PROTOCOL: Efficacy and effectiveness of micronutrient supplementation and fortification interventions on the health and nutritional status of children under-five in low and middle-income countries: a systematic review

Micronutrient Supplementation and Fortification Interventions on Health and Development Outcomes among Children Under-Five in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Micronutrient deficiencies continue to be widespread among children under-five in low- and middle-income countries (LMICs), despite the fact that several effective strategies now exist to prevent them. This kind of malnutrition can have several immediate and long-term consequences, including stunted growth, a higher risk of acquiring infections, and poor development outcomes, all of which may lead to a child not achieving his or her full potential. This review systematically synthesizes the available evidence on the strategies used to prevent micronutrient malnutrition among children under-five in LMICs, including single and multiple micronutrient (MMN) supplementation, lipid-based nutrient supplementation (LNS), targeted and large-scale fortification, and point-of-use-fortification with micronutrient powders (MNPs). We searched relevant databases and grey literature, retrieving 35,924 papers. After application of eligibility criteria, we included 197 unique studies. Of note, we examined the efficacy and effectiveness of interventions. We found that certain outcomes, such as anemia, responded to several intervention types. The risk of anemia was reduced with iron alone, iron-folic acid, MMN supplementation, MNPs, targeted fortification, and large-scale fortification. Stunting and underweight, however, were improved only among children who were provided with LNS, though MMN supplementation also slightly increased length-for-age z-scores. Vitamin A supplementation likely reduced all-cause mortality, while zinc supplementation decreased the incidence of diarrhea. Importantly, many effects of LNS and MNPs held when pooling data from effectiveness studies. Taken together, this evidence further supports the importance of these strategies for reducing the burden of micronutrient malnutrition in children. Population and context should be considered when selecting one or more appropriate interventions for programming.

Faktor Risiko Stunting pada anak di Negara Berkembang

Background: The problem of stunting occurs in developing countries including Indonesia. In Indonesia the prevalence of child stunting is 30.8%, still above the world prevalence, which is 22.2%. The prevalence of stunting in sub-Saharan Africa is 34.5%, in Ethiopia is 52.4%, and the prevalence of stunting in Congo is 40%. While WHO stipulates that nutrition problems should not exceed 20%. Stunting could inhibit linear growth, development and degenerative diseases later in adulthood.Objective: This review discussed the risk factors of child stunting in developing countries.Discusion: One of the causes of increased stunting in children was due to inadequate nutritional intake in a long period. Stunting was often not realized by parents and only visible after the age of 2 due to low stature. Based on the results of the literature review the likelihood of stunting in developing country were: 16.43 times morelikely due to low birth length, 3.27 times higher due to maternal education, 2.45 times higher if the children were living in rural area, 4.5 times higher due to low birth weight, no risk Antenatal Care increase the risk 3.4 times, 6.38 times higher due to no immunization, and no exclusive breastfeeding increase the risk of stunting 4.0 times.Conclusion: The risk factor for child stunting in developing countries are exclusive breastfeeding, socioeconomic, low birth weight, length of birth, low maternal education, infectious disease.ABSTRAKLatar Belakang: Masalah stunting (stunting) yang terjadi di Negara Berkembang seperti Indonesia masih tinggi yaitu 30,8% masih  di atas dunia yaitu 22,2%.  Stunting di sub sahara Afrika 34,5%, di Ethiopia  52,4%, prevalensi stunting di Congo 40%. Word Health Organization sudah menentukan bahwa terjadinya masalah gizi suatu negara sebaiknya kurang dari 20%. Stunting memiliki risiko gangguan pertumbuhan, perkembangan dan penyakit degeneratif pada usia dewasa nanti.Tujuan: Review ini bertujuan untuk mengidentifikasi faktor risikos apa saja yang dapat menentukan terjadinya stunting anak di Negara berkembang.Ulasan: Berdasarkan dari beberapa hasil penelitian menyebutkan bahwa salah satu penyebab stunting pada anak adalah karena tidak terpenuhinya gizi yang baik pada kurun waktu yang panjang dan sering kali tidak disadari oleh orang tuanya sehingga setelah anak usia di atas 2 tahun baru terlihat bahwa anaknya mengalami stunting. Berdasarkan hasil literatur review menunjukkan bahwa faktor risiko terjadinya stunting adalah panjang lahir berisiko 16,43 kali, pendidikan ibu yang rendah berisiko 3,27 kali, serta anak yang tinggal di desa berisiko 2,45 kali,  BBLR berisiko 4,5 kali, tidak ANC berisiko 3,4 kali, tidak imunisasi berisiko 6,38 kali, dan tidak ASI Eksklusif berisiko 4,0 kali  adalah merupakan faktor risiko  stunting anak di negara berkembang.Kesimpulan: Hasil sintesis ini secara konsisten yang menjadi faktor risikos terjadinya stunting pada anak di negara berkembang adalah tidak diberikan ASI eksklusif, sosial ekonomi, berat bayi lahir rendah, panjang lahir, pendidikan ibu rendah, penyakit infeksi.