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Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review.

Abstract：

OBJECTIVE:We systematically evaluated health and nutrition programmes to identify context-specific interventional packages that might help to prioritise the implementation of programmes for reducing stunting in low and middle income countries (LMICs). METHODS:Electronic databases were used to systematically review the literature published between 1980 and 2015. Additional articles were identified from the reference lists and grey literature. Programmes were identified in which nutrition-specific and nutrition-sensitive interventions had been implemented for children under 5 years of age in LMICs. The primary outcome was a change in stunting prevalence, estimated as the average annual rate of reduction (AARR). A realist approach was applied to identify mechanisms underpinning programme success in particular contexts and settings. FINDINGS:Fourteen programmes, which demonstrated reductions in stunting, were identified from 19 LMICs. The AARR varied from 0.6 to 8.4. The interventions most commonly implemented were nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. A programme was considered to have effectively reduced stunting when AARR≥3%. Successful interventions were characterised by a combination of political commitment, multi-sectoral collaboration, community engagement, community-based service delivery platform, and wider programme coverage and compliance. Even for similar interventions the outcome could be compromised if the context differed. INTERPRETATION:For all settings, a combination of interventions was associated with success when they included health and nutrition outcomes and social safety nets. An effective programme for stunting reduction embraced country-level commitment together with community engagement and programme context, reflecting the complex nature of exposures of relevance. PROSPERO REGISTRATION NUMBER:CRD42016043772.

journal_name

Arch Dis Child

journal_title

Archives of disease in childhood

authors

Hossain M,Choudhury N,Adib Binte Abdullah K,Mondal P,Jackson AA,Walson J,Ahmed T

doi

10.1136/archdischild-2016-311050

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

903-909

issue

eissn

0003-9888

issn

1468-2044

pii

archdischild-2016-311050

journal_volume

102

pub_type

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Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review.