1. 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

2. 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

3. 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 : 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

4. 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)

6. 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

7. 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

8. Models Under Development and Appraisal