A qualitative study to explore mother's experiences of a family MUAC project in two provinces in South Africa.

Abstract

Background: In South Africa, severe acute malnutrition remains a significant cause of child mortality. Measuring mid-upper arm circumference (MUAC) is a simple, cost-effective approach to identify malnutrition in communities. The Family MUAC intervention supported community health workers (CHWs) to mentor mothers and child caregivers to measure MUAC, record their findings and access nutrition information from the child's Road-to-Health-Book. Family MUAC was implemented in seven sites in two provinces in South Africa: Gauteng and KwaZulu-Natal. This study aimed to explore mother/caregiver's perceptions and experiences of participating in Family MUAC.

Methods: Focus group discussions (FGDs) were conducted with mothers purposively selected by CHWs based on their active participation in Family MUAC. Trained qualitative researchers conducted one FGD at each participating site. Coding reliability thematic analysis with topic summaries was employed to analyse the data using Nvivo v12.

Results: Seven FGDs were conducted with a total of 59 participants. Key themes identified were mother's perceptions of the CHW's role, experiences of implementing Family MUAC activities, and perceptions of the broader effect on maternal empowerment and child health. Mothers appreciated the support from CHWs who were perceived as patient and caring, taking time to develop mother's skills and answer questions. CHWs provided ongoing care, encouraged participation and understood the mother's home situation. Mothers experienced group learning positively, and helped each other learn about MUAC measurements. Most mothers experienced measuring MUAC as challenging initially, needing support from CHWs to gain confidence to measure and record findings. Participating in Family MUAC empowered mothers in caring for their child, and improved their relationships with CHWs. Mothers compared support from CHWs to care received at the clinic, saying clinic visits were costly and time-consuming and nurses frequently did not explain their findings. Mothers reported feeling more confident to ask questions during clinic visits after participating in family MUAC.

Conclusions: Using CHWs to support mothers measuring MUAC in households was acceptable and feasible. CHWs provided ongoing good quality care, relevant advice and support, and empowered mothers. Family MUAC had wide ranging benefits for building relationships and peer support in communities and strengthened mothers perceived role in the care of her child.