The MUAC Z-Score Tape Helps Address Childhood Malnutrition Challenges Globally

Simple Device Helps Identify Childhood Nutritional Challenges

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The MUAC z-score tape and strategic partnerships are helping more children around the globe get screened for malnutrition risk.

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A healthcare provider measures a child's arm with MUAC z-score tape.

MAY 17, 2023   6 MINUTE READ

Strong partnerships are key to building health equity by effectively addressing health disparities, expanding access to resources and removing barriers that prevent people from living healthy lives. Tackling the global issue of childhood malnutrition requires our best efforts. Severe malnutrition affects 45 million children worldwide each year — the equivalent of 1 out of every 3 children under age 5.

But when helping to solve some of the world's biggest challenges, a simple idea and unique partnerships have the potential to make a big impact. To help identify pediatric malnutrition, a medical innovator, a global healthcare company, a greeting card company and a nonprofit children's organization joined forces to do exactly that.

From there, Abbott and the Real Madrid Foundation, an organization founded by the club to promote the values inherent in sport to children globally, have implemented real-world programs to beat malnutrition, building capacity and knowledge within communities through education and training on malnutrition screening.

How It Started

In 2019, Dr. Susan Abdel-Rahman, the director of healthcare innovation for the Children's Mercy Research Institute at that time, developed an inexpensive, paper-based device that resembles a traditional measuring tape. The MUAC z-score tape includes age-specific, color-coded indicators to signal the risk of malnutrition in children. To use the mid-upper arm circumference (MUAC) tool, healthcare providers take one end of the tape and slide it through two slits to create a loop. The provider can then slide the loop to the middle of a child's arm and use the color-coded indicators to assess malnutrition risk — all within a matter of minutes. 

To produce the tool, Dr. Abdel-Rahman and a small team printed large sheets of the measuring tape on the same tear-resistant paper used in shipping envelopes and cut each one by hand. Through these efforts, Dr. Abdel-Rahman and Children's Mercy Kansas City were able to evaluate 10,000 children in just two years.

With a little extra support from Hallmark, Children International and Abbott, the partnership has become a truly world-changing idea, making a positive impact on children's health around the world.

Building Key Partnerships

To help improve the MUAC z-score tape, Children's Mercy connected with two other Kansas City companies: Hallmark and Children International. Hallmark's team of greeting card experts optimized the color contrast; ensured the paper, printing and cutting met quality standards; determined efficiencies for larger production runs; and provided contacts for local, high-quality printers that could meet the unique requirements for the MUAC z-score tape.

With the improved tools, Children International began validating the MUAC z-score tape in Guatemala and India. It has since expanded its use to vulnerable communities in nine of the 10 countries where the nonprofit operates. In 2020, Children International identified more than 5,000 children in need of nutrition support — leading to more treatment programs — and has managed at least another 1,800 children since then. 

These efforts took place during the COVID-19 pandemic amidst global lockdowns. By providing families with training and the MUAC z-score tape screening tool, this organization was able to preserve continuity of care and identify new children in need of services despite COVID challenges. 

Abbott is committed to helping raise awareness of pediatric malnutrition through education about the importance of early identification and intervention.

Karyn Wulf, MD, MPH, Abbott senior medical director

Connecting to a Network of Half a Million

To further identify and support early intervention in the nutritional challenges of even more children, Children's Mercy Kansas City connected with the Abbott Nutrition Health Institute (ANHI). ANHI creates educational programming and other evidence-based tools to enhance health outcomes. It's also connected to a network of half a million healthcare professionals worldwide. This network allows ANHI to serve as an education and awareness-building partner for the MUAC z-score tape.

"Abbott is committed to helping raise awareness of pediatric malnutrition through education about the importance of early identification and intervention," said Karyn Wulf, M.D., MPH, a senior medical director at Abbott. "Through this partnership with Children's Mercy Kansas City and Dr. Abdel-Rahman, we can connect clinicians around the world to this simple but effective malnutrition identification tool to help accomplish that goal."

Building upon this partnership, Abbott recognized an opportunity to not just distribute the tool but also to train clinicians to use it. Through one of Abbott's educational training programs, the ANHI Growth Summit, Dr. Abdel-Rahman showed 150 pediatricians, dietitians and clinicians from more than 20 countries around the world how to use this simple and effective malnutrition screening tool.

