What Works for Maternal and Child Undernutrition: A Review of the Evidence

Abstract

Background: Policy and programming to improve maternal and child nutrition has become a mainstay of most countries because of the direct implications of nutrition on population health, economic development, and human capital. Since the 2013 Lancet Nutrition series, more evidence on the set of 10 recommended interventions has emerged, along with evidence for newer interventions. This paper primarily aims to determine what works in the current low and middle-income country (LMIC) context to improve maternal and child undernutrition.

Methods: We undertook ten new systematic reviews that examined the impact of direct and indirect nutrition interventions on maternal, newborn, child, and adolescent health and nutrition with a focus on LMICs. We used the PICO methodology to construct our search strategies; appropriate syntax was applied to key words and MeSH terms/key words were combined with Boolean operators. Searches were run in all relevant databases, which varied depending on the research question, and grey literature searches were conducted in Google, Google Scholar, and within websites of key nutrition organizations. Review updates were also undertaken. Results from our reviews and review updates were triangulated with other, high-quality published evidence of intervention effects.

Findings: The updated evidence underscores the effectiveness of the ten interventions recommended in the 2013 Lancet Nutrition Series including periconceptional folic acid supplementation or fortification, maternal balanced energy protein supplementation, maternal calcium supplementation, maternal multiple micronutrient supplementation, promotion of breast feeding, appropriate complementary feeding, vitamin A and preventive zinc supplementation in children 6-59 months of age, and management of severe- and moderate-acute malnutrition. The evidence for antenatal multiple micronutrient supplementation has strengthened, with greater effects on stillbirths and babies born preterm, small for gestational age and with low birthweight compared to iron-folic acid supplementation. Emerging interventions with evidence of effects on child growth outcomes include small-quantity lipid-nutrient supplements for children 6-23 months of age and kangaroo mother care for healthy term and late preterm neonates through facility and community-based approaches. Evidence supports the provision of supplementary food to pregnant women and children residing in food-insecure settings, and community-based approaches to manage children with acute malnutrition with locally produced supplementary and therapeutic food. Indirect nutrition strategies, such as malaria prevention, preconception care, and water, sanitation, and hygiene, may provide nutritional benefits in some settings.

Interpretation: Evidence continues to support the direct nutrition interventions and the indirect health and nutrition interventions recommended in 2013. Additionally, small-quantity lipid-nutrient supplements and kangaroo mother care should be considered for scale up in LMICs to improve growth and micronutrient status. The coverage of priority interventions remains low, especially in contexts where they are needed most. Hence, greater focus and effort are required to improve the reach of these interventions, especially for the most vulnerable populations. There is also a need to develop evidence-based strategies to address undernutrition in school-age children and adolescents.

Funding Statement: This study was funded by the Bill & Melinda Gates Foundation with additional support from the Centre for Global Child Health, the Hospital for Sick Children, Toronto and the Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.

Declaration of Interests: The authors declare that they have no conflicts of interest.

Ethics Approval Statement: Not required.

Keywords: Undernutrition; intervention; efficacy; effectiveness; systematic review; maternal nutrition; child nutrition; adolescent nutrition