Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review
Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review
Objective: We 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).
Methods: Electronic 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.
Findings: Fourteen 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.
Interpretation: For 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.
903-909
Hossain, Muttaquina
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Choudhury, Nuzhat
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Abdullah, Khaleda Adib Binte
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Mondal, Prasenjit
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Jackson, Alan A.
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Walson, Judd
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Ahmed, Tahmeed
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October 2017
Hossain, Muttaquina
22374aec-ce76-4f93-8aa5-292055e9743f
Choudhury, Nuzhat
2bc5dd16-f332-49ec-94fb-d0f8c1d15290
Abdullah, Khaleda Adib Binte
4dcb9d9e-b635-4175-a146-95d18e49e42b
Mondal, Prasenjit
afcdf0a6-e069-418d-af2c-0f7d03211043
Jackson, Alan A.
c9a12d7c-b4d6-4c92-820e-890a688379ef
Walson, Judd
a68edced-927a-4dcf-a0a6-ec3b7fa9fe20
Ahmed, Tahmeed
d26ebe86-7732-4409-b059-f88b5b309732
Hossain, Muttaquina, Choudhury, Nuzhat, Abdullah, Khaleda Adib Binte, Mondal, Prasenjit, Jackson, Alan A., Walson, Judd and Ahmed, Tahmeed
(2017)
Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review.
Archives of Disease in Childhood, 102 (10), .
(doi:10.1136/archdischild-2016-311050).
Abstract
Objective: We 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).
Methods: Electronic 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.
Findings: Fourteen 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.
Interpretation: For 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.
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Accepted/In Press date: 2 December 2016
e-pub ahead of print date: 27 April 2017
Published date: October 2017
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Local EPrints ID: 443359
URI: http://eprints.soton.ac.uk/id/eprint/443359
ISSN: 0003-9888
PURE UUID: 0c90986e-3b90-4332-8b31-addd7061c5c9
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Date deposited: 21 Aug 2020 16:30
Last modified: 16 Mar 2024 09:01
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Contributors
Author:
Muttaquina Hossain
Author:
Nuzhat Choudhury
Author:
Khaleda Adib Binte Abdullah
Author:
Prasenjit Mondal
Author:
Judd Walson
Author:
Tahmeed Ahmed
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