Global Courant
No scale, no meter, no calculator, nor the growth charts and graphs that he had in his pediatric office at Children’s Mercy in Kansas City, United States. When Susan Abdel Rahman traveled to other countries, to work with remote communities, most of the time she did not have those elements that make it possible to assess growth and nutritional status in childhood and adolescence.
Taking note of this contrast pushed her to design an accessible tool, easy to transport and use, regardless of the environment and the resources available.
In its development and validation, it applied the scientific method, but a teaching from Chinese philosophy, attributed to Lao-Tse, was the one that inspired it in the first instance: “Get closer to people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have.”
All these suggestions came together in the development of the MUAC z-score, a paper tape that by measuring the circumference of the arm makes it possible to identify malnutrition risks from 2 months of life to 18 years of age.
A clinic in your pocket
“For several years I worked in low-income communities and realized that they didn’t have the tools that seem common to us in the areas where we work. So the question was: how do we know the weight of the children? How do we assess their nutritional status when we don’t have a scale or when we do, but it’s not well calibrated? So I looked for a way to improve an existing tool or design a new one,” the researcher told Clarín.
What did he do then? Together with his team, he took as a basis the MUAC tape (upper arm circumference) that the World Health Organization (WHO) has used for more than five decades to diagnose severe acute malnutrition in children from six months to five years of age and developed a similar, but that broadens the age range in which it can be used (from two months to 18 years) and that also allows excess weight to be measured.
“It took us three to four years to get from the idea to the final device. We worked with dietitians, nutritionists, doctors, nurses, and more than 30,000 children during the development of the tool to make sure the results were the right ones,” said Abdel Rahman, director of healthcare innovation at Mercy Children’s Research Institute.
The first ribbons were printed and cut by hand by Abdel Rahman’s team.
print and cut
In the early days, they printed the new tape measure on large sheets of tear-resistant paper (like the kind used in shipping envelopes) and cut them by hand. With these “homemade” tapes, the Children’s Mercy team evaluated some 10,000 boys and girls in just two years.
“It’s much easier for mothers and fathers to understand when we tell them ‘your child is in the red zone and that’s why we’re worried. It’s not just a change in weight. They can see that their son’s body is actually decreasing or increasing,” he commented in an article published in 2020 by that medical institution Karen Stephens, Assistant Director of Nutrition Services.
Later came the alliances that allowed innovation to be taken to another scale. Hallmark’s greeting card division optimized color contrast, paper quality, printing and cutting. In turn, the non-governmental organization Children International promoted testing in vulnerable communities in Guatemala and India.
“Once we identified that healthcare professionals could use it effectively, we moved on to social workers and then to families. At each step we did validation and testing to make sure it was working properly,” Susan said.
As part of the validation process of the tool, in 2019 they were published in Archives of Public Health the results of the study carried out in Guatemala on more than 800 boys and girls over 5 years of age. Almost 90% of the measurements coincided with the nutritional risk status predicted by the body mass index (BMI, which arises from a calculation between weight and height) and with those carried out by medical personnel.
Susan with children from the Real Madrid sports schools and their parents.
nutrition and sport
The last alliance was the one sealed with the Abbott Company’s Health and Nutrition Institute (ANHI), which since shortly before the pandemic facilitated its distribution and training for its use among health professionals in Latin American countries and the world.
In addition, it promotes their incorporation into programs such as the one carried out with the Real Madrid Foundation, in Spain. Together, at the beginning of the month they launched the “Fight malnutrition” campaign in the Spanish capital, to which Clarín traveled at the invitation of Abbott and where he spoke with Abdel Rahman.
Within the framework of this agreement, the coaches of the social sports schools that the Spanish club has in different countries are instructed to teach the boys who attend these institutions about the importance of incorporating healthy habits.
In addition, they are trained to use the Muac z-score tape. Information from the assessment is sent to parents, and children identified as at risk of malnutrition are referred to a health professional for further assessment and treatment.
All the information collected through the use of the tape in different countries and settings will contribute to generate more evidence on “how it works, the impact it has and how we can support families that have it at home: we must call them, send them text messages, visit them at their homes. These are steps that we are taking and in parallel we are writing articles to continue advancing,” said Abdel Rahman.
What has been observed so far allows him to affirm that the tape -which in 2021 was recognized by Fast Company among the Ideas that change the World, for the Well-being and Technologies of Developing Nations- “is an independent and simple tool to identify malnutrition “.
“This is critical when families are waiting in long lines at pediatric clinics, for health professionals caring for children at home, for children being evaluated at community centers, or living in rural communities. When mothers and parents who use it feel empowered and more involved in the nutritional status of their children.A mother told me “I no longer feed him what he wants, but what is good for him.”
—Currently, in addition to malnutrition, malnutrition due to excess (overweight and/or obesity) is a concern. Which is harder to tackle?
“It’s a very difficult question.” I think it depends on where in the world we are and what is the most prevalent problem in each place. There are differences even within each country. It may be a question of access to food or more related to education. The difficulty is often found in the cause of malnutrition: if the problem is access, it is different from the difficulty posed by a child who is sedentary and has access to inadequate food. They are different challenges and must be treated differently.
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