World Vision Development Foundation (WVDF) takes pride in being tapped as one of the primary implementing partners of the Korea International Cooperation Agency Philippines (KOICA) and UNICEF Philippines for the implementation of the project entitled, “The Integrated Nutrition and Health Actions in the First 1,000 Days of Life (F1KD) Project”. Under this project and in consultation with the Department of Health (DOH), World Vision conducted Training of Trainers (TOT) on “Family MUAC: Teaching the Community to Screen for Malnutrition” in the provinces of Samar, Northern Samar and Zamboanga del Norte since June 2020. Family Mid-upper-arm circumference (MUAC) screening or Mother-MUAC screening also known as Family MUAC is a community screening approach which can early-detect wasting in children aged 6 – 59 months old. This approach empowers mothers/caregivers to screen wasting on their children by teaching them how to properly obtain MUAC measurements and assess the presence of edema. One of the major objectives of this training is to discuss how Family MUAC Approach can be used as a method to help improve early identification of Acute Malnutrition and Philippine Integrated Management of Acute Malnutrition (PIMAM) coverage.
Last July 28, 2020, the first ever household level training of Family MUAC approach in the Philippines for mothers and caregivers was initiated by the local government of Pagsanghan in Samar after their barangay-level health and nutrition workers have successfully completed their TOT session. In the pilot training conducted by the local nutrition office of Pagsanghan, Samar, a total of 82 mothers and caregivers in eight barangays were trained on how to use mid-upper-arm circumference (MUAC) to screen and detect acute malnutrition in their children at home. This roll-out training was spearheaded by the Pagsanghan Municipal Nutrition Action Officer (MNAO) Mr. Jovelle “Ichigo” Royandoyan and their barangay health workers (BHWs) and Barangay Nutrition Scholars (BNSs).
According to MNAO Royandoyan, the reason why he offered his full support to the roll-out of this program in their municipality is because of the fact that malnutrition is still a problem in their locality primarily due to the lack of enough funds allocated for their health and nutrition (H&N) programs and the availability of health workers who can assist them in implementing the national and local H&N programs.
Mr. Royandoyan added that one of the good things about their community is the positive health-seeking behaviors of the mothers which makes it much easier for them to adopt the different health and nutrition services delivered to them by the health workers. He said in an online key informant interview that because of the Family MUAC training for mothers/caregiver, he can attest that cooperation and collaboration between the mothers/caregivers and the health workers in monitoring the health and nutrition needs of the children in their community is indeed achievable.
Ms. Wilma Josol, a Barangay Nutrition Scholar of Barangay Canlapwas, also a trained health worker for the Family MUAC training shared in a separate online key informant interview that part of her job as a BNS is to monitor the progress of the malnourished children in their barangay. The most important lesson she learned during the Family MUAC training is that all mothers should really be taught on how to assess their children and determine when to seek help if they suspect that their child is malnourished. Ms. Josol mentioned that mothers would be of great help in preventing malnutrition if they know how to screen their own child. As a BNS, Ms Josol pledged that she will continue to help the mothers and caregivers in their community by continuing to provide counselling and offering them health and nutrition advices.
Two of the trained mothers, Ms. Rochelle Tulop and Ms. Myra Orquil graced the project team for an interview as well to share their experience on the Family MUAC approach training. Ms. Tulop, a mother of 3 and expecting her 4th, shared that she is thankful and happy with the outcomes of the training because she learned more about wasting and other forms of malnutrition and how she can prevent this from happening to her children. The training taught her how to screen and monitor and when to refer her own children to the health facility for immediate medical attention. At 7th month of her pregnancy, Rochelle is currently monitoring the baby of her neighbor while waiting for her to give birth and the chance to monitor her own baby at the right time.
Meanwhile, Ms. Myra, a mother of 4 and another participant of the Family MUAC training last July 2020 shared that despite having 4 children already, she just learned that malnutrition can have severe effects to children. Through the training, she now knows how to monitor for malnutrition. The training has been a way for her and other mothers as well to know how to use the MUAC tape for the first time. Initially, she expressed the difficulty in learning how to use the MUAC tape during the training. However, she realized that it was just in the beginning and later on, it became easier after some more practice. Ms. Myra mentioned that she really takes good care of her MUAC tape by keeping it in an envelope.
According to The Lancet article authored by Fore et al. (2020), the ongoing pandemic is worsening the child malnutrition situation all over the world, particularly for the low-income and middle-income countries. This can be attributed to the deteriorating quality of the children’s diets, interruption in nutrition and other essential services, as well as disruptions in humanitarian response and social protection systems. Before the pandemic, the estimated global prevalence of wasting for children under 5 years is 47 million. This figure would translate to an estimated 6 to 7 million children with wasting during the first 12 months of the pandemic.
In the Philippines, the country is also experiencing disruptions of basic health services and humanitarian response due to COVID-19 pandemic. This includes services for the prevention and treatment of wasting, especially in the geographically isolated and disadvantaged areas (GIDA) or hard-to-reach vulnerable communities. Given this context, there is a strong call to action now to strengthen the existing programs on the management of acute malnutrition. To mitigate this, we would need to think of innovative solutions to prevent the increase of prevalence of wasting in our country during the pandemic. One strategy to address this is to screen wasting at the onset; and to do this, we would need the whole community to collaborate in monitoring their own children. The Family MUAC approach is one simple way to capture this at the grassroot levels.
Within three months since the pilot roll-out of the Training of Trainers a total of 1,446 local health and nutrition workers and 1,184 mothers/caregivers have been trained to screen their children aged 6 to 59 months. In this era of COVID-19, World Vision Philippines, together with our partners, hopes to increase the efficiency in finding acute malnutrition cases in the communities supported by the First 1,000 Days Project despite the disruptions in the delivery of health and nutrition services at the local level due to the pandemic. With the series of ongoing capacity-building activities, we aim to improve the knowledge, skills and confidence not only of our community health and nutrition workers but also the mothers and caregivers of young children who are in the best place to early detect the signs of acute malnutrition.