Exploring care-seeking practices within a family mid-upper arm circumference approach in South Sudan: a mixed-methods prospective study
Abstract Background Despite the growing adoption of the Family Mid-Upper Arm Circumference (MUAC) approach to empower caregivers in detecting child malnutrition, limited evidence exists on whether caregivers act on identified cases by seeking care and factors influencing their decisions. Most resear...
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BMC
2025-05-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-025-23010-w |
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| author | Sarah Bauler Chiara Altare Sule Ismail Daniel Atem Sandra Banks Prachi Srivastava Julia Hussian Emily Lyles Eva Leidman Shannon Doocy |
| author_facet | Sarah Bauler Chiara Altare Sule Ismail Daniel Atem Sandra Banks Prachi Srivastava Julia Hussian Emily Lyles Eva Leidman Shannon Doocy |
| author_sort | Sarah Bauler |
| collection | DOAJ |
| description | Abstract Background Despite the growing adoption of the Family Mid-Upper Arm Circumference (MUAC) approach to empower caregivers in detecting child malnutrition, limited evidence exists on whether caregivers act on identified cases by seeking care and factors influencing their decisions. Most research has focused on the accuracy of caregiver MUAC measurements, leaving a gap in understanding behavioral, social, emotional, and contextual barriers to care-seeking. Addressing this gap is critical for informing interventions to ensure early detection translates into timely treatment. This study aimed to explore the barriers and facilitators influencing care-seeking practices within a Family MUAC program in South Sudan. Methods We conducted a mixed-methods, prospective, non-randomized study in Central Equatoria and Warrap States, South Sudan, between March 2022 and January 2023. We enrolled 2,893 children aged 5–53 months and trained their caregivers on using MUAC tapes. Caregivers were followed for 8 months, including three monitoring visits and baseline/endline surveys, capturing self-reported care-seeking practices. Qualitative data were obtained through 20 focus group discussions (FGDs) with caregivers, using the Health Belief Model as a theoretical framework to explore perceptions, barriers, and enablers of care-seeking. A combined deductive and inductive coding approach was used for thematic analysis. Results Among children identified with wasting using MUAC tapes, 86.5% of caregivers sought care, with significantly higher rates in Warrap (97.6%) than Central Equatoria (79.4%) (p < 0.008). Barriers to care-seeking included distance to health facilities (18.9%), transportation costs (11.3%), and treatment costs (9.4%). Qualitative findings revealed additional challenges such as social stigma, lack of knowledge about where to seek care, and negative experiences with health workers. Despite some caregivers reporting a lack of encouragement, most valued the MUAC tapes, used them weekly, and were confident in their ability to take accurate measurements. Conclusions Policies and programmatic interventions should consider integrating Family MUAC programs with community-based financial initiatives like savings groups to address financial barriers. Tailoring interventions to rural and urban contexts through formative research can enhance program effectiveness, while training health workers in compassionate care may improve caregiver trust and increase care-seeking rates. Strengthening these areas can maximize the impact of Family MUAC and improve child health outcomes. Trial registration N/A. |
| format | Article |
| id | doaj-art-a738c854422c4e018a9ac4dd85fde8ae |
| institution | DOAJ |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj-art-a738c854422c4e018a9ac4dd85fde8ae2025-08-20T03:06:39ZengBMCBMC Public Health1471-24582025-05-0125111010.1186/s12889-025-23010-wExploring care-seeking practices within a family mid-upper arm circumference approach in South Sudan: a mixed-methods prospective studySarah Bauler0Chiara Altare1Sule Ismail2Daniel Atem3Sandra Banks4Prachi Srivastava5Julia Hussian6Emily Lyles7Eva Leidman8Shannon Doocy9World Vision InternationalJohns Hopkins Bloomberg School of Public HealthIntegral Global ConsultingWorld Vision South SudanJohns Hopkins Bloomberg School of Public HealthJohns Hopkins Bloomberg School of Public HealthJohns Hopkins Bloomberg School of Public HealthJohns Hopkins Bloomberg School of Public HealthUS Centers for Disease Control and