Using Mid-Upper Arm Circumference z-score (MUACz) tapes for community-based assessment and monitoring of nutrition risks among young children: a qualitative analysis of experiences and lessons from southwest Kenya

In 2023, Community Health Volunteers (CHVs) and the Ministry of Health (MOH) staff were trained to use the novel MUAC z-score (MUACz) tape for household anthropometric measurements in southwestern Kenya as part of a randomized controlled trial titled ALIMUS-We are Feeding! In this qualitative study, we aimed to understand the experiences and lessons learned from using the MUACz tape for screening and monitoring among health professionals. In this qualitative study, Focus Group Discussions (FGDs) were used to explore the experiences of CHVs and MOH staff, who were trained on using the MUACz tape and applied the device for nutrition screening among 617 children aged between 23 and 59 months. Two FGDs were conducted with CHVs (n = 14) and one with MOH staff (n = 7). Trained facilitators led discussions using a semi-structured interview guide in Dholuo and Swahili. FGDs were recorded, transcribed, translated, and analyzed using thematic analysis. Broad emerging themes showed that intensive training is essential for learning to use the MUACz tape. Trainings should be in an open learning environment, using simple language and incorporating hands-on practice. Participants had positive experiences using the MUACz tape, appreciating the expanded age, risk and color-coding categories. Challenges in using the tape included durability and the font size of tape markings. Participants emphasized the importance of integrating MUACz tape in existing CHV tool kits and data collection, in addition to adding z-score as an indicator in the health care database and services to ensure consistency and sustainability. The findings highlight that a few improvements of MUACz tapes could facilitate community-based nutrition screening and monitoring. Frontline community health workers play a critical role in shaping the implementation of public health programs. Accessible training is important for their buy-in.