Determinants of Caregivers’ Ability to Accurately Detect Acute Malnutrition Using Color-Coded Mid-Upper Arm Circumference Tape and Pitting Edema

Abstract

Background

In Malawi, inadequate community health workers are delaying admission of acute malnutrition cases into therapeutic programs. Training caregivers to screen their children for early identification of acute malnutrition has been shown to improve early admissions, prevent serious complications, and save lives. However, there are knowledge gaps regarding the determinants of caregivers to accurately screen for acute malnutrition.

Objectives

To identify determinants of accuracy in detecting acute malnutrition using color-coded mid-upper arm circumference (MUAC) tape and pitting edema among caregivers.

Methods

This was a cross-sectional study taken as a baseline for a larger non-random pragmatic interventional study. Using a cascade model, community health workers (health surveillance assistants, n = 148) from 2 southern districts of Nsanje and Phalombe in Malawi, trained 12,057 caregivers of children aged 6 to 54 months in nutritional screening using color-coded MUAC tapes and pitting edema. Pretested structured questionnaires were used in face-to-face interviews with the caregivers to collect data on their age, marital status, education, district, occupation, and age of the child, which were predictor variables. Caregivers’ accuracy was the response variable. Binary logistic regression was used to assess the effect of each predictor variable on accuracy of caregivers.

Results

Compared to caregivers who were farmers (86.2%), those who were formally employed (1.8%) were nearly 70% less likely to accurately determine acute malnutrition [adjusted odds ratio (AOR): 0.30; 95% confidence interval (CI): 0.12, 0.75] than farmers. Caregivers from Phalombe district were nearly 5 times more likely to be accurate than caregivers from Nsanje district (AOR: 4.93; 95% CI: 3.31, 7.35). Caregivers were twice and thrice more likely to accurately screen children aged 31–42 mo (AOR: 2.44; 95% CI: 1.43, 4.17) and 43–54 mo (AOR: 2.83; 95% CI: 1.45, 5.54), respectively, than children aged 6–11 mo.

Conclusions

The outcome of training caregivers to use color-coded MUAC tapes and pitting edema to screen for acute malnutrition is likely to be sensitive to several factors including residence, occupation of the caregivers, and age of the children. More data and further studies are required to validate the present results.