The early detection of child wasting in Indonesia amidst the COVID-19 pandemic

ABSTRACT

The objectives of this study were to (1) describe the family-centred MUAC pilot programme, and (2) describe the accuracy of MUAC measurements by caregivers and CHVs during the ongoing COVID-19 pandemic. The programme employed a train-thetrainer model. First, the CHVs received orientation from the PHC health workers on how to train caregivers;CHVs were provided with MUAC tapes and information, education and communication materials for distribution to caregivers. Then, CHVs were responsible for training and mentoring five to12 nearby caregivers either online or in-person based on an existing list of children under the age of five years who lived within their area of operation. Screening resulted in 2,249 children being referred to PHCs, including 1,684 children screened by CHVs and 565 by caregivers, for confirmation of their wasting diagnosis. Of these, less than half (42%) of children visited a PHC as instructed with a higher proportion of children screened by caregivers (86%) visiting the PHC compared to those referred by CHVs (27%). This trend was largely driven by differences in attendance among children in Kupang District;in this peri-urban setting, only 26% of children referred by CHVs attended the health centres compared to 87% of children referred by caregivers. Attendance was more comparable among CHVs (100%) and caregivers (86%) in Kupang Municipality. Therefore, given the accuracy of caregiver screening, continuing the family-centred MUAC screening programme beyond the COVID-19 pandemic warrants consideration. Future work should aim to better understand the differences in attendance between caregivers and CHV referrals in order to address any barriers to case confirmation.