Integrating nutrition assessment into routine ANC services to establish the nutrition status of pregnant women

Albert Mugabi
Tuesday, October 28, 2014
Context: What was the issue or process affected? What was the root cause of the challenge?: 

During the period of January-March 2014, only 35% of pregnant women who attended Antenatal (ANC) services at Hoima RRH had their nutritional status assessed using the Mid-Upper Arm Circumference (MUAC) method. This was below the national standard of 100%.
Root causes:

  • Gaps in documenting client information: ANC staff often recorded the MUAC measurement results in the mothers’ passports, but little information was recorded in the integrated ANC register. Sometimes, the information would not be documented at all.
  • Staff challenges: Some staff felt that taking MUAC measurements was an added task that needed to be assigned to specific staff. Sometimes the task would be left to student nurses who had never been trained on conducting nutrition assessment using the MUAC method.
  • Logistics challenges: MUAC tapes were initially kept in the unit in-charge’s cupboard that would be locked most of the time. In absence of the in-charge, especially in the early morning, clients with ANC appointments in the early hours of each day wouldn’t have their nutritional status assessed.
  • Stigma: The community, it was reported, perceived anyone whose nutrition status is assessed and is given Ready-To-Use Therapeutic Foods (RUTF) to be HIV-positive; therefore, pregnant women avoided being identified as beneficiaries for RUTF.
What Happened: How was the challenge or gap addressed or improved?: 

The hospital nutritionist discussed the unit’s nutrition performance with the ANC In-charge at the end of March 2014 and the following changes were implemented:

  • At the end of first week of April 2014, a meeting was convened involving staff from ANC where teams were oriented on the need for ensuring that all pregnant women should have their nutrition status assessed using the MUAC method
  • Teams also agreed that measuring of MUAC should be conducted by staff that take blood pressure and weight measurements
  • They were also oriented on where to document the nutrition assessment results within the integrated ANC register
  • An open place (an unlocked cupboard) in ANC was identified where at least one MUAC tape is kept and is easily accessible
  • Midwives further oriented nursing students on taking MUAC measurements during their internship
  • Information on nutrition and the importance of assessing nutrition status was integrated into ANC health education sessions
  • New students/staff were assigned to the ANC Clinic and educated on how to properly conduct nutrition assessments by measuring the MUAC and appropriately record the results in the integrated ANC register
Nugget: What is the lesson for others?: 

Integrating MUAC measurement in client flow systems at ANC (especially at specific points where blood pressure, weight and other vitals are measured) ensures that every pregnant woman gets her nutrition status assessed for subsequent appropriate management.

Impact: What are the results of applying the nugget?: 
  • At each ANC visit, malnourished pregnant women were easily identified and given appropriate interventions, including RUTF
  • Women with good nutritional status were given additional information on good feeding and hygiene practices
  • By the end of June 2014, use of MUAC to assess nutrition status of pregnant women accessing ANC services had improved from 35% to 76%
Implementation: What steps are needed to apply the lesson?: 

Healthcare facility ANC and nutrition teams should organize a joint meeting to accomplish the following:

  • Orient ANC staff on using MUAC to assess nutrition status and importance of this procedure
  • Agree on when in the client flow process MUAC should be measured
  • Clarify roles to identify who will conduct the assessment (e.g., by the midwife or student intern)
  • Ensure appropriate documentation tools (registers) are available and staff know where to record the assessment results
  • Keep MUAC tapes together with other equipment used in measuring weight and blood pressure, for easy accessibility and use
  • Agree on specific dates for conducting periodic review meetings with ANC staff to track and improve performance
  • Ensure ANC health education sessions address the importance of nutrition assessment during pregnancy and how acutely malnourished clients are managed using therapeutic foods
  • Allocate daily tasks to staff on duty to take responsibility for nutrition assessment and link identified malnourished clients to the nutrition unit
Action: Who is this for? Where does this nugget to go next?: 

Midwives, Nutritionists, Paediatrician, Gynecologist and other health workers and program managers

Albert Mugabi, Nutritionist ( Getrude Matsika, Senior Nursing Officer Sr. Gladys Kato , Enrolled nurse Margaret Nyakaisiki, Nursing officer Ruth Nankwanga, Nursing Officer Joyce Ayubo, Records assistant Sarah Mugisha, Nursing Assistant Jane Najuma Evaline Bakyetaho