This study evaluated how the frequency of caregiver training and supervision affects the accuracy and cost-effectiveness of Family Mid-Upper Arm Circumference (MUAC) screening — a method that trains caregivers to detect acute malnutrition in young children at home. Conducted across nine kebeles in three rural districts in Ethiopia, the quasi-experimental study compared a control group with two intervention arms: minimal support (initial training plus one supervisor visit) and intensive support (the same training plus supervisor visits every six weeks over six months, plus a follow-up at month nine).
Nearly 1,500 caregiver-child pairs participated, with 93% completing the endline assessment. Both the minimal and intensive support groups showed large, statistically significant improvements in caregivers’ ability to accurately measure MUAC, correctly color-code results, and identify edema, compared to the control group. Notably, the intensive supervision group did not perform meaningfully better than the minimal support group, despite the added ongoing training.
Cost-effectiveness analysis found that minimal training and supervision was substantially more efficient for mass screening, at about US$26 per child, while intensive supervision offered only marginal accuracy gains at a higher cost, though it may still provide value for identifying the most severe cases. Caregiver education level was linked to more accurate MUAC measurement, but not to color-coding or edema identification skills.
The study concludes that a one-time training with a single follow-up visit is sufficient to equip caregivers to conduct high-quality malnutrition screening at scale, offering a cost-effective model for expanding early detection of acute malnutrition in low-resource settings.
