Abstract
BackgroundAnnually, undernutrition contributes globally to 45% (3.1 million) of preventable deaths in children under 5. Effect following undernutrition i.e. physical growth & cognitive development etc. can be prevented during the first 1000 days also called window of opportunity. There is substantial evidence of positive nutrition outcomes resulting from integrating nutrition-specific interventions into nutrition specific program. However, there is paucity of knowledge on establishing and sustaining effective integration of nutrition intervention in fragile context. The objective of this review is to map and review the integration of nutrition-specific intervention to nutrition sensitive program and its impacts on nutrition outcomes.MethodsIn the study, we systematically searched the literature on integrated nutrition intervention into multi-sectoral programme in PUBMED, Google’s Scholar, the Cochrane Library, World Health Organisation (WHO), United Nations Children’s Fund (UNICEF), World Bank and trial registers from their inception until Oct 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. This study is registered with PROSPERO (CRD42020209730).ResultForty-four studies were included in this review, outlining the integration of nutrition-specific interventions among children 0–59 months with various existing programme. Most common integration platform in the study included integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non-nutrition outcomes with a number of model of integration which varies according to the context and demands of the particular setting in which integration occurs.ConclusionOverall, existing evidence for nutrition sensitive and specific interventions is not robust and remains limited. It’s worthwhile to note, for future studies/interventions should be based on the context key criteria like relevance, political support, effectiveness, feasibility, expected contribution to health system strengthening, local capacities, ease of integration and targeting for sustainability, cost effectiveness and financial availability.
Highlights
Undernutrition contributes globally to 45% (3.1 million) of preventable deaths in children under 5
Types of participants We considered studies/ programme that reported on integration of nutrition sensitive and specific interventions directed at populations with an intention to improve nutrition outcome
Search methods for identification of studies We developed a comprehensive search strategy from their inception until Oct 30, 2020 using the framework described in Supplementary Table 2 (S2), for websites, peer-reviewed studies and grey literature with no time and language limits
Summary
Undernutrition contributes globally to 45% (3.1 million) of preventable deaths in children under 5. There is substantial evidence of positive nutrition outcomes resulting from integrating nutrition-specific interventions into nutrition specific program. Undernutrition is a major cause of disease and death in impoverished communities i.e. fragile settings where sub-optimal growth is responsible for an estimated 2.2 million deaths annually in children under five years of age [1]. Under-nutrition has often been viewed as a problem of limited food availability and solutions for addressing under-nutrition with main focus to increase food production. Such a vertical approach ignores a wide range of contributing factors which nutrition interventions need to address in order to achieve tangible results. To have a meaningful WASH & Nutrition integration requires a good understanding of complex causes and determinants of undernutrition
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