FAMILY MUAC STUDY DESIGN CONSULTANT

Background

High levels of acute malnutrition in Northern Kenya

The prevalence of global acute malnutrition (GAM) among children under-five remains persistently high in the Arid and Semi-Arid Lands (ASAL) of northern Kenya, despite improvements in other areas of Kenya over recent years. Marsabit and Isiolo counties are among the most affected of the ASALs. In both counties, the GAM prevalence has been at either the critical (15%–29.9%) or serious (10%–14.9%) phase of acute malnutrition based on the Integrated Phased Classification (IPC) according to annual surveys for most of the past ten years (2010 – 2019).1 Coverage of services for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) has been sub-optimal for much of that period. Despite progress, many challenges remain and surveys indicate that only between half and two-thirds of children suffering from acute malnutrition are accessing essential treatment in ASAL areas.2 A major obstacle to the early detection and treatment of acute malnutrition is that caretakers of young children often do not know their child is malnourished and would be admitted to treatment services if brought to the health facility. In most settings, including Kenya, caretakers rely on Community Health Workers (CHWs) or Community Health Volunteers (CHVs) to screen and refer children using a mid-upper arm circumference (MUAC) band at community level. However, the network of community workers and volunteers are generally overstretched and under-resourced, meaning many malnourished children are identified very late or not at all. The Family MUAC approach supports caretakers of children under-five to regularly screen their own children for acute malnutrition using a MUAC band, rather than waiting for a community worker of volunteer. Mothers are trained to take and interpret the MUAC measurement themselves and bring their child to the health facility if they find their child to be severely wasted (marked red on the MUAC band) or moderately wasted (marked yellow on the MUAC band). With these skills, mothers can catch malnutrition early and be confident when they make the often long journey to the health facility, it will be worth the journey. The Family MUAC approach has been rapidly scaling up since first piloted in Niger in 2011 by the NGO ALIMA. Several studies across West Africa have shown mothers can accurately screen their children, and operational experience suggests that Family MUAC has the potential to promote earlier detection and better recovery of wasting.3 Family MUAC was first piloted in Kenya in 2017, and the Kenya Ministry of Health (MoH) endorsed the approach as a longer term strategy, following scale up during the COVID-19 pandemic.

Operational study on Family MUAC planned in Northern Kenya (2022-2023)

Building on the success of a previous study in Northern Kenya led by Concern with funding from the innocent Foundation, the proposed research aims to generate evidence on the effectiveness and cost-effectiveness of integrating the Family MUAC approach into standard Community Health Volunteer (CHV)-led screening and referral for acute malnutrition. By comparing this novel, integrated approach to the current status quo which relies solely on CHVs to screen and refer children at community level, Concern aims to generate practical evidence and recommendations to help the Kenya health authorities at national, county and sub-county level make informed plans to scale up the Family MUAC approach and how much it is likely to cost.

Main research questions for the study:

• Primary Question: Is screening of children under five for acute malnutrition by mothers/ carers combined with standard CHVs more effective (improved screening, referral and treatment coverage) and cost-effective (lower cost per Disability-Adjusted Life Years,DALY, averted) than screening by CHVs alone in the ASAL context (Marsabit County)?
• Secondary Questions:

1. Timely/ early detection: Does mother/carer-led screening combined with CHV screening lead to earlier detection of children with acute malnutrition than by CHV screening alone in the ASALs?
2. Appropriate referral action: Can mothers/ carers take appropriate action based on screening results (i.e. decide to refer/ not to refer) with at least the same accuracy and consistency as CHVs in the ASALs?
3. Accuracy of screening: Can mothers/ carers screen their own children with at least the same accuracy as CHVs in the ASAL context?
4. Frequency of screening: Can mothers/ carers screen their own children with at least the same frequency as CHVs in the ASAL context?
5. Sustainability: What are the challenges and motivators that influence a mother’s/carer’s ability to screen regularly and accurately and refer correctly and to sustain the behaviour over time?
6. Integrated implementation model: What is the most effective and efficient implementation strategy to promote mothers/ carers and CHVs working together to screen and refer children?

Main methods for the Family MUAC study

The operational research approach will take place of 12 months in North Horr Ward in North Horr sub-county and combine qualitative and quantitative methods to answer the above research questions. The main quantitative method will be a cross-sectional survey of screening agents (Family MUAC trained caretakers and CHVs) at baseline (mid 2022), midline (end 2023) and Endline (mid 2023) to assess the three main study outcomes: screening coverage, referral coverage and treatment coverage of children suffering from wasting. These will be complemented by a smaller study to further assess accuracy of caretakers’ MUAC measurements, compilation of health facility data to understand referral patterns and focus group discussions and key informant interviews.

