So, I had a good day at the Martin Preuss clinic with the programmers from Baobab. We went for them to interview the stakeholders of the system they've put in place at this combined HIV and outpatient TB center. That was very interesting and gave me some great insights into how the system functions overall.

Then we stopped by the office of one of the nurses, Jane, and Mike McKay helped me out by asking some questions about how Mid-Upper Arm Circumference is tested and why. Some results:

MUAC is measured in the HIV/AIDS clinic on:

• Pregnant Women
• Lactating Women
• Children 1 to 5 years old

The MUAC determines the nutrition status.

For children 1 to 5 the ranges are:

• At risk: 12 to 13.5 cm
• Moderate: 11 to 11.9 cm
• Severe: less than 11 cm

For pregnant or lactating women:

• At risk: 22 to 23 cm
• Moderate: 19 to 21.9 cm
• Severe: less than 19 cm

These patients have their MUAC taken every time they come in.

We then went to the vitals station to see how this was measured. The band used has markings between 7 and 30.5 cm.

MUAC Strip from Martin Preuss Clinic

There is only one of these and it is made of flexible plastic, maybe 5 mil or slightly more in thickness.

At the station, I found:

• A balance scale and stadiometer very much like that in the lab at home (Detecto brand)
• A Baobab touchscreen terminal
• A bar-code scanner
• The MUAC strip
• Detergent dish soap
• Bleach
• Cotton swabs

This leads me to three tentative assumptions:

• The strip is permanent and is regularly cleaned and disinfected
• The vitals station consists of most of what I wanted to include in the system already--the bar-code scanner is already there with the terminal!
• I missed the memo on the length of the band, but it can be changed without much hardship

I am going to try and sit in on a clinician taking these measurements over the next few days and actually watch the station at work. If I can get good observations of the movements and timings involved, I could use that data as a baseline to judge the new work.

I guess you could say today was a good day.