title: Mothers 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.
abstract: BACKGROUND
  Mid-upper arm circumference (MUAC) was recently endorsed and recommended for screening for acute malnutrition in the community. The objective of this study was to determine whether a colour-banded MUAC strap would allow minimally trained mothers to screen their own children for malnutrition, without locating the mid-point of the left upper arm by measurement, as currently recommended.
  
  
  METHODS
  A non-randomised non-blinded evaluation of mothers' performance when measuring MUAC after minimal training, compared with trained Community Health Workers (CHW) following current MUAC protocols. The study was conducted in 2 villages in Mirriah, Zinder region, Niger where mothers classified one of their children (n = 103) aged 6-59 months (the current age range for admission into community malnutrition programs) using the MUAC tape.
  
  
  RESULTS
  Mothers' had a sensitivity and specificity for classification of their child's nutritional status of > 90% and > 80% respectively for global acute malnutrition (GAM, defined by a MUAC < 125 mm) and > 73% and > 98% for severe acute malnutrition (SAM, defined by a MUAC < 115 mm). The few children misclassified as not having SAM, were classified as having moderate acute malnutrition (MAM). The choice of arm did not influence the classification results; weighted Kappa of 0.88 for mothers and 0.91 for CHW represent almost perfect agreement. Errors occurred at the class boundaries and no gross errors were made.
  
  
  CONCLUSIONS
  Advanced SAM is associated with severe complications, which often require hospital admission or cause death. Mothers (with MUAC tapes costing $0.06) can screen their children frequently allowing early diagnosis and treatment thereby becoming the focal point in scaling-up community management of acute malnutrition.
  
  
  BACKGROUND
  The trial is registered with clinicaltrials.gov (Trial number NCT01790815).
authors.affiliation: Alliance for International Medical Action (ALIMA), Dakar, Senegal ; Department of Critical Care, University of Queensland, Brisbane, Australia.
authors.forename: Nikki
authors.initials: N
authors.lastname: Blackwell
authors.affiliation: Brixton Health, Llawryglyn, Wales UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Myatt
authors.affiliation: Alliance for International Medical Action (ALIMA), Dakar, Senegal.
authors.forename: Thierry
authors.initials: T
authors.lastname: Allafort-Duverger
authors.affiliation: Alliance for International Medical Action (ALIMA), Dakar, Senegal.
authors.forename: Amour
authors.initials: A
authors.lastname: Balogoun
authors.affiliation: Bien Être de la Femme et de l'Enfant (BEFEN), Niamey, Niger.
authors.forename: Almou
authors.initials: A
authors.lastname: Ibrahim
authors.affiliation: Department for International Health, University of Tampere School of Medicine, Tampere, Finland ; Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: André
authors.initials: A
authors.lastname: Briend
keywords: Community management of acute malnutrition; Mid-upper arm circumference; Screening by mothers; Severe acute malnutrition