Two-Pronged Screening Approach to Increase Coverage

A Case-Study in Dollo Ado Camps, Ethiopia

From Relief to Self-Reliance

Nutrition and Food Security DepartmentDaniel Takea, Alexandra Rutishauser-Perera,

Caroline AblaNFS@internationalmedicalcorps.org

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IMC program in Dollo Addo

CMAM in 2 camps: 4 Community Nutrition Centers in both Melkadida and Kobe (8 in total)• OTP: 608 Admissions of SAM U5 (Jan-Aug 2013)

Point Coverage in August 2013: 88.7%• TSFP : 1,904 Admissions of MAM U5 (Jan-Aug 2013)

Point Coverage in August 2013: 92.5%• BSFP : Enrolled 8,043 U5 and 3,184 PLW (Jan-Aug 2013)• SC : Referral to Government health center+ IYCF/ECD Preventive activities

Screening Methodology

• MUAC Screening only Monthly• 2 pronged screening approach Quarterly

Screening

• Children with MUAC 11.5-12.49 cm are admitted to the targeted supplementary feeding program (TSFP) while

• children with MUAC <11.5 cm are admitted to the outpatient therapeutic feeding program (OTP).

Screening

• WHZ is measured on children in the “at-risk” category, MUAC between 12.5 and 13.5 cm for children 6-23 months and 12.5-14.5 cm for children 24-59 months.

• Children with WHZ >3SD and <-2SD are admitted to TSFP and children with WHZ <-3 are admitted to OTP, regardless of their MUAC.

Kobe: Screening May 2013• Identified with GAM by MUAC 86 children or 6.4% of 6-23M 18 children or 0.4% of 24-59M

• Identified by WFH (from MUAC at-risk) 169 children or 30.1% (6-23m) 390 children or 29.8% (24-59m)

Based on the two-step screening protocol 255 children or 19.0% (6-23 m)408 children or 7.9% (24-59 m)

Melkadida: Screening May 2013• Identified with GAM by MUAC 20 children or 1% ( 6-23m) 11 children or 0.3% ( 24-59m)

• Identified by WFH (from MUAC at-risk) 109 children or 25.3% (6-23m) 161 children or 22.4% (24-59m)

Based on the two-step screening protocol 129 children or 6.8% (6-23 m)172 children or 4.1% (24-59 m)

Recommendation 1 :

At health facility level (fixed or mobile), there should be systematic case finding by MUAC to identify children requiring management of SAM. If a child is not identified by MUAC, WHZ should be measured where it is feasible (capacity in terms of materials, time and trained human resources) without jeopardizing other essential health services.

• In Somali populations in Dollo Ado refugee camps it is clearly important to screen for acute malnutrition using both MUAC and WHZ.

• In July 2013, International Medical Corps has initiated a monthly two-step screening protocol for acute malnutrition in both camps.

Practical Implications

• In camp versus non camp setting

• Availability of resources (trained human and material) to use the two-pronged screening

• Availability and capacity of treatment programs to absorb the cases.