O3224: Using Mid-Upper Arm Circumference z-score Tapes in Pediatric Community Sports and Wellness Programs to Identify Malnutrition Risk and Inform Care

Background: Historically, mid-upper arm circumference (MUAC) has been instrumental to identifying malnutrition in resource restricted settings for over half a century. Updated and validated pediatric MUAC growth curves incorporating age- and gender-specific data (z-scores) expand screening eligibility for malnutrition (2 months-18 years) including overweight/obesity. An innovative partnership was created to integrate MUAC z-score measurement training/screening and nutritional education in the Real Madrid Foundation’s (RMF) Social Sports Schools (S3) program, which provides sports and wellness programming to under-resourced communities. This work aimed to investigate the feasibility of leveraging non-healthcare professionals (non-HCPs) to identify malnutrition risk as part of RMF S3, with a focus on undernutrition.

Methods: This global, two-part program on malnutrition risk identification included training adult facilitators (coaches, staff, volunteers, program directors) and screening children aged 5-17 years attending RMF S3. RMF facilitators were trained with didactic lectures on malnutrition, and practical hands-on learning of proper MUAC z-score tape measurement. Aggregate data on facilitators and the number of times to correctly administer the MUAC z-tape were recorded. Aggregate data on child malnutrition risk screenings were also collected.

Results: Nine countries participated representing Europe, Pacific Asia, Africa, Latin America, and North America. In total, 318 children were screened, and 143 RMF facilitators were trained across 11 sites with 286 training hours. More than half of facilitators were male (56%, n=80), and majority were coaches (41.3%, n=59), followed by staff (25.2%, n=36), and volunteers (16.1%, n=23). Facilitator attempts ranged from 1 to 4 times for proper MUAC z-score administration with mean 2.12 (± 0.86). There were no significant differences for attempts among RMF facilitator types (p=0.10). Sixteen percent (n=51) of children screened below 2 z-scores for age and were referred for follow-up with an HCP. The highest prevalence of malnutrition risk was observed in India (50%, n=35/70), Tanzania (16%, n=4/25), and Colombia (12%, n=3/25).

Conclusion: Integration of MUAC z-score based malnutrition risk screening within community sports and wellness programming introduces a novel, and relatively untapped, strategy for documenting and addressing pediatric malnutrition risk among children living in under-resourced communities. Equipping non-HCP facilitators embedded in community sports and wellness programs with training on malnutrition screening provides a means to meet under-resourced families where they live and play. This can promote conversations around malnutrition risk with the hope of establishing effective pathways to care that improve the health and future potential of these children. Future research should focus on: 1) scaling up the program with longitudinal and outcomes data capture; and 2) scaling out to new populations through community-based programs outside of sports and wellness.