2. Purpose Main purpose of the consultancy

To support the finalization of the Family MUAC operational study protocol, implementation plan, and tools for commence the study by 15th June 2022.

3. Justification

The study design consultant should have experience in research and nutrition to lead the development of the research protocol. The current health and nutrition team does not have the bandwidth to develop the research design and protocol.

4. Methodology and Technical Approach

a. Develop a firm understanding of the IMAM and Family MUAC implementation context in North Horr sub-county (Marsabit County) and the objectives and proposed methods of the operational study.

b. Finalize and clearly describe the qualitative and quantitative methods for the study in close collaboration with Concern Worldwide and government health counterparts in the form of a study implementation plan

c. Finalize the sampling approach and sample sizes for each study component using up to date population data and sound assumptions regarding e.g. the expected prevalence of wasting (also in the form of a study implementation plan)

d. Finalize an analysis plan for the quantitative data (including the six-monthly cross sectional surveys as well as compilation of health facility records) and qualitative data (largely focus group discussions and key informant interviews)

e. In line with the agreed methods, develop a relevant set of data collection tools (including digital and paper based tools) for quantitative and qualitative data.

f. Develop a set of practical enumerator training materials based on the methods and tools agreed and finalized with Concern Worldwide and government counterparts.

5. Outputs and Deliverables

• Full Ethic research protocol consisting of:

1..1. Detailed study implementation plan, including outline of methods, sampling approach and sizes and analysis plan

1..2. A full set of data collection tools for each study component

1..3. A practical set of training materials to orient enumerators on the methods and tools

6. Working Conditions

Concern seeks a full time consultant to work with the Concern team and government counterparts to further develop the methods and tools outlined above based on the draft study protocol.

7. Timeframe: 15 days between May and July 2022

8. Remuneration

• Concern will pay the consultant a fee per day for the agreed number of days required for the work.
• Please indicate the number of days required (share a detailed work plan) and your daily rate in the proposal
• The payment is subject to withholding tax and other requirements under the Laws of Kenya.
• In your quotation clearly indicate if VAT is applicable or not

9. Essential qualifications

• A relevant degree in nutrition, public health, epidemiology, statistics or other related discipline.
• At least one year’s experience supporting nutrition programming in a developing context such as Kenya (in Kenya is preferred)
• Advanced knowledge of descriptive and statistical analysis and study methods
• Experience developing detailed operational research plans and tools
• Strong and concise writing skills

10. Supporting documentation required

• Certificate of Incorporation (firms) or National ID card (individual)
• Valid Tax Compliance Certificate
• PIN Certificate
• Company / Consultant’s Profile
• CVs of key staff
• Certificate/reference information of previous undertakings of similar contracts with NGOs/UN agencies
• Safeguarding Policy, Code of Conduct etc. or what are the necessary provisions have you put in place to keep everyone safe in the course of your engagement.
• Attach copy of Certificate of Good Conduct or proof that you have applied for the same
• Confirm the gender ratio for the team that you will be engaging in this exercise
• A detailed work plan with milestones

Safeguarding at Concern: Code of Conduct and its Associated Policies

Concern has an organisational Code of Conduct (CCoC) with three Associated Policies; the Programme Participant Protection Policy (P4), the Child Safeguarding Policy and the Anti-Trafficking in Persons Policy. These have been developed to ensure the maximum protection of programme participants from exploitation, and to clarify the responsibilities of Concern staff, consultants, visitors to the programme and partner organisation, and the standards of behaviour expected of them. In this context, staff have a responsibility to the organisation to strive for, and maintain, the highest standards in the day-to-day conduct in their workplace in accordance with Concern’s core values and mission. Any candidate offered a consultancy opportunity with Concern Worldwide will be expected to sign the Concern Code of Conduct and Associated Policies as an appendix to their consultancy contract. By signing the Concern Code of Conduct, candidates acknowledge that they have understood the content of both the Concern Code of Conduct and the Associated Policies and agree to conduct themselves in accordance with the provisions of these policies. Additionally, Concern is committed to the safeguarding and protection of vulnerable adults and children in our work. We will do everything possible to ensure that only those who are suitable to do consultancy work or volunteer with vulnerable adults and children are recruited by us for such roles. Subsequently, being hired as a consultant with Concern is subject to a range of vetting checks, including criminal background checking.

Concern’ is the trading name of ‘Concern Worldwide’, a company limited by guarantee, registered number 39647; registered charity number CHY 5745, registered in Ireland, registered address is 52-55 Lower Camden Street, Dublin 2, Ireland. Follow Concern online: www.concern.net