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The nutrition crisis in South Sudan is severe. An estimated 5.3 million people, 48% of the country’s population, are severely food insecure. Those most affected are children under the age of five and Pregnant and Lactating Women (PLWs). Renk, located in the north of South Sudan, has high Global Acute Malnutrition (GAM) rates: 27.1% in the camp community and 32.2% in the host community.

Medair’s nutrition team

Medair’s nutrition team operates four static nutrition clinics: Abayok, Saraya, Jelhak, and Wonthow, alongside seven mobile nutrition clinics: Gerger, Halaka, Atam, Molbuk, Dugdug, Saraya, and Zahara. The Outpatient Therapeutic Programme (OTP) for treatment of Severe Acute Malnutrition (SAM) and the Targeted Supplementary Feeding Programme (TSFP) for treatment of Moderate Acute Malnutrition (MAM) are provided at these sites. The team also operates a Stabilisation Centre (SC) at Abayok clinic to treat children with malnutrition suffering from medical complications. The Medair nutrition team also  carries out regular mass Mid Upper Arm Circumference Measurement (MUAC) screening, where they visit house-to-house throughout the county to screen children under five and PLWs and refer SAM and MAM cases to the nutrition clinics.

MUAC uses a simple tape designed to measure the circumference of the arm with red, yellow, and green indicators to determine if a child has malnutrition and at what level. If a child measures red (less than 11 cm), the child has SAM and needs immediate treatment. A yellow measurement (11-12.4 cm) indicates MAM and green (12.5 cm +) shows the child as normal.

Looking beyond ‘MUAC’ results 

Jevaise Aballo, Nutrition Project Manager, observed that purely screening children using the MUAC might exclude some who were at risk of malnutrition and in need of nutritional treatment. The team considered this possibility and decided to revise the referral threshold for children during the August 2017 mass MUAC screening exercise. All children with a green MUAC measurement up to 13.5 cm (12.5-13.5 cm), which would normally only be considered as “normal”, were instead proactively referred to the nearest nutrition clinic for further screening on Weight For Height (WFH) to confirm their status.

Of the 267 referred ‘green  MUAC’ children who visited a nutrition clinic for further screening on WFH, 124 of them were confirmed as MAM and admitted into the nutrition programme for treatment. In this exercise, it became clear that using the MUAC results alone cannot guarantee that a child is not malnourished.

“It is not just about the desire to deliver in order to meet routine nutrition programming needs, but taking pragmatic steps to achieve better results,” says Aballo.

Had the team not adapted their standard approach to identify children in need, many would have been at risk of worsening malnutrition, medical complications, and even death. In future mass MUAC screening exercises, the nutrition team will continue to follow this adapted referral procedure to ensure that all children who need nutrition treatment are correctly identified.

Commitment 7 of the Core Humanitarian Standard on Quality and Accountability (CHS) states: “Communities and people affected by crisis can expect delivery of improved assistance as organisations learn from experience and reflection.” Renk nutrition team’s approach to addressing the immense malnutrition needs in the community demonstrates their ability to adapt and learn to better provide assistance and care.

Medair’s work in South Sudan is made possible with support from EU Civil Protection and Humanitarian Aid, US Agency for International Development, UK aid from the UK Government, Swiss Agency for Development and Cooperation, Swiss Solidarity, SlovakAid, and generous private donors.

This content was produced with resources gathered by Medair field and headquarters staff. The views expressed herein are those solely of Medair and should not be taken, in any way, to reflect the official opinion of any other organisation.