1
|
Herrera DJ, Herrera ML, Amora D, Bas S, Miranda CA, Van Hal G. Mixed-method study on the association between inclusion to conditional cash transfer program and the multiple faces of malnutrition in children and adolescents aged 3 to 19 years: a school-based evidence from Caraga Region, the Philippines. BMC Pediatr 2023; 23:630. [PMID: 38093230 PMCID: PMC10717276 DOI: 10.1186/s12887-023-04438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND This study aimed to investigate the association between inclusion to Pantawid Pamilyang Pilipino Program (4Ps), a CCT program in the Philippines, and malnutrition in children and adolescents and examine the perceptions and experiences of parents and other stakeholders on how 4Ps influenced child nutrition. METHODS A concurrent mixed-method study was conducted in the Caraga Region, Philippines. Quantitative data from 5541 children and adolescents aged 3 to 19 were analyzed using multilevel mixed-effect logistic models. To allow in-depth understanding of the programmatic components that support the findings from the quantitative study, eight focused group discussions (FGDs) were concurrently conducted, cumulating 33 participants, including 4Ps parents, school coordinators/teachers, and school nurses. A constructivist grounded theory approach was used for analysis, and joint displays were employed to integrate quantitative and qualitative results. RESULTS Quantitative findings revealed high rates of malnutrition, with significant rates of stunting (12.0%), wasting/thinness (9.4%), and overweight/obesity (16.4%) among children and adolescents. 4Ps beneficiaries had higher odds of stunting and overweight/obesity compared to non-4Ps beneficiaries (AOR = 1.43, 95%CI: 1.08-1.91; AOR = 1.21, 95%CI: 1.01-1.45, respectively). However, no significant association was observed between inclusion to 4Ps and concurrent stunting and wasting/thinness or overweight/obesity (AOR = 1.05, 95%CI: 0.72-1.55). Geographic variations were observed, with 4Ps children in Agusan del Sur having lower odds of stunting than those in Agusan del Norte (AOR = 0.41, 95%CI: 0.23-0.71). Age and gender also showed significant associations with malnutrition. The qualitative analysis provided insights into the challenges contributing to malnutrition, including child labor, sickness, long distances to school, limited access to healthy food, and larger families. Unintended consequences such as cash card mismanagement, inappropriate cash grant allocation, and falsification of school attendance were identified. However, teachers and parents demonstrated resilience by implementing adaptive approaches to enhance child nutrition. CONCLUSIONS While 4Ps beneficiaries exhibit higher odds of stunting and overweight/obesity, the program's association with malnutrition was significantly influenced by geographic variations. It is crucial for social protection programs to prioritize comprehensive support strategies that effectively counter unintended consequences and challenges faced by beneficiaries and other stakeholders and address malnutrition in children and adolescents.
Collapse
Affiliation(s)
- Deborah Jael Herrera
- Family Medicine and Population Health Department, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Miraluna L Herrera
- Action for Greater Advancement of Knowledge (AGAK) Center, Caraga State University, Agusan del Norte, Butuan City, Philippines
| | - Donnacham Amora
- Department of Medical Technology, Agusan del Norte, Butuan Doctors College, Butuan City, Philippines
| | - Sherlyn Bas
- Action for Greater Advancement of Knowledge (AGAK) Center, Caraga State University, Agusan del Norte, Butuan City, Philippines
| | - Caryl Aya Miranda
- Action for Greater Advancement of Knowledge (AGAK) Center, Caraga State University, Agusan del Norte, Butuan City, Philippines
| | - Guido Van Hal
- Family Medicine and Population Health Department, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
2
|
Barnett I, Meeker J, Roelen K, Nisbett N. Behaviour change communication for child feeding in social assistance: A scoping review and expert consultation. MATERNAL & CHILD NUTRITION 2022; 18:e13361. [PMID: 35502622 PMCID: PMC9218306 DOI: 10.1111/mcn.13361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
To increase the effectiveness of social assistance on child nutrition, programmes are increasingly combined with behaviour change communication for improved infant and young child feeding (BCC for IYCF). Unfortunately, there is limited knowledge about which BCC strategies are most effective when combined with social assistance. A systematic scoping review and an expert consultation was conducted to (1) describe the landscape of BCC for IYCF strategies used in social assistance within low- and middle-income countries and (2) to examine the effects of these BCC strategies on IYCF practices and child nutrition. Ten quantitative, three qualitative and four mixed methods studies were reviewed and complemented by 12 expert consultations carried out between August and October 2020. In most of the studies attendance in BCC for IYCF was conditional for receiving social assistance, although experts agreed that this conditionality may be counterproductive. A variety of BCC strategies were used with two being most common-group sessions with pre-determined topics and individual counselling. Context-specific adaptation, interactive delivery and building on existing IYCF knowledge emerged as crucial but was perceived as economically infeasible in social assistance programmes. Given the variety of BCC strategies and inconsistency in outcomes, it is impossible to draw conclusions regarding effectiveness. Nevertheless, tentative evidence suggests that the promotion of existing nutrition services, educational group sessions and individual counselling may be effective in improving IYCF. BCC for IYCF can make social assistance more beneficial, but may increase costs, demands on beneficiaries, and deviate from the original focus of the programmes.
