Evaluation of the family-led MUAC component of an integrated package of interventions to reduce wasting in Chad and Mali

• Family-led MUAC, where caregivers and other household members screen their own children regularly to detect child wasting early-on, is a promising strategy to boost screening coverage leading to more children with wasting to be referred and enrolled in available treatment services. • In settings with regular active screening for wasting by community care groups in Chad and Mali, family-led MUAC had limited reach and effectiveness, thus contributing few additional cases detected, referred, and enrolled in wasting treatment services. • The introduction of family-led MUAC remained below expectation because the anticipated monthly home visits (main delivery platform) represented too much of a workload for volunteers. Monthly group sessions can be a suitable platform to train households to apply family-led MUAC on the condition that the attending number of caregivers per session is capped to allow for a more individualized approach. • Less than half of the households disposing of MUAC tapes screened their children monthly. The main reason reported for non-adoption was lack of knowledge and confidence on how to conduct the measurements, which calls for better training of caregivers and more social support to conduct the measurements. • Both the inadequate introduction by community volunteers, as well as the poor adoption by households of family-led MUAC resulted in a low reach of monthly screening by households (up to 10% in Chad and up to 25% in Mali). • Caregivers were able to measure their children’s MUAC accurately, and caregiver knowledge of family-led MUAC was moderate (Mali) to very high (Chad). • The short duration of the IRAM program (7-9 months), due to the COVID-19 crisis, may have hampered a continuous learning process leading to improvement of family-led MUAC over time.