Article type
Year
Abstract
Background: Undernutrition is a major public health problem in low- and middle-income countries (LMIC). It is particularly devastating for young children, responsible for 35% of deaths and 35% of morbidity in children under five years old. Undernutrition also contributes to poorer psychosocial development and to decreased life chances. So it is vital for governments, funders, and nongovernmental organisations to have evidence about the effectiveness of nutrition interventions for young children, and to understand who they work for, why, and under what circumstances.
Objectives: To report findings of our recently published systematic review and process evaluation of one such intervention; supplementary feeding programs for children aged three months to five years.
Methods: We included RCTs, CCTs, CBAs and ITS studies of programs that provided meals, snacks or beverages to children under five across the world. We followed strict Cochrane methodology. Our analyses of change used the MD or SMD correcting for clustering when needed. We assessed %RDI given in each program, leakage, mode of delivery, and supervision. Subgroup analysis was used to explore the impact some of these factors as well as equity considerations.
Results: Providing supplementary food to young children in LMIC had significant positive effects on weight and height gain, but they were small (0.12 kg and 0.27 cm, respectively over six months in RCTs). Supplementary feeding resulted in significant small positive changes in HAZ, WHZ and larger changes in haemoglobin (SMD = 0.49). Finally, we found moderate positive effects on psychomotor development (SMD = 0.41) and mixed, but generally null evidence of effects on cognitive development.Subgroup analyses found that supplementary feeding was more effective for children under two years old. Programs were generally more effective for the poorer/less well-nourished. There is some evidence that studies that provided a greater proportion of the %RDI for energy and were well-supervised may be more effective.
Conclusions: Results for growth were lower than we expected. We believe better implementation would result in better outcomes.
Objectives: To report findings of our recently published systematic review and process evaluation of one such intervention; supplementary feeding programs for children aged three months to five years.
Methods: We included RCTs, CCTs, CBAs and ITS studies of programs that provided meals, snacks or beverages to children under five across the world. We followed strict Cochrane methodology. Our analyses of change used the MD or SMD correcting for clustering when needed. We assessed %RDI given in each program, leakage, mode of delivery, and supervision. Subgroup analysis was used to explore the impact some of these factors as well as equity considerations.
Results: Providing supplementary food to young children in LMIC had significant positive effects on weight and height gain, but they were small (0.12 kg and 0.27 cm, respectively over six months in RCTs). Supplementary feeding resulted in significant small positive changes in HAZ, WHZ and larger changes in haemoglobin (SMD = 0.49). Finally, we found moderate positive effects on psychomotor development (SMD = 0.41) and mixed, but generally null evidence of effects on cognitive development.Subgroup analyses found that supplementary feeding was more effective for children under two years old. Programs were generally more effective for the poorer/less well-nourished. There is some evidence that studies that provided a greater proportion of the %RDI for energy and were well-supervised may be more effective.
Conclusions: Results for growth were lower than we expected. We believe better implementation would result in better outcomes.