Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

Bhutta, Zulfiqar Ahmed; Das, Jai K; Rizvi, Arjumand; Gaffey, Michelle F; Walker, Neff; Horton, Susan; Webb, Patrick; Lartey, Anna; Black, Robert E.

doi:10.1016/s0140-6736(13)60996-4

Cited by 2,292 publications

(2,334 citation statements)

References 145 publications

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“…Strong evidence exists for the efficacy of many nutrition interventions, but the impact of these often falls short of expectations when integrated in programmatic contexts due to gaps in the quality of programme implementation (Bhutta et al, 2013; Habicht & Pelto, 2012; Leroy & Menon, 2008). Micronutrient powders (MNP), a mixture of vitamins and minerals, enclosed in single‐dose sachets, which are stirred into a child's portion of food immediately before consumption, are efficacious to reduce iron deficiency and anaemia in children 6–23 months of age (De‐Regil, Suchdev, Vist, Walleser, & Peña‐Rosas, 2013).…”

Section: Introductionmentioning

confidence: 99%

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Vossenaar¹,

Tumilowicz

D’Agostino

et al. 2017

Maternal & Child Nutrition

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Continual course correction during implementation of nutrition programmes is critical to address factors that might limit coverage and potential for impact. Programme improvement requires rigorous scientific inquiry to identify and address implementation pathways and the factors that affect them. Under the auspices of “The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,” 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powder (MNP) interventions for young children. This paper focuses on how MNP interventions undertook key elements of programme improvement, specifically, the use of programme theory, monitoring, process evaluation, and supportive supervision. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that although much has been written and published about the use of monitoring and process evaluation to inform MNP interventions at small scale, there has been little formal documentation of lessons for the transition from pilot to scaled implementation. Supervision processes and experiences are not documented, and to our knowledge, there is no evidence of whether they have been effective to improve implementation. Improving the efficiency and effectiveness of interventions requires identification of critical indicators for detecting implementation challenges and drivers of impact, integration with existing programmes and systems, strengthened technical capacity, and financing for implementation of effective monitoring systems. Our understanding of programme improvement for MNP interventions is still incomplete, especially outside of the pilot stage, and we propose a set of implementation research questions that require further investigation.

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Section: Introductionmentioning

confidence: 99%

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Vossenaar¹,

Tumilowicz

D’Agostino

et al. 2017

Maternal & Child Nutrition

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“…Intervention across the life course, as well as in the first 1000 days, is thus also indicated. To prevent wasting in children 6–12 months, and chronic malnutrition in children 6–24 months leading to stunting [4], complementary feeding during the transition from breast milk to solid foods could be emphasized or supported with food distribution in this population [9]. …”

Section: Discussionmentioning

confidence: 99%

“…Managing acute malnutrition using WHO guidelines has the potential to save more lives globally than any other existing nutrition intervention; it also could substantially decrease the prevalence of wasting and stunting by allowing child growth to recover to international norms [9]. Inpatient and outpatient treatment of severe and moderate acute malnutrition is part of the WHO Essential Nutrition Actions (ENAs) [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention

McCuskee

Garchitorena

Miller

et al. 2018

Global Health Action

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Background: Child malnutrition, a leading cause of death and disability worldwide, is particularly severe in Madagascar, where 47% of children under 5 years are stunted (low height-for-age) and 8% are wasted (low weight-for-height). Widespread poverty and a weak health system have hindered attempts to implement life-saving malnutrition interventions in Madagascar during critical periods for growth faltering. Objective: This study aimed to shed light on the most important factors associated with child malnutrition, both acute and chronic, and the timing of growth faltering, in Ifanadiana, a rural district of Madagascar. Methods: We analyzed data from a 2014 district-representative cluster household survey, which had information on 1175 children ages 6 months to 5 years. We studied the effect of child health, birth history, maternal and paternal health and education, and household wealth and sanitation on child nutritional status. Variables associated with stunting and wasting were modeled separately in multivariate logistic regressions. Growth faltering was modeled by age range. All analyses were survey-adjusted. Results: Stunting was associated with increasing child age (OR = 1.03 (95%CI 1.02–1.04) for each additional month), very small birth size (OR = 2.32 (1.24–4.32)), low maternal weight (OR = 0.94 (0.91–0.97) for each kilogram, kg) and height (OR = 0.95 (0.92–0.99) for each centimeter), and low paternal height (OR = 0.95 (0.92–0.98)). Wasting was associated with younger child age (OR = 0.98 (0.97–0.99)), very small birth size (OR = 2.48 (1.23–4.99)), and low maternal BMI (OR = 0.84 (0.75–0.94) for each kg/m2). Height-for-age faltered rapidly before 24 months, then slowly until age 5 years, whereas weight-for-height faltered rapidly before 12 months, then recovered gradually until age 5 years but did not reach the median. Conclusion: Intergenerational transmission of growth faltering and early life exposures may be important determinants of malnutrition in Ifanadiana. Timing of growth faltering, in the first 1000 days, is similar to international populations; however, child growth does not recover to the median.

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“…The movement was a response to the 2008 Lancet series on maternal and child nutrition which showed that there was an unacceptably high burden of undernutrition among women and children (2)(3)(4)(5)(6) . The 2008 series and its sequel in 2013 (7)(8)(9)(10) both demonstrated that undernutrition, especially stunting, was clustered in a few high burden countries. The series further identified the existence of proven nutrition-specific interventions which should be implemented at scale, together with the other nutritionsensitive strategies in a policy environment which calls for partnerships in efforts across implementing agencies.…”

Section: The Scaling Up Nutrition Movementmentioning

confidence: 99%

Capacity for scaling up nutrition: a focus on pre-service training in West Africa and a Ghanaian case study

et al. 2015

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The 2013 Lancet series on maternal and child nutrition is identified and advocated for improved institutional and human capacity in nutrition towards scaling up nutrition (SUN) in countries with high stunting rates. Of the fifty-four countries with high burden of child undernutrition who have committed to the SUN movement, thirty-six are in Africa. In the present paper, the academic platform of the SUN movement in Ghana presents an overview of nutrition pre-service capacity in West Africa with a focus on Ghana. The present paper is based on the findings of a sub-region-wide assessment of degree programmes in nutrition in West Africa, plus another report on pre-service nutrition capacity in diploma awarding nursing and nutrition programmes in Ghana. Although there is inadequate evidence on pre-service nutrition training in the sub-region, the two reports provide useful evidence for action, including inadequate number and distribution of pre-service nutrition training programmes, low nutrition graduate output, poor quality of the programme curriculum and instruction, and sub-optimal capital investment. The present paper calls for urgent action to improve pre-service nutrition capacity building as a critical step towards SUN in West Africa.

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Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

Cited by 2,292 publications

References 145 publications

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention

Capacity for scaling up nutrition: a focus on pre-service training in West Africa and a Ghanaian case study

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