Mid-upper arm circumference z-score tapes for childhood malnutrition screening: an implementation study from rural Kenya
In brief
85% of under-5 children screened each round with MUAC z-score tapes
In rural Siaya County, Kenya, 15 community health volunteers used MUAC z-score tapes to screen 575 children under five, achieving at least 85% coverage across four visits over a year. Malnutrition risk fell from 18.2% to 14.1%, with 12% of children improving their status. The study shows strong uptake of the tool, though longer-term impact on outcomes remains to be seen.
- Journal
- BMC public health (Q1)
- Published
- 12 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Dominic Bassah, Emilie McClintic, Amy R Sharn, Suela Sulo, Erick Agure, Grace Wothaya Kihagi, et al.
- PMID
- 42587286
- DOI
- 10.1186/s12889-026-28857-1
Why clinicians should know about it
- Picked for Pediatrics and Child Health (top studies of the week, 16 August 2026): MUAC‑z‑score tapes for child malnutrition screening
Abstract
BACKGROUND: In many remote and low-resource regions, standard methods for assessing the nutritional status of children are hindered by inadequate access to equipment, inaccurate equipment, high costs of screening, and under-resourced health facilities for malnutrition risk screening. Mid-upper arm circumference (MUAC) is a relatively simple, inexpensive, and established method for malnutrition risk screening in children, but monitoring of nutritional risk status over time can be challenging. MUAC tapes that instantly display age-specific MUAC z-scores in addition to absolute MUAC have become available. However, there are limited studies exploring the penetration and adoption of MUAC z-score tapes' use and implementation by community health volunteers (CHVs) in community settings. METHODS: As part of the ALIMUS cluster-randomized controlled trial, 15 CHVs were trained on the use of MUAC z-score tapes. The CHVs then applied the tapes during routine home visits to screen for malnutrition risk among children < 5 years of age living in Siaya County, Kenya. The study comprised 4 screenings over 1 year at 2-3 month intervals. The proportions of executed MUAC z-score screenings and nutritional risk status at each home visit were determined. RESULTS: Of the 575 children (mean age, 15 months; SD, 5.08 months at enrollment) from 575 households, at least 85% (488/575) were screened using the MUAC z-score tape during each of the 4 screening periods. The overall proportion of malnutrition risk (overnutrition and undernutrition) declined from 18.2% in the first round to 14.1% in the fourth round of screening, increasing the proportion with normal nutritional status from 82% to 86%. Among the 451 children who completed all four screenings, 12% improved their nutritional risk status, while 7% experienced a deterioration in nutritional risk status. CONCLUSIONS: MUAC z-score tapes were repeatedly applied for nutrition risk screening in the ALIMUS study, supporting the penetration and adoption of their use by CHVs working in remote and low-resource community settings. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00019076. Registered on 27 July 2021.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.