PreventionJohns Hopkins Bloomberg School of Public HealthAbstract Background Despite the growing adoption of the Family Mid-Upper Arm Circumference (MUAC) approach to empower caregivers in detecting child malnutrition, limited evidence exists on whether caregivers act on identified cases by seeking care and factors influencing their decisions. Most research has focused on the accuracy of caregiver MUAC measurements, leaving a gap in understanding behavioral, social, emotional, and contextual barriers to care-seeking. Addressing this gap is critical for informing interventions to ensure early detection translates into timely treatment. This study aimed to explore the barriers and facilitators influencing care-seeking practices within a Family MUAC program in South Sudan. Methods We conducted a mixed-methods, prospective, non-randomized study in Central Equatoria and Warrap States, South Sudan, between March 2022 and January 2023. We enrolled 2,893 children aged 5–53 months and trained their caregivers on using MUAC tapes. Caregivers were followed for 8 months, including three monitoring visits and baseline/endline surveys, capturing self-reported care-seeking practices. Qualitative data were obtained through 20 focus group discussions (FGDs) with caregivers, using the Health Belief Model as a theoretical framework to explore perceptions, barriers, and enablers of care-seeking. A combined deductive and inductive coding approach was used for thematic analysis. Results Among children identified with wasting using MUAC tapes, 86.5% of caregivers sought care, with significantly higher rates in Warrap (97.6%) than Central Equatoria (79.4%) (p < 0.008). Barriers to care-seeking included distance to health facilities (18.9%), transportation costs (11.3%), and treatment costs (9.4%). Qualitative findings revealed additional challenges such as social stigma, lack of knowledge about where to seek care, and negative experiences with health workers. Despite some caregivers reporting a lack of encouragement, most valued the MUAC tapes, used them weekly, and were confident in their ability to take accurate measurements. Conclusions Policies and programmatic interventions should consider integrating Family MUAC programs with community-based financial initiatives like savings groups to address financial barriers. Tailoring interventions to rural and urban contexts through formative research can enhance program effectiveness, while training health workers in compassionate care may improve caregiver trust and increase care-seeking rates. Strengthening these areas can maximize the impact of Family MUAC and improve child health outcomes. Trial registration N/A.https://doi.org/10.1186/s12889-025-23010-wChild wastingFamily mid-upper arm circumference (MUAC) approachCare seekingAcute malnutritionLow- and middle-income countries (LMICs)South Sudan |
| spellingShingle | Sarah Bauler Chiara Altare Sule Ismail Daniel Atem Sandra Banks Prachi Srivastava Julia Hussian Emily Lyles Eva Leidman Shannon Doocy Exploring care-seeking practices within a family mid-upper arm circumference approach in South Sudan: a mixed-methods prospective study BMC Public Health Child wasting Family mid-upper arm circumference (MUAC) approach Care seeking Acute malnutrition Low- and middle-income countries (LMICs) South Sudan |
| title | Exploring care-seeking practices within a family mid-upper arm circumference approach in South Sudan: a mixed-methods prospective study |
| title_full | Exploring care-seeking practices within a family mid-upper arm circumference approach in South Sudan: a mixed-methods prospective study |
| title_fullStr | Exploring care-seeking practices within a family mid-upper arm circumference approach in South Sudan: a mixed-methods prospective study |
| title_full_unstemmed | Exploring care-seeking practices within a family mid-upper arm circumference approach in South Sudan: a mixed-methods prospective study |
| title_short | Exploring care-seeking practices within a family mid-upper arm circumference approach in South Sudan: a mixed-methods prospective study |
| title_sort | exploring care seeking practices within a family mid upper arm circumference approach in south sudan a mixed methods prospective study |
| topic | Child wasting Family mid-upper arm circumference (MUAC) approach Care seeking Acute malnutrition Low- and middle-income countries (LMICs) South Sudan |
| url | https://doi.org/10.1186/s12889-025-23010-w |
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