The importance of implementation evaluation. Case study of a review on preschool feeding programmes to improve the health of disadvantaged young children

Oral
2013 Québec City
Francis D1, Liberato S2, Benkhalti Jandu M3, Welch V3, Batel M4, Greenhalgh T5, Rader T6, Noonan E7, Shea B8, Janzen L9, Wells G10, Petticrew M11
1Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Jamaica
2Nutrition Research Team, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
3Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Canada
4Nutrition Program/Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
5Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, London, UK
6Cochrane Musculoskeletal Group, Ottawa, Canada
7Social Research Unit, Norwegian Knowledge Centre for the Health Services
8CIET, Institute of Population Health, University of Ottawa, Ottawa, Canada
9The Hospital for Sick Children, University of Toronto; Canada
10Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
11Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK

Background:

35% of deaths and another 35% of the disease burden in children under 5 years old are attributable to under nutrition. Throughout the life cycle, under nutrition contributes to increased risk of infection, lowered cognitive performance, chronic disease, and mortality. It is vital for funders to have evidence about the effectiveness of nutrition interventions for young children

Objectives:

To understand effectiveness and factors that impact on effectiveness for feeding interventions which provided energy through food or drink to improve the health of disadvantaged children aged 3 months to 5 years.

Methods:

Our implementation analysis was based on our logic model and issues identified in the review process. We included randomized controlled trials, controlled before after and interrupted time series studies that assessed feeding interventions with or without co-intervention. Children had to be aged 3 months to 5 years.

Results:

29 387 articles were identified through searches: 290 were retrieved and 29 studies met inclusion criteria; 26 of these from LMIC. The results showed small (0.67 cm per year) and significant effects on height and small, significant effects on weight (0.25 kg per year), and medium effects on psychomotor development (Standardized mean difference = 0.62, 95% C.I = 0.23–1.02). Our implementation analysis was critical in identifying subpopulations for whom the intervention was more effective: children with greater need, girls, and younger children. We also found out that the target children only ingested 36–75% of the total energy of the supplement; this was partly due to redistribution within the family. Implementation analysis showed that interventions with greater than 30% of RDA for energy were more effective. Greater supervision increased effectiveness.

Conclusions:

This review highlights the importance and policy relevance of implementation evaluation as part of a systematic review, and we will discuss implications for how to conduct implementation analysis in other reviews.