ArticlePloS one2026
Acceptability, feasibility, appropriateness, uptake and cost perceptions of family mid-upper arm circumference supported by two-way SMS in western Kenya.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Early identification and treatment of acute malnutrition can decrease mortality and morbidity related to wasting or low weight-for-height. Teaching caregivers to measure mid-upper arm circumference (MUAC), an approach known as Family MUAC, may support early diagnosis of wasting. Family MUAC paired with mobile support from healthcare workers resulted in a 37% reduction in child wasting in the Mama Aweza trial in Kenya. This study examines the intervention's acceptability, feasibility, appropriateness, uptake, perceptions of cost savings, and factors influencing engagement with Family MUAC. This qualitative study involved eight focus group discussions with caregivers enrolled in the Mama Aweza trial and fourteen in-depth interviews with caregivers who participated in the intervention arm, Family MUAC supported by two-way short message service (SMS). Caregivers were purposively selected based on engagement level with the intervention. Eighteen program staff and healthcare workers from three facilities in western Kenya participated in in-depth interviews. The Theoretical Domains Framework informed design of data collection tools. Caregiver and healthcare worker perceptions of Family MUAC with two-way SMS centered on seven themes. The intervention was viewed as acceptable, cost-saving, appropriate, feasible, and empowering. Caregiver uptake was high, and integrating child growth monitoring with other health services may help enhance sustainability. Barriers to uptake included inconsistent MUAC measurements, limited social support, and issues with phone sharing. Refresher trainings could increase accuracy of MUAC measurements and improve engagement. Direct communication with healthcare workers via SMS built trust and strengthened patient-provider relationships. Caregivers also reported perceived cost savings, as SMS communication reduced unnecessary travel to health centers when children were not malnourished. This study supports Family MUAC with two-way SMS as a promising approach to empower caregivers and highlights their critical role in child health and nutrition interventions. Future interventions can focus on improving measurement accuracy and mitigating negative social influences on caregiver-led interventions.
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