Collapse
Affiliation(s)
- Inka Barnett
- Institute of Development Studies (IDS)University of SussexBrightonUK
| | - Jessica Meeker
- Institute of Development Studies (IDS)University of SussexBrightonUK
| | - Keetie Roelen
- Institute of Development Studies (IDS)University of SussexBrightonUK
| | - Nick Nisbett
- Institute of Development Studies (IDS)University of SussexBrightonUK
| |
Collapse
|
3
|
Aizawa T. Do cash transfers increase nutritional intakes? Experimental evidence from an unconditional cash transfer in Kenya. Health Policy Plan 2021; 35:784-798. [PMID: 32504088 DOI: 10.1093/heapol/czaa030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2020] [Indexed: 11/14/2022] Open
Abstract
Malnutrition due to persistent food insecurity has been a serious public health issue in Kenya. An unconditional cash transfer programme, the Hunger Safety Net Programme (HSNP), was launched in 2009 in northern Kenya to reduce extreme poverty and to mitigate food insecurity. This study investigates the impact of the HSNP, on expenditure on food, types of food consumed and nutritional intake. Focusing on nutritional intake as well as spending and consumption is important because an unconditional cash transfer, which does not specify how the transferred money must be used, does not guarantee nutritional intake improvement. Converting food consumption data to caloric intake and nutrient content using food consumption databases, we calculate the intake of five macro-nutrients, seven vitamins and seven minerals and then estimate the impacts on nutritional intake 12 and 24 months after treatment exposure. This study finds the increased total expenditure on food items. Specifically, the beneficiary households increased their expenditure on milk and milk products and that on sugar after 12 months and expenditure on roots and tubers after 24 months. For consumption amounts, however, the HSNP did not show significant increases in all food categories except sugar. On the other hand, the HSNP improved the nutritional intakes of some macro- and micro-nutrients. The results show that beneficiary households substantially increased their intake of fat by 25.2% after 24 months and their intake of vitamin B12 by 36.6% and calcium by 34.9% after 12 months. The result does not yield sufficiently strong evidence that poorer households significantly enjoy greater improvements than other households.
Collapse
Affiliation(s)
- Toshiaki Aizawa
- Department of Economics and Related Studies, University of York, York YO10 5DD, UK
| |
Collapse
|
4
|
Khan GN, Kureishy S, Ariff S, Habib MA, Usmani AA, Mubarik A, Hussain M, Akbar N, Rodriguez de Castro P, Garzon AC, de Pee S, Soofi SB. Specialized Nutritious Food Combined With Cash Transfers and Social and Behavior Change Communication to Prevent Stunting Among Children Aged 6 to 23 Months in Pakistan: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19001. [PMID: 32831183 PMCID: PMC7477667 DOI: 10.2196/19001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 11/22/2022] Open
Abstract
Background In Pakistan, the prevalence of stunting in children younger than 5 years has remained above global critical levels over the past two decades, with the stunting rate being 40.2% in 2018. Children living in rural areas and in the poorest households suffer the most from stunting across the country—43.2% in rural areas and 51.4% in the lowest wealth quintile. As a continuing public health concern, it is essential that stunting prevention is a national priority in order to ensure human capital development, especially among the poorest households. Objective The primary objective of this study is to determine the effect of a medium quantity of a lipid-based nutrient supplement (LNS) combined with unconditional cash transfers and social and behavior change communication (SBCC) on reduction of stunting in children aged 6 to 23 months. Methods A 5-arm cluster randomized controlled trial will be conducted in the district of Rahim Yar Khan in Punjab, Pakistan. The intervention packages will be (1) cash only, (2) cash with LNS, (3) cash with SBCC, and (4) cash with SBCC and LNS. The control arm will receive routine standard of care. We will enroll children at 6 months of age and follow up on a monthly basis up to 24 months of age. A total of 2000 children, 400 in each arm, will be enrolled to detect a 20% reduction in the prevalence of stunting among children aged 24 months. Length, weight, food intake, compliance to interventions, morbidities, and other relevant data will be collected at enrollment and on a monthly basis over the period of 18 months. The process evaluation will assess acceptability of the interventions and potential barriers to implementation through focus group discussions and in-depth interviews with the target population and relevant stakeholders. Furthermore, a cost analysis will be conducted to assess the cost-effectiveness of each intervention package. Results The study protocol was approved by the Ethics Review Committee of Aga Khan University in Pakistan on January 4, 2017. Data collection began in May 2017 and was completed in July 2019. Data analyses are yet to be completed. This study will explore the effectiveness of intervention packages comprised of cash transfers from Benazir Income Support Programme with or without additional LNS and SBCC in preventing childhood stunting. We expect the results to be published in peer-reviewed journals by autumn of 2020. Conclusions The findings of this trial will provide robust evidence as to which intervention packages can have significant effects on linear growth of children and design effective intervention packages to prevent stunting in children aged 6 to 23 months. Trial Registration ClinicalTrials.gov NCT03299218; https://clinicaltrials.gov/ct2/show/NCT03299218 International Registered Report Identifier (IRRID) DERR1-10.2196/19001
