The following are the few questions I am yet to include in my introduction and maybe you can help me.

1. What challenges do we have with the two measurements MUAC and WHZ?
1.1 Inadequate trained facility and community health providers
1.2 Extremely great numbers of wrong MUAC tapes were produced prior the revision from <11cm to
11.5cm and less for SAM. Currently distribution of these wrong MUAC tapes (6-59months) by both NFNC
who are the distributors and our cooperating partners who support certain district or facilities. Our and our
cooperating partners. These tapes are in donor supported districts and facilities. When questioned why
NFNC is still distributing these wrong tapes the response is that there is nothing NFNC can do since
these were produced as]t a very high costs and cannot be destroyed and the only way is to district and
manually repaint the tapes to correct them. Now this is very unprofessional as the used paints fade away
with time and also painting is a deviation from MoH standard.
1.3 For health institution who have tried to uphold the use of the correct tapes, they have challenges in
procurement as the funds as insufficient for the needs( to cater for all zonal CBVs)
1.4 Ware and tear of the tapes is very high with no replacement
1.5 WFH equipment is not available form the system and thus not all district can afford to provide for
each level of care( zone, health post, health centre or hospital).
1.6 There are no WFH cards yet in circulation yet the current Growth Monitoring training package includes
measuring wasting.
1.7 There are very limited stadiomenterr to cover all facilities to enable measuring height or length
1.8 Both MUAC and WFH are not yet done routinely done in all facilities and thus cannot be represented
of what the status of the area(district, nation, province ) meaning the current data cannot be used for
proper decision making.
1.9 There are very few people trained to correctly measure height or MUAC

2. How are they different

MUAC measure the mid upper arm circumference. It is a very good tool to access acute malnutrition. It is
most useful especially when weight and height cannoy be measured. The uuper arm is very sensitive to
rapid weight loss. It is also a very good tool for predicting death risk, the lower the reading the hoigher the
risk of death in children while weight for height measures body mass (wasting) in relation to height or
length and describes the current nutrition status. Wasting is assign of short time eriods of food
deprivation and or a recent bout of illness casing weight loss
3. If these two measurements were implemented in the Zambian policy, what would that translate
to, for example, if MUAC was being used as a gold standard, would it mean identifying more
children with SAM? If more children were identified and admitted, what are the implications in
terms of cost and space for admission, can Zambia handle it?
It would be very useful to have MUAC as a gold standard due to its ease of use and interpretation.
Meaning that we can be able to expand our HR base as this tool can be easily used at community level.
However with more children diagnosed with either MAM or SAM ultimately the cost of treatment and need
for more hospital space would be higher in the short term but cheaper in the long run as hospitals will be
decongested once malnutrition is identified and managed within the communities. What is happening now
is that moderate malnutrition is missed and is just seen in its severe form

4. How do we currently do it, when admitting what do we follow, during and upon discharge? David told
me they use the WHY for admission, monitoring and discharge.
See admission and discharge criteria in the OTP training manuals I have attached
5. Whats MOH position on the way forward for the measuring tools for malnutrition and where are we
headed to as a district or Province
MoH is still developing the children clinic card booklet according to the planning updates for 2019 to 2021.
For now there is no clear guidance on the way forward as the country has been split by donor and it may
seem that each province of district is driven by the nature of support. This means that there is no
uniformity in implementing GMP in Zambia.
I am going to send you a number of Zambian documents for your reference.