Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review

Abstract

Abstractobjectives Malnutrition contributes to paediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aimed to characterise such interventions and their effects on paediatric mortality, anthropometric measures and serum markers of nutrition.methods A systematic search of OVID MEDLINE, Cochrane Library and relevant grey literature was conducted. We included all randomised controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18 years) within a disaster or complex emergency. We extracted study characteristics, interventions and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.results A total of 31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High-and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers.conclusion In disasters and complex emergencies, high variability and low quality of controlled studies on paediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger gaps may offer a generalisable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed.

Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

“…This finding highlights health intervention evidence gaps in conflict IDP settings, thus, supporting the observations from other reviews. 25,66 Conflict-induced displacements are most times complex and hamper humanitarian efforts, 12,67 and from the included studies, factors observed to influence intervention implementation included security, politics, IDP migration and climate seasonal changes. Recommendations by the authors to address the shortage and uneven distribution of interventions included the need for more integrative intervention studies, increased health education and extended research duration to allow for proper monitoring of long-term intervention effects.…”

“…In contrast to findings from other reviews with focus on boarder humanitarian settings and scope, 25,66 only one food and nutrition study met the criteria for this review. This highlighted the gap in interventions related to conflictinduced IDPs.…”

“…46 Rationing is considered an effective method of ensuring whole populations have access to resources offered; however, for food and nutrition interventions, this often requires micronutrient standardization to ensure individual nutritional needs are met. 23 The review by Balhara et al 66 on the impact of nutrition interventions further outlined other effective food-related interventions; these included ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers. Integration of these different options based on specific target groups could improve nutritional outcomes.…”

Crianças menores de 5 anos ainda morrem por desnutrição?

“…4 A study carried out in regions lacking emergency support found that 45% of child deaths in 2011 were directly related to malnutrition. 5 This same study was revealed that malnutrition is likely responsible for up to 23% of infant mortality in refugee populations. 5 In summary, malnutrition is the imbalance between the need for nutrients and the intake of nutrients, and there may be a lack, excess, or disproportion of certain nutrients in the organism, resulting in deficits in energy, protein, or micronutrients.…”

“…5 This same study was revealed that malnutrition is likely responsible for up to 23% of infant mortality in refugee populations. 5 In summary, malnutrition is the imbalance between the need for nutrients and the intake of nutrients, and there may be a lack, excess, or disproportion of certain nutrients in the organism, resulting in deficits in energy, protein, or micronutrients. This may be a result of metabolic deficiencies in which there is a decrease in nutrient absorption or of irregular consumption of nutrients.…”