Effectiveness of Community Nutrition-Specific Interventions on Improving Malnutrition of Children under 5 Years of Age in the Eastern Mediterranean Region: A Systematic Review and Meta-Analysis.

Delaram Ghodsi,Elham Shakibazadeh,Roshanak Roustaee,Ayoub Al-Jawaldeh,Nasrin Omidvar,Bahareh Nikooyeh

doi:10.3390/ijerph18157844

Abstract

Childhood malnutrition remains an important public health and development problem in low- and middle-income countries. This study aimed to systematically review the community-based nutrition-specific interventions and their effectiveness and/or cost-effectiveness on the nutritional status of children under 5 years of age in the Eastern Mediterranean Region (EMR). A systematic literature search of the English electronic databases, including PubMed, Scopus, ISI Web of Knowledge, Ovid, EMBASE, as well as Persian databases (SID and Magiran) was performed up to May 2019. Studies regarding the effectiveness/cost-effectiveness of the community-based nutrition-specific programs and interventions targeted at under-five-year children in EMR countries were selected. The primary outcomes were mean of Weight-for-age z-score (WAZ), Height-for-Age z-score (HAZ), and Weight-for-Height z-score (WHZ) of children or prevalence of wasting, stunting, and/or underweight among the children. Meta-analysis was also performed on the selected articles and intervention effects (mean differences) were calculated for each outcome for each study and pooled using a weighted random effects model. Risk of bias (ROB) of each included study was assessed based on the Cochrane Handbook for Systematic Reviews. The study protocol was registered in PROSPERO (CRD42020172643). Of 1036 identified studies, eight met the inclusion criteria. Amongst these, seven were from Pakistan and one from Iran. Only one study conducted in Pakistan reported the cost-effectiveness of nutrition-specific interventions in the region. Nutrition education/consultation and cash-based interventions were the most common nutrition-specific strategies used for management of child malnutrition in the EMR countries. Out of these eight studies, four were included in the meta-analysis. When different interventions were pooled, they had resulted in a significant improvement in WHZ of children (MD: 0.26; 95% CI: 0.07 to 0.46, three studies, I2 82.40%). Considering the high prevalence of child malnutrition in a number of countries in the region, capacity building and investigation regarding the implementation of new approaches to improve nutritional status of children and their effect(s) and cost-effectiveness assessment are highly recommended.

Highlights

Childhood malnutrition remains an important public health and development problem in low- and middle-income countries (LMICs) and regional, sub-regional, and country disparities in undernutrition remain [1]
Nutrition-specific interventions that address the immediate determinants of child malnutrition [8] are being used for improvement of child malnutrition in different contexts
This systematic review showed that in addition to nutrition education and cash-based transfer interventions, there is a need to invest in proper strategies to empower mothers and communities to be more actively involved in such interventions

Summary

Introduction

Childhood malnutrition remains an important public health and development problem in low- and middle-income countries (LMICs) and regional, sub-regional, and country disparities in undernutrition remain [1]. Recent studies have shown that childhood undernutrition affects children’s health and growth and their cognitive abilities and productivity in adulthood, with measurable economic impacts [2]. This is why, ending all forms of hunger and malnutrition has been targeted as one of the Sustainable Development Goals (SDGs), explicitly referencing chronic child malnutrition [3]. Even though the fact that addressing childhood undernutrition is one of the approaches that can result in increased individual well-being, as well as overall economic growth, cost-effectiveness/cost–benefit of different strategies needs to be measured in different context. Nutrition-specific interventions that address the immediate determinants of child malnutrition [8] are being used for improvement of child malnutrition in different contexts. Studies have shown that the scaled-up coverage of nutrition-specific interventions is crucial for undernutrition reduction [9,10]

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