Global WACh

November 27, 2018

Drs. Christine McGrath, Kirk Tickell receive a Thrasher Award for innovative strategy to train and support mothers to identify early childhood malnutrition

Dr. Christine McGrath, PhD, MPH

Dr. Kirk Tickell, MBBS, MPH










Malnutrition programs in limited-resource settings currently rely on community health workers to screen children for acute malnutrition by measuring their mid-upper arm circumference (MUAC), which is the circumference of a patient’s arm at the midpoint between the shoulder and elbow.  MUAC uses a simple, color-coded plastic band to provide an assessment of nutritional status and is an effective tool to predict mortality.  Recruiting and retaining community-based providers who are adequately trained and equipped to perform this screening is challenging and can result in high costs, low screening coverage, and late identification of malnourished children.  What if mothers had the tools and training to quickly determine their child’s nutritional status in their own homes and rapidly engage with nutritional services, if needed?

This is the novel idea proposed by Principal Investigator Dr. Christine McGrath, PhD, MPH (Assistant Professor, Global Health) and Co-Investigator Dr. Kirk Tickell, MBBS MPH (Physician from the UK and former Global Health Senior Research Fellow; current Epidemiology PhD student) that received an E.W. “AI” Thrasher Award, which is given to proposals that have the potential to translate into clinically meaningful results within a few years.  This project involves key investigators from the Department of Global Health: Drs. Jennifer Unger, MD (Assistant Professor), Carol Levin, PhD (Clinical Professor), Arianna Rubin Means, PhD (Acting Assistant Professor), Barbra Richardson, PhD (Statistician and Research Professor), and Dr. Benson Singa, MBChB, as the Kenya Medical Research Institute (KEMRI) Site Principal Investigator.

In their randomized controlled trial titled, “Maternal Administered Malnutrition Monitoring System (MAMMS),” mothers in Migori County, Kenya will learn how to measure their child’s MUAC at six or nine-month immunization visits at a healthcare facility.  At the six-month follow up, mothers will receive weekly text messages prompting them to measure and send their child’s MUAC to a computer system, which will alert a health worker when a child with malnutrition is identified.  This scalable childhood growth monitoring system could dramatically increase coverage of malnutrition screening and facilitate rapid engagement with nutritional services where necessary.


The MUAC band is color-coded to indicate nutritional status. The green zone indicates proper nourishment while the red zone indicates severe malnourishment. Photo credit: Mother and Child Nutrition. Click here to enlarge.


It is crucial to detect children with nutritional problems early as malnutrition is a major cause of mortality among children.  As acute malnutrition becomes more severe, the vicious circle made up of inadequate food intake and a progressively weakened immune system leaves children vulnerable to infectious diseases, which often requires intensive medical care to treat.  Acute malnutrition affects 52 million children, costs the global economy $2.1 trillion, and contributes to 45% of deaths among children under five years of age annually.  The MAMMs system has the potential to increase the number of identified malnourished children and offer treatment and, in turn, substantially reduce malnutrition-associated deaths.