Bringing Child Health Closer to Families: Lessons From a Family MUAC Intervention in Urban and Rural South Africa

Mid-upper-arm circumference measurement (MUAC) is a simple, cost-effective approach to identify wasting in children. The Family MUAC intervention supported community health workers (CHWs) to mentor mothers and child caregivers to measure their children's MUAC at home. Sixty-four CHWs participated in seven sites in Gauteng and KwaZulu-Natal (KZN), South Africa. A cross-sectional survey was conducted to determine caregivers' ability to measure MUAC correctly and regularly. Ten households were randomly selected from household lists provided by each CHW. Fieldworkers collected data about the household, all children aged 6 months to 5 years living there and assessed caregiver's knowledge and skills in MUAC measurement. Data were collected in 521 households (Gauteng 201; KZN 351); 560 mothers/caregivers, (Gauteng 207; KZN 353) and 703 children (Gauteng 235; KZN 468) participated. Gauteng sites were high-density urban with small families in informal houses with access to water and sanitation, compared to rural KZN with larger households and poor water and sanitation access. Low household income and household food insecurity was the norm across all sites. In KZN a higher proportion of mothers/caregivers had received Family MUAC training compared to Gauteng (256/353; 72.5% vs. 93/270; 34.4%, p < 0001). Most trained mothers/caregivers achieved competency (263/349; 75.3%); this was significantly higher in KZN compared to Gauteng (215/256; 83.9% vs. 48/93; 51.6%; p < 0.001). Mothers/caregivers of 126/703 (17.9%) children recorded MUAC for ≥ 6 months (KZN 116/468, 24.8%; Gauteng 10/235, 4.3%). When designing community-based interventions for hard-to-reach communities it is important to address context-specific challenges to achieve sustainable high coverage.