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What works? Interventions for maternal and child undernutrition and survival

What works? Interventions for maternal and child undernutrition and survival
What works? Interventions for maternal and child undernutrition and survival
We reviewed interventions that affect maternal and child undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25 (95% CI 0.01-0.49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41 (0.05-0.76). Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0.45, 0.32-0.62), and recent studies suggest that newer commodities, such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. Effective micronutrient interventions for pregnant women included supplementation with iron folate (which increased haemoglobin at term by 12 g/L, 2.93-21.07) and micronutrients (which reduced the risk of low birthweight at term by 16% (relative risk 0.84, 0.74-0.95). Recommended micronutrient interventions for children included strategies for supplementation of vitamin A (in the neonatal period and late infancy), preventive zinc supplements, iron supplements for children in areas where malaria is not endemic, and universal promotion of iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. To eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment
pregnancy, nutritional requirements, management, infancy, diet therapy, nutrition, review, administration & dosage, iron, epidemiology, disease, women, outcomes, growth, mother, mortality, reduction, malnutrition, female, therapeutic use, health promotion, preschool, guidelines, child nutrition disorders, micronutrients, education, birth, poverty, child, cohort, infant, maternal, risk, maternal welfare, undernutrition, humans, deficiency, mothers, food, fortified, children, methods, breast feeding, world health, community, newborn, intrauterine growth
417-440
Bhutta, Z. A.
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Ahmed, T.
0fd9ccd2-14ab-448a-97ca-bce5da041c1e
Black, R. E.
6333963b-a540-4018-a964-45ffc43d8eef
Cousens, S.
8ca157c7-adb4-4104-a059-7bb5f911ed77
Dewey, K.
dc25dbc1-446f-4318-9cdd-619dec3b2788
Giugliani, E.
8f832d46-134d-4f8c-a184-a5c1d2dbedc2
Haider, B. A.
2a98a510-9d8a-40e0-a460-6ea9f4bea7ce
Kirkwood, B.
53ee598b-8eae-415d-b460-51e8eeb0aeea
Morris, S. S.
f04d0062-0e4d-418c-8640-737d722832a3
Sachdev, H. P.
fb1b2723-48bc-469c-9cab-ae966c42b3ed
Shekar, M.
26ae4ce4-47c3-42a0-afcb-7f1db039056e
Bhutta, Z. A.
34a9f09e-d9b2-4b63-97c9-87a1f1b14de9
Ahmed, T.
0fd9ccd2-14ab-448a-97ca-bce5da041c1e
Black, R. E.
6333963b-a540-4018-a964-45ffc43d8eef
Cousens, S.
8ca157c7-adb4-4104-a059-7bb5f911ed77
Dewey, K.
dc25dbc1-446f-4318-9cdd-619dec3b2788
Giugliani, E.
8f832d46-134d-4f8c-a184-a5c1d2dbedc2
Haider, B. A.
2a98a510-9d8a-40e0-a460-6ea9f4bea7ce
Kirkwood, B.
53ee598b-8eae-415d-b460-51e8eeb0aeea
Morris, S. S.
f04d0062-0e4d-418c-8640-737d722832a3
Sachdev, H. P.
fb1b2723-48bc-469c-9cab-ae966c42b3ed
Shekar, M.
26ae4ce4-47c3-42a0-afcb-7f1db039056e

Bhutta, Z. A., Ahmed, T., Black, R. E., Cousens, S., Dewey, K., Giugliani, E., Haider, B. A., Kirkwood, B., Morris, S. S., Sachdev, H. P. and Shekar, M. (2008) What works? Interventions for maternal and child undernutrition and survival. The Lancet, 371 (9610), 417-440. (doi:10.1016/S0140-6736(07)61693-6).

Record type: Article

Abstract

We reviewed interventions that affect maternal and child undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25 (95% CI 0.01-0.49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41 (0.05-0.76). Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0.45, 0.32-0.62), and recent studies suggest that newer commodities, such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. Effective micronutrient interventions for pregnant women included supplementation with iron folate (which increased haemoglobin at term by 12 g/L, 2.93-21.07) and micronutrients (which reduced the risk of low birthweight at term by 16% (relative risk 0.84, 0.74-0.95). Recommended micronutrient interventions for children included strategies for supplementation of vitamin A (in the neonatal period and late infancy), preventive zinc supplements, iron supplements for children in areas where malaria is not endemic, and universal promotion of iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. To eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment

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More information

Published date: 2008
Keywords: pregnancy, nutritional requirements, management, infancy, diet therapy, nutrition, review, administration & dosage, iron, epidemiology, disease, women, outcomes, growth, mother, mortality, reduction, malnutrition, female, therapeutic use, health promotion, preschool, guidelines, child nutrition disorders, micronutrients, education, birth, poverty, child, cohort, infant, maternal, risk, maternal welfare, undernutrition, humans, deficiency, mothers, food, fortified, children, methods, breast feeding, world health, community, newborn, intrauterine growth
Organisations: Dev Origins of Health & Disease

Identifiers

Local EPrints ID: 70291
URI: https://eprints.soton.ac.uk/id/eprint/70291
PURE UUID: c9510241-9e67-45b8-9f5f-eea47408b250

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Date deposited: 28 Jan 2010
Last modified: 05 Oct 2018 12:12

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Contributors

Author: Z. A. Bhutta
Author: T. Ahmed
Author: R. E. Black
Author: S. Cousens
Author: K. Dewey
Author: E. Giugliani
Author: B. A. Haider
Author: B. Kirkwood
Author: S. S. Morris
Author: H. P. Sachdev
Author: M. Shekar

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