly

Screening Children with MUAC cm are admitted to the targeted supplementary feeding program (TSFP) while children with MUAC <11.5 cm are admitted to the outpatient therapeutic feeding program (OTP).

Screening WHZ is measured on children in the “at-risk” category, MUAC between 12.5 and 13.5 cm for children 6-23 months and cm for children months. Children with WHZ >3SD and <-2SD are admitted to TSFP and children with WHZ <-3 are admitted to OTP, regardless of their MUAC.

Kobe: Screening May 2013 Identified with GAM by MUAC  86 children or 6.4% of 6-23M  18 children or 0.4% of 24-59M Identified by WFH (from MUAC at-risk)  169 children or 30.1% (6-23m)  390 children or 29.8% (24-59m)  Based on the two-step screening protocol  255 children or 19.0% (6-23 m)  408 children or 7.9% (24-59 m)

Melkadida: Screening May 2013 Identified with GAM by MUAC  20 children or 1% ( 6-23m)  11 children or 0.3% ( 24-59m) Identified by WFH (from MUAC at-risk)  109 children or 25.3% (6-23m)  161 children or 22.4% (24-59m)  Based on the two-step screening protocol  129 children or 6.8% (6-23 m)  172 children or 4.1% (24-59 m)

Recommendation 1 : At health facility level (fixed or mobile), there should be systematic case finding by MUAC to identify children requiring management of SAM. If a child is not identified by MUAC, WHZ should be measured where it is feasible (capacity in terms of materials, time and trained human resources) without jeopardizing other essential health services.

In Somali populations in Dollo Ado refugee camps it is clearly important to screen for acute malnutrition using both MUAC and WHZ. In July 2013, International Medical Corps has initiated a monthly two-step screening protocol for acute malnutrition in both camps.

Practical Implications In camp versus non camp setting Availability of resources (trained human and material) to use the two-pronged screening Availability and capacity of treatment programs to absorb the cases.