Malnutrition which comes in many forms affects lives, particularly that of the children’s. Emergency situations such as earthquakes, floods, and pandemics like COVID-19 put them at higher risk of undernutrition.

Wasting, which is a form of acute malnutrition, indicates recent and severe weight loss. It is caused by any or a combination of: insufficient food intake, repeated bouts of infection and inappropriate childcare practices. Acute malnutrition is often used to assess the severity of an emergency because it is caused by a lack of food and illness (WFH, Hunger Glossary, 2016).

The degree of acute malnutrition, moderate or severe, can be classified through anthropometric measurements, namely, mid-upper arm circumference (MUAC) and z-score for the weight for height/length (WFH/L) and clinical measure (presence of bilateral pitting edema). Children who are severely acute malnourished (SAM), are at least 9-12 times more likely to die than children who are well nourished.

Table 1. Criteria for classifying the degree of acute malnutrition for 6-59 months old children

Source: WHO Standards

MUAC is widely used at the community level for rapid screening and admission tool for potential MAM or SAM cases because health and nutrition workers can carry it with ease, and it is easy to use. However, MUAC can only be used for children more than 6 months old.

In taking MUAC measurements, nutrition worker should note the following procedures:

1. Ask the mother to remove the clothing that may cover the child’s left arm.

2. Position behind the child and estimate the midpoint of the child’s left upper arm.

• 1. 1. Bend the child’s left arm and locate the tip of the shoulder and tip of the elbow
     2. Place the MUAC tape at zero, which is indicated by two arrows, on the tip of the shoulder.
     3. Pull the tape straight down past the tip of the elbow.
     4. Read the number at the tip of the elbow to the nearest centimeter.
     5. Divide this number by two to estimate the midpoint.
     6. Mark the midpoint with a pen.

3. Straighten the child’s arm and wrap the tape around the arm at the midpoint.

• 1. 1. Insert and pull the pointed end through the slit opening beside the window.
     2. Make sure the numbers are right side up so that you can read them.
     3. Make sure the tape is flat around the skin.
     4. Inspect the tension of the tape on the child’s arm.
     5. Make sure the tape has the proper tension and is not too tight such that the skin is too compressed or too loose that the tape does not contact the skin around the arm.

4. When the tape is in the correct position on the arm with correct tension, read the measurement to the nearest 0.1 cm.

To assess the nutritional status of the children and record the result, the National Nutrition Council (NNC) in partnership with Food and Agriculture Organization (FAO) developed an electronic Operation Timbang (OPT) Plus tool for Acute Malnutrition.

Nutrition screening is among the activities that need to be done despite the pandemic. To limit the contact and protect both the health care provider and the child, the Department of Health issued the Department Memorandum No. 2020-0237 with the subject “Interim Guidelines for the Delivery of Nutrition Services in the Context of COVID-19 Pandemic”. This memo suggests the use of MUAC measurement instead of the weight and height/length. It also emphasizes disinfecting the MUAC tapes every after use.

Capacitating all the health care providers including the nutrition workers is important to generate accurate measurement. These data are the basis for possible nutrition interventions, particularly in times of emergency.

NNC suggests to the OPT Team to take this opportunity to teach mothers and/or caregivers to assess the nutritional status of their children through MUAC. Assessing and monitoring of children’s nutritional status are not the sole responsibility of the nutrition workers but, that of the mothers and/or caregivers as well.                       

Knowledge of the proper and appropriate childcare is crucial to secure that children achieve their fullest potential. (NO II Arlie Joy O. Damiles)

Reference:

World Health Organization. 15 April 2020. Malnutrition. Retrieved from https://www.who.int/news-room/q-a-detail/malnutrition

World Health Organization. 20 January 2020. Malnutrition: Emergencies and disasters. Retrieved from https://www.who.int/news-room/q-a-detail/malnutrition-emergencies-and-disasters#

Department of Health and World Food Programme. 2016. National Guidelines on the Management of Moderate Acute Malnutrition for Children under Five Years. Manual of Operations.

Department of Health and United Nations International Children's Emergency Fund. February 2017.  Training Module on the National Guidelines on the Management of Severe Acute Malnutrition for Children under Five Years. Participan’s Manual.