Evaluation of the impact of a nutritional program for undernourished children in Brazil

Abstract

To assess the effectiveness on child growth and body composition of a supplementary feeding program (Milk Supplement Program), a prospective, controlled study was conducted in Northeast Brazil. When entering the Program, children from 10 municipalities with the highest coverage rates in the Program (intervention group) were compared to non-beneficiary children from 10 municipalities with the lowest coverage rates (control group). A total of 219 children aged 6-18 months were enrolled. At entry, both groups were comparable in terms of age, sex, and nutritional status. There were frequent gaps in delivery of the supplement, no extra milk was provided to siblings less than 5 years of age, intra-household redistribution of milk was high, and maternal compliance with recommendations was low. Adjusted analyses by multilevel modelling showed average changes in weight, length, weight-age and length-age Z-scores, and % body water (deuterium method), at 6 months, of 1.53kg, 6.34cm, 0.33, 0.05, and 1.11% respectively among supplemented children as compared to 1.54kg, 6.5cm, 0.26, 0.07, and 4.10% among controls, with no statistically significant difference between groups. Thus, the Program failed to compensate for nutritional deficiencies in undernourished children in Northeast Brazil.

Efetividade da Estratégia Nacional para Alimentação Complementar Saudável na melhoria da alimentação complementar de lactentes em um município do Sul do Brasil

“…Destacamos a metanálise realizada por Sunguya et al 35 , que comprovou que a capacitação em nutrição dos profissionais de saúde melhorou a ingestão de energia, a frequência alimentar e a diversidade da dieta de crianças de 6 a 24 meses. Os autores concluíram que profissionais de saúde capacitados em nutrição infantil oferecem 36,37 . Sabe-se que o consumo elevado de alimentos não saudáveis na infância pode acarretar várias doenças, como deficiência de micronutrientes 38,39 , obesidade 40,41 , dislipidemias 42 e hipertensão arterial 43,44,45 .…”

Supplementary feeding for improving the health of disadvantaged infants and children: what works and why?

“…The proportion of the child's daily recommended intake of energy provided by the supplementary food varied widely, from 8% to 136%. Seven of the programmes 4,[30][31][32][33][34][35] provided additional rations for the family (to reduce redistribution of the child's supplement).…”

“…Analysis of quasi-experimental studies did not find significant differences in child growth between programmes delivered in centres compared to homes (although gains in growth were larger when programmes were delivered at a daycare centre or preschool). 28,32,41,71,72,77,78 Another option for programme design is to provide the supplementary food in the home, but also incorporate a variety of design features to reduce the likelihood that food will be distributed to other family members instead of the targeted child. Some programmes gave the family extra rations to reduce sharing of supplementary foods.…”

“…Comparing studies with strict supervision and those with moderate supervision showed mixed results, but the studies with strict supervision were the only ones to show a significant effect on child height. 25,26,30,32,36,72,74,[79][80][81] …”

Supplementary feeding for improving the health of disadvantaged infants and young children

“…In one study, 50% of the caregivers reported 'gaps in delivery''; 36% reported that these gaps occurred more than twice. 101 One of the studies that did not meet the eligibility criteria for the Cochrane review (but which provided important data for wider theory-building) reported that in India, supplies failed to reach those who delivered the programme 20-30% of the time. 64 In low-resource settings, trained staff may be in short supply.…”