With the help of ANHI and its connections, the team has been able to further expand the reach of the MUAC z-score tape. ANHI offers MUAC z-score tape training materials and an accredited self-study course, free of cost, as well as access to the MUAC z-score tape. More than 9,292 clinicians have accessed ANHI's MUAC z-score tape educational resources so far.

With its global reach and impact on childhood nutrition and health, the MUAC z-score tape was recognized among Fast Company's World Changing Ideas in Wellness and Developing Nation Technologies for 2021.

Supporting Malnutrition Screening and Education

Of course, to beat malnutrition, you first have to find it. That's where the Real Madrid Foundation comes in. Understanding that malnutrition screening is the first step on the path to care, Abbott and the Real Madrid Foundation launched a global nutrition screening program using MUAC z-score tape to aid the early identification of children at risk for malnutrition. Local Real Madrid Foundation partners are supporting this grassroots approach in different regions around the world.

In the hands of the community, the MUAC z-score tape is an example of an effective screening tool that can help families understand their children's nutritional status and encourage them to start conversations with healthcare providers if needed.

To further support prevention, this partnership implemented Future Well Kids, a health and nutrition curriculum created by the Abbott Fund, in nine countries: Brazil, Colombia, Kenya, India, Israel, Mexico, Spain, the United Kingdom and the United States. This initiative has delivered 15,000 hours of curriculum to teach children about the relationship between what they eat and chronic illnesses, such as diabetes and cardiovascular disease. This education lays the foundation for helping children make healthy lifestyle choices that can help reduce their risk of chronic disease later in life.

The partnership between Abbott and Real Madrid Foundation illustrates the power of Abbott’s work under the Abbott Center for Malnutrition Solutions, a collaboration between Abbott and external partners focused on reducing malnutrition in every region of the world.

Establishing Strong Partnerships for Health Equity

Abbott’s unique partnership with the Real Madrid Foundation, Children's Mercy Kansas City, Hallmark and Children International are great examples of how distinct organizations can leverage their areas of expertise and resources to move toward stronger health equity, providing global scale and reach for the early identification of childhood malnutrition:

  • Dr. Abdel-Rahman, previously at Children's Mercy Kansas City, conceived of and developed the MUAC z-score tape.
  • Hallmark conducted research, tested the paper-based tool and developed manufacturing recommendations.
  • Children International piloted the tape outside of the U.S. in Guatemala and India and demonstrated the tool's effectiveness to support hard-to-reach communities outside of hospital settings. Now, it's scaling the tape for communities and caregivers to use across nine countries.
  • Abbott Nutrition Health Institute tapped its network of half a million healthcare providers to increase awareness and provide educational training on the tool.
  • The Real Madrid Foundation partnered with Abbott to implement nutrition education and screening programs in its social sports projects in nine countries to further support malnutrition prevention and care.

A single innovation won't solve childhood malnutrition. It will require global, multisectoral partnerships to create more world-changing ideas like the MUAC z-score tape. Abbott's goal is to help more families, healthcare professionals and communities around the world access the tools and resources they need to improve health and well-being.

Eliminating Pediatric Malnutrition A Call for Universal Screening

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By: Karyn Wulf, MD, MPH, Pediatric Medical Director at Abbott

Appropriate growth during childhood lays the foundation for a lifetime of health. While important, growth alone does not always tell the full story of a child’s health. A child may not be getting all the nutrients they need, and occasional growth screenings may not catch nutrient deficiencies until a child is malnourished. The consequences of nutrient deficiencies can include not only poor growth, but also impaired physical or cognitive development. Identifying children at risk is crucial so that dietary or nutritional interventions can be started long before growth or development issues occur.

Currently, there is no universal malnutrition screening tool used in pediatric care, and childhood malnutrition remains far too common around the world. Nearly 150 million children under 5 are stunted and 50 million are wasted, demonstrating an urgent need for a pediatric screening process to identify those who are at nutritional risk.

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Improving Childhood Nutrition with a Multidisciplinary Approach

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By: Karyn Wulf MD, MPH, Pediatric Medical Director at Abbott.

When it comes to assessing childhood nutrition, it can be more complex than simply making sure your kid eats his or her vegetables. Key outcomes of good childhood nutrition aren’t just linear growth or weight gain, but also includes organ and brain development. Nutritional limitation in any of those areas may cause long-term problems with optimal growth and development. That’s why primary care physicians should consider a team approach when treating kids who are falling behind on growth. 

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