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

Abstract

ObjectiveWe 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).MethodsElectronic 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.FindingsFourteen 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.InterpretationFor 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 numberCRD42016043772.

As tall as my peers – similarity in body height between migrants and hosts

“…The 6 interventions with a positive impact on stunting had small effects, with the mean improvement close to the typical value for measurement error. Another systematic review evaluated the effectiveness of urban and rural health and nutrition programmes in low income nations to prevent stunting of under-5 year old infants and children (Hossain et al 2017). Literature between 1980 and 2015 was searched and only 14 programmes were identified that effectively reduced stunting based on the criteria of an annual rate of reduction ≥ 3%.…”

Socio-demographic factors associated with normal linear growth among pre-school children living in better-off households: A multi-country analysis of nationally representative data

“…Working with international partners such as World Health Organisation (WHO) and United Nations Children's Fund (UNICEF), governments in SSA have put in place various interventions to improve child growth by addressing stunting in the region [4,5]. However, the implementation of these programmes tends to focus more on child growth deficiencies and how to protect children against risk factors of growth deficiencies [6,7]. Therefore, it may be difficult to directly attribute the effects of the programmes on child healthy growth outcomes, except to infer that reduction in stunting implies an increase in healthy growth.…”

The association between malnutrition and childhood disability in low‐ and middle‐ income countries: systematic review and meta‐analysis of observational studies

“…For instance, Hossain et al . recently showed programmes that effectively reduced stunting in LMIC most commonly implemented interventions of nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. These approaches will require strengthening of the public health services to be effective.…”

“…There is a lack of robust evidence available on what works, and so best in class interventions that prevent malnutrition in children should be assessed for effectiveness for children with disabilities in LMIC [57]. For instance, Hossain et al [35] recently showed programmes that effectively reduced stunting in LMIC most commonly implemented interventions of nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. These approaches will require strengthening of the public health services to be effective.…”