Effectiveness of interventions to manage acute malnutrition in children under 5 years of age in low‐ and middle‐income countries: A systematic review

Abstract

Background Childhood malnutrition is a major public health concern as it is associated with significant short‐ and long‐term morbidity and mortality. Objectives To comprehensively review the evidence for the management of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) according to the current World Health Organization protocol using facility‐ and community‐based approaches as well as the effectiveness of ready‐to‐use therapeutic food (RUTF), ready‐to‐use supplementary food (RUSF), prophylactic antibiotic use and vitamin A supplementation. Search methods We searched relevant electronic databases till 11 February 2019. No date or language restrictions were applied. Selection criteria We included randomised controlled trials (RCTs) and quasi‐experimental studies including controlled before‐after (CBA) studies and interrupted time series (ITS) studies. Data collection and analysis Two review authors independently screened studies for relevance, extracted data, assessed risk of bias and rated the quality of the evidence using the GRADE approach. We carried out statistical analysis using Review Manager software and set out the main findings of the review in “Summary of findings” tables. Main results This review summarises findings from a total of 42 studies (48 papers) including 35,017 children. Thirty‐three of the included studies were RCTs; six studies were quasi‐experimental and three studies were cost studies. Majority of the studies were judged to be at high risk of bias for blinding of the participants, personnel and outcome assessment. Majority of the outcomes were rated as either moderate or low quality. Outcomes were downgraded mainly due to study limitations, high heterogeneity, imprecision and small sample size. Community‐based strategies to screen and manage SAM/MAM versus no community‐based strategies (two studies): Integrated community‐based management probably improves recovery rate by 4% [risk ratio (RR): 1.04; 95% confidence interval (CI): 1.00 to 1.09; one study; 1,957 participants; moderate‐quality outcome], and reduces weight gain by 0.8 g·kg−1·day−1 [mean difference (MD): −0.80 g·kg−1·day−1; 95% CI: −0.82 to −0.78; one study; 1,957 participants; moderate‐quality outcome] compared with no community‐based strategies, while mortality was similar between the two groups (RR: 0.93; 95% CI: 0.60 to 1.45; one study; 1,957 participants; moderate‐quality outcome). Facility‐based strategies to screen and manage uncomplicated SAM versus other standard of care (four studies): There was no evidence of effect on recovery (RR: 1.00; 95% CI: 0.80, 1.25; one study; 60 participants; very‐low‐quality evidence) and mortality (RR: 1.21; 95% CI: 0.75 to 1.94; two studies; 473 participants; low‐quality outcome). Facility‐based management with RUTF versus F100 (“catch‐up” formula to rebuild wasted tissues containing 100 kcal and 2.9 g protein per 100 ml) for SAM (three studies): There was no evidence of effect on weight gain (MD: 2 g·kg−1·day−1; 95% CI: −0.23 to 4.23; three studies; 266 part...

The effect of Clarias cookies on the growth and development of wasting children

“…By involving various sectors such as agriculture, education, and social welfare, a comprehensive approach can be developed to tackle the underlying causes of malnutrition and ensure the holistic wellbeing of children under five. 45,46 Primary health workers are crucial in controlling malnutrition in children under five years of age because they are often the first to encounter health-related issues outside their homes. These health workers play a vital role in identifying and diagnosing malnutrition at an early stage, allowing for timely intervention and treatment.…”

Soya-maize-sorghum ready-to-use therapeutic food (SMS-RUTF) for the management of severe acute malnutrition among children: A systematic review and meta-analysis

“…Childhood malnutrition presents a significant public health challenge, as it is being associated with notable morbidity and mortality [1]. The consequences of malnutrition may manifest in a short or term, leading to issues like illness, death, and disability [2].…”

The Comparative Effect Between Pellets and Porridge Made from Local Ingredients on Body Weight of Rats with Protein-Energy Deficiency

“…Toddlers with PED are a major public health problem that causes significant morbidity and mortality in the long term (Das et al, 2020). Sensitive and specific nutritional interventions can reduce these risks and improve their health (Ruel and Alderman, 2013).…”