(OR02-03-26) Impact of Family MUAC Training and Supervision Intensity on Caregiver Accuracy and Cost‑Effectiveness in Rural Ethiopia

Objectives: Acute malnutrition causes ~20% of pediatric admissions in Ethiopia. The Family Mid-Upper Arm Circumference (MUAC) approach supports early malnutrition detection and reduces delays in care. This study evaluates how training and supervision frequency affect the accuracy and cost-effectiveness of Family MUAC in rural Ethiopia.

Methods: A quasi‑experimental study in nine randomly assigned kebeles across three rural districts. Households with children aged 6–47 months were randomly selected across T1 (Control), T2 (Minimal), and T3 (Intensive) arms. Caregiver accuracy in MUAC and edema assessment were the outcomes. T2 received initial training and one supervisor visit; T3 received the same plus visits every six weeks for six months, plus one at month nine. Baseline/endline surveys and cost-monitoring data were analyzed using Difference-in-Differences (DiD) with wild‑bootstrap standard errors and incremental cost-effectiveness.

Results: 1,463 caregiver-child pairs participated in the intervention, 1,360 (93%) completed endline assessments. Covariate adjusted DiD estimates (in percentage points) showed improvements in accurate MUAC measurement (T2: +69.3 (95% CI: 0.538, 0.816); T3: +67.3 (95% CI: 0.471, 0.813)) MUAC color‑coding accuracy (T2: +64.7 (95% CI: 0.376, 0.949); T3: +69.5 (95% CI: 0.492, 0.946)), and edema assessment (T2: +54.6 (95% CI: 0.178, 0.891); T3: +62.2 (95% CI: 0.303, 0.903)) relative to control. Both T2 and T3 showed large gains in correct MUAC color coding and edema identification accuracy, but T2 was more cost-effective with a similar effect size, showing that minimum caregiver training is sufficient for accurate MUAC measurement. Ongoing supervision (T3) increases costs with minimal added accuracy, while no significant difference between T2 and T3. Caregiver education was positively associated with MUAC measurement accuracy (Beta = 0.102 (95% CI: 0.042, 0.161)), but not with color‑coding and edema identification accuracy.

Conclusions: Caregivers can conduct high-quality malnutrition screening. T2 is the mass screening "efficiency champion" at $26.2 per child; T3 yields superior clinical accuracy for detecting severe acute cases at a higher cost.

Funding Sources: World Vision, Inc.