CeaSurge: Operations research on mothers’ use of MUAC screening to improve early detection, referral and prevention of malnutrition among children under the age of five in North Horr pastoralist communities, kenya

Community Management of Acute Malnutrition (CMAM) Surge Capacity Model is an innovation that enables the health system to predict and cope with surges in cases of acute malnutrition. The model helps strengthen the capacity of the entire health system to better withstand and recover from short-term increases in demand in services, which is essential to ensuring quality health services in the longer term. However, despite improved coverage there remains a discrepancy between the numbers predicated by nutrition surveys and the actual numbers of children admitted to nutrition treatment programs in the health system. Fewer acutely malnourished children are managed by the health system than would be forecast by the survey due to the weak community-level structures. Referral has been weak and this has challenged the robustness of the model in remote rural areas where health facilities are far apart from each other.

This research proposes to address this gap by exploring the effects of teaching mothers to take, interpret Mid-Upper-Arm Circumference (MUAC) measurements of their own children.


The project aims to determine whether mothers’ screening of their children using MUAC measurements increases the percentage of children referred for nutrition services among the pastoralist communities in Marsabit County. It will:

  1. Determine the reliability of mothers to take and interpret MUAC measurement.

  2. Determine whether training of mothers in screening for malnutrition using MUAC measurements influence their knowledge, attitudes and practices on child feeding practices.

  3. Determine whether Mothers screening of their children using MUAC measurements increase the percentage of children referred for malnutrition at health facilities,

This is a mixed methods study, using a quasi-experimental design to test mother’s use of MUAC, and qualitative research to further explore findings and patterns arising within the quantitative research. For the quantitative component (quasi-experimental) a cluster randomized design will be applied whereby 20 sites (villages) will be matched into 10 matched-pairs in North Horr sub-county, Marsabit. Village sites will be matched based on a number of site characteristics, prior to random assignment to one of the two study arms. 

This research will be conducted at North Horr sub-county, Marsabit County, Kenya. The sub-county has high caseloads of malnutrition due to its geographical location, occasioning frequent drought shocks.


It is anticipated that findings from this project will influence nutrition programming, specifically for the CMAM Surge Model within North Horr, Marsabit and in other programme countries. This can help support the diagnosis of undernutrition, and relieve some strain on the often over-burdened community health volunteers and community health system.

If positive results are shown, this training may be a cost-effective, important resource to increase positive child feeding within such hard-to-reach communities. Specifically, successful implementation of Mother MUAC will allow health systems to significantly reduce the enormous under-five mortality burden attributed to severe acute malnutrition, as well and other child illness, not only during nutrition emergencies but also on regular basis as part of improved community health services. Early identification of children at risk as well as those already affected by malnutrition will facilitate the timely management of malnutrition, contributing to better treatment outcomes.



Started: September 2018

Implementation period: 24 Months

Results expected: September 2020


  • Marsabit County Department of Health

  • Concern Worldwide

  • Trinity College Dublin’s School of Medicine

CONTACT: Weldon Ngetich, Nutrition Technical Specialist, Kenya. weldon.ngetich@concern.net

For more on Concern’s Surge approach visit their website here.

Hear from some of researchers working on CeaSurge, interviewed as a part of our 2019 Women in Science Campaign

View all the research studies in the No Wasted Lives portfolio here