Addressing malnutrition in low- and middle-income countries with double-duty actions.

Rebecca Pradeilles,Michelle Holdsworth,Kaleab Baye

doi:10.1017/s0029665118002616

Rebecca Pradeilles, Michelle Holdsworth + Show 1 more

Open Access

https://doi.org/10.1017/s0029665118002616

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Abstract

Multiple forms of malnutrition co-exist (the double burden) in low- and middle-income countries, but most interventions and policies target only one form. Identifying shared drivers of the double burden of malnutrition is a first step towards establishing effective interventions that simultaneously address the double burden of malnutrition (known as double-duty actions). We identified shared drivers for the double burden of malnutrition, to assess which double-duty actions are likely to have the greatest reach in preventing all forms of malnutrition, in the context of the sustainable development goals. We reviewed existing conceptual frameworks of the drivers of undernutrition, obesity and environmental sustainability. Shared drivers affecting all forms of malnutrition and environmental sustainability were captured using a socio-ecological approach. The extent to which drivers were addressed by the five double-duty actions proposed by the WHO was assessed. Overall, eighty-three shared drivers for the double burden of malnutrition were identified. A substantial proportion (75·0%) could be addressed by the five WHO double-duty actions. 'Regulations on marketing' and 'promotion of appropriate early and complementary feeding in infants' addressed the highest proportion of shared drivers (65·1% and 53·0%, respectively). Twenty-four drivers were likely to be sensitive to environmental sustainability, with 'regulations on marketing' and 'school food programmes and policies' likely to have the greatest environmental reach. A quarter of the shared drivers remained unaddressed by the five WHO double-duty actions. Substantially more drivers could be addressed with minor modifications to the WHO double-duty actions and the addition of de novo actions.

Highlights

A third of the global population is affected by one or more forms of malnutrition and 88 % of countries face a serious burden of either two or three forms of malnutrition[1] (Fig. 1)
The proposed double-duty actions that are likely to have the greatest reach in preventing the double burden of malnutrition remains unknown
Most interventions and policies address only one form of malnutrition, so there is a need for double-duty actions to address this growing double burden of malnutrition more effectively, since policy-makers have limited resources

Summary

Introduction

A third of the global population is affected by one or more forms of malnutrition and 88 % of countries face a serious burden of either two or three forms of malnutrition[1] (Fig. 1). The WHO has recently proposed five potential double-duty actions (Table 1): (i) initiatives to promote and protect exclusive breast-feeding (EBF) in the first 6 months, and beyond; (ii) promotion of appropriate early and complementary feeding in infants; (iii) regulations on marketing; (iv) maternal nutrition and antenatal care programmes; and (v) school food policies and programmes[7] Identifying and categorising the shared drivers of the double burden of malnutrition Existing conceptual frameworks relating to undernutrition[9,10,11] and obesity[12], and the non-communicable disease (NCD) global monitoring framework[13] were reviewed (Supplementary Materials 1–5). EBF prevents undernutrition (e.g. wasting, stunting and micronutrient deficiency) in early

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