 First, I want to thank MSF for inviting us to this discussion and to say that I'm privileged to be a small part of a much larger team that carried out this research. I will describe the results from a study in rural Niger in which a Lima and its national partner, Bethan, trained mothers and other family members in a health zone to screen their own children for malnutrition by using color-coded mid-upper arm circumference or MUAC tapes and checking for edema. These mothers were compared to a health zone where screenings were conducted by community health workers or CHWs, which is the current practice. Here I will only focus on the MUAC results. Second, and with apologies, I will be using four main acronyms throughout this talk from time to time. I already used two. So MUAC, which stands for mid-upper arm circumference, CHWs, which stands for community health workers, SAM, which stands for severe acute malnutrition, and MAM, which stands for moderate acute malnutrition. Before I start, I want to share two anecdotes. The first is from the pilot study. The research team there planned to go door-to-door to teach more than 100 women how to screen by MUAC in two villages. But after explaining the purpose of the study, community leaders felt it was too important to go door-to-door and instead called the entire village together for a common meeting where the entire community learned how to use these MUAC tapes. The second anecdote is from a subsequent large-scale study. Several trainers there said that after showing mothers how to use MUAC tapes, many women, if a light bulb had gone off, said, now I understand why my child was accepted or rejected in previous years for treatment and malnutrition. On to the results of the pilot study. So in 2011, 103 mothers were taught how to use MUAC tapes, and their screening results were compared to community health workers. There was excellent agreement between the two groups with errors only at the boundaries between SAM and MAM and MAM and normal. Of note, there was no difference in either group between measuring the left arm or the right arm. With the proof of concept established, Alima and Bethan carried out a large-scale study comparing at the health zone level, mothers versus community health workers at screening children for malnutrition by MUAC. In 2013, the characteristics of 12 health zones in Mariah district where Alima and Bethan ran health and malnutrition treatment programs were examined in order to identify two zones with similar demographics, geography, SAM burden, health care provision, access barriers, and program performance. Taqueta and Dogo showed the most similarities, especially for SAM prevalence and the percentage of children under five treated for SAM previous to the study. Taqueta was chosen as the community health workers zone because managers felt it had the best functioning CHW network. The training strategy in the two zones consisted of the following. For mothers, 20 to 30 minute group sessions were followed by individual demonstrations of how to use MUAC. Most mothers were trained in the first round in May 2013 with follow-up trainings conducted during the three subsequent coverage surveys that were carried out or during consultations. Community health workers were trained with the standard curriculum and supervised accordingly. Over the course of the year, nearly 13,000 mothers and caretakers representing other family members were trained in the mother zone and 36 CHWs were trained in the community health worker zone. Key messages for mothers in the group sessions included definitions of malnutrition, either wasting or edema, and discussions about the importance of identifying malnutrition early. Practical demonstrations of how to perform MUAC were accompanied by descriptions of how to read the color in the MUAC window, or what to do if your child was identified as red, yellow, or green. But of course, one mother in Mariah put the messages a little bit differently than us. She said, red is milk, yellow is flour, and green is paradise. Over the course of the study, there were no differences in terms of admissions by the various criteria in the two zones. Though there were more overall SAM cases in the mother zone. At the end of the study, we found a difference in the median MUAC admission for children who had been admitted by the MUAC criteria. It was 1.6 millimeters higher in the mother zone, or roughly 112 millimeters versus 110 in the community health worker zone. Thus, malnutrition was detected at an earlier stage in the mother zone, and every millimeter higher of MUAC admission can make a big difference in terms of complications and mortality. Consistent with earlier detection and treatment seeking, children admitted in the mother zone were less likely to require inpatient care than children in the community health worker zone, both at admission and at any point in the treatment episode. The most pronounced difference was at admission for those enrolled by MUAC criteria, where children in the mother zone were a little more than 11 times less likely to require inpatient care than children in the community health worker zone. Referrals by MUAC in the mother zone were also nearly two times more likely to be in agreement with the health center agents compared to referrals in the community health worker zone. And finally, point coverage at the end of the study was similar in both areas. Even though, now onto a discussion of costs, even though the mother zone required a higher initial investment, overall costs for the year were less than half of those in the community health worker zone. While initial costs for the community health workers were low, the modest monthly incentives provided to each community health worker represented the largest part, or 85% of the costs. Strengths of this study include an earlier detection of malnutrition in the children in the mother zone with a higher median MUAC at admission and fewer hospitalizations. Limitations included the short time of the study. Also, in addition to that, there was uneven MAM services in the two zones, which caused a lot of problems, especially for messaging in an area where there is limited or no treatment for moderate acute malnutrition. And then finally, a height restriction for eligibility by MUAC unnecessarily excluded short children with low mid-upper arms or conference. In conclusion, we found that mothers were non-inferior to the current practice of community health workers in screening for malnutrition and at a much lower cost. Empowering mothers and other family members to screen their own children for malnutrition is feasible at scale, and we would recommend it. Based on the initial analysis, Alima has gone on to train tens of thousands of more mothers in Burkina Faso, Niger, Mali, and Chad. And finally, we feel that a family MUAC screening strategy will be most efficient in MUAC-based programs that integrates both severe and moderate acute malnutrition treatment in one program. A report from one such program in Sierra Leone showed much higher coverage compared to standard management. I want to thank the following people in groups, but most especially the mothers and children in Dogo and Taqueta, who participated in the study. Thank you.