Abstract
BackgroundThere are an estimated 2.7 million children living within institutionalized care worldwide. This review aimed to evaluate currently available data on the nutrition status of children living within institutionalized care.MethodsWe searched four databases (Pubmed/Medline, CINHAL Plus, Embase and Global Health Database) for relevant articles published from January 1990 to January 2019. Studies that included information on anthropometry or micronutrient status of children living within institutionalized care were eligible for inclusion. The review is registered on PROSPERO: CRD42019117103.ResultsFrom 3,602 titles screened, we reviewed 98 full texts, of which 25 papers were eligible. Two (8%) studies reported data from multiple countries, nine (36%) were from Asia, four (16%) from Africa, three (12%) from Eastern Europe, four (16%) from the European Union and one (4%) from each of the remaining regions (Middle East, South America and the Caribbean). Twenty-two (88%) were cross sectional. Ten (40%) of the studies focused on children >5 years, seven (28%) on children <5 years, seven (28%) covered a wide age range and one did not include ages. Low birth weight prevalence ranged from 25–39%. Only five (20%) included information on children with disabilities and reported prevalence from 8–75%. Prevalence of undernutrition varied between ages, sites and countries: stunting ranged from 9–72%; wasting from 0–27%; underweight from 7–79%; low BMI from 5–27%. Overweight/obesity ranged from 10–32% and small head circumference from 17–41%. The prevalence of HIV was from 2–23% and anemia from 3–90%. Skin conditions or infections ranged from 10–31% and parasites from 6–76%. Half the studies with dietary information found inadequate intake or diet diversity. Younger children were typically more malnourished than older children, with a few exceptions. Children living within institutions were more malnourished than community peers, although children living in communities were also often below growth standards. High risk of bias was found.ConclusionsThis study highlights the limited amount of evidence-based data available on the nutritional status of children in institutions. Of the studies reviewed, children living within institutionalized care were commonly malnourished, with undernutrition affecting young children particularly. Micronutrient deficiencies and obesity were also prevalent. Data quality was often poor: as well as suboptimal reporting of anthropometry, few looked for or described disabilities, despite disability being common in this population and having a large potential impact on nutrition status. Taken together, these findings suggest a need for greater focus on improving nutrition for younger children in institutions, especially those with disabilities. More information is needed about the nutritional status of the millions of children living within institutionalized care to fully address their right and need for healthy development.
Highlights
Malnutrition impacts millions of children around the world (Black et al, 2013; The World Bank Group, 2019; UNICEF, 2019)
Twelve (48%) included control or comparison groups of children who were community children (CC) or orphaned, separated or abandoned children living in family-based care (FBC), or children living on the streets (CLS)
Control groups were typically orphaned children living in family-based care (FBC) or community children (CC) with no history of institutional care and the groups were selected from different settings including from local schools, communities, clinics or hospitals, lists, house-to-house census or other child-related programs (Braitstein et al, 2013; Johnson et al, 2010; Whetten et al, 2014)
Summary
Malnutrition impacts millions of children around the world (Black et al, 2013; The World Bank Group, 2019; UNICEF, 2019). Being malnourished has many adverse consequences including increased risk and severity of infections, increased risk of disability, and death (Black et al, 2013; Groce et al, 2014; McDonald et al, 2013; Myatt et al, 2018) This can be a part of a cyclical interaction between infections and undernutrition which leads to poor nutritional status, illnesses and impacted growth.The first 1,000 days of a child’s life are important because poor nutrition at this stage predisposes children to long-term impairments such as stunted growth, impaired cognition and poor performance at school and work (Black et al, 2013; UNICEF, 2019).
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