Collapse
Affiliation(s)
- Gul Nawaz Khan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Atif Habib
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Masawar Hussain
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Naveed Akbar
- Benazir Income Support Programme, Government of Pakistan, Islamabad, Pakistan
| | | | | | | | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
5
|
Durao S, Visser ME, Ramokolo V, Oliveira JM, Schmidt BM, Balakrishna Y, Brand A, Kristjansson E, Schoonees A. Community-level interventions for improving access to food in low- and middle-income countries. Cochrane Database Syst Rev 2020; 8:CD011504. [PMID: 32761615 PMCID: PMC8890130 DOI: 10.1002/14651858.cd011504.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND After decades of decline since 2005, the global prevalence of undernourishment reverted and since 2015 has increased to levels seen in 2010 to 2011. The prevalence is highest in low- and middle-income countries (LMICs), especially Africa and Asia. Food insecurity and associated undernutrition detrimentally affect health and socioeconomic development in the short and long term, for individuals, including children, and societies. Physical and economic access to food is crucial to ensure food security. Community-level interventions could be important to increase access to food in LMICs. OBJECTIVES To determine the effects of community-level interventions that aim to improve access to nutritious food in LMICs, for both the whole community and for disadvantaged or at-risk individuals or groups within a community, such as infants, children and women; elderly, poor or unemployed people; or minority groups. SEARCH METHODS We searched for relevant studies in 16 electronic databases, including trial registries, from 1980 to September 2019, and updated the searches in six key databases in February 2020. We applied no language or publication status limits. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster randomised controlled trials (cRCTs) and prospective controlled studies (PCS). All population groups, adults and children, living in communities in LMICs exposed to community-level interventions aiming to improve food access were eligible for inclusion. We excluded studies that only included participants with specific diseases or conditions (e.g. severely malnourished children). Eligible interventions were broadly categorised into those that improved buying power (e.g. create income-generation opportunities, cash transfer schemes); addressed food prices (e.g. vouchers and subsidies); addressed infrastructure and transport that affected physical access to food outlets; addressed the social environment and provided social support (e.g. social support from family, neighbours or government). DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts, and full texts of potentially eligible records, against the inclusion criteria. Disagreements were resolved through discussion or arbitration by a third author, if necessary. For each included study, two authors independently extracted data and a third author arbitrated disagreements. However, the outcome data were extracted by one author and checked by a biostatistician. We assessed risk of bias for all studies using the Effective Practice and Organization of Care (EPOC) risk of bias tool for studies with a separate control group. We conducted meta-analyses if there was a minimum of two studies for interventions within the same category, reporting the same outcome measure and these were sufficiently homogeneous. Where we were able to meta-analyse, we used the random-effects model to incorporate any existing heterogeneity. Where we were unable to conduct meta-analyses, we synthesised using vote counting based on effect direction. MAIN RESULTS We included 59 studies, including 214 to 169,485 participants, and 300 to 124, 644 households, mostly from Africa and Latin America, addressing the following six intervention types (three studies assessed two different types of interventions). Interventions that improved buying power: Unconditional cash transfers (UCTs) (16 cRCTs, two RCTs, three PCSs): we found high-certainty evidence that UCTs improve food security and make little or no difference to cognitive function and development and low-certainty evidence that UCTs may increase dietary diversity and may reduce stunting. The evidence was very uncertain about the effects of UCTs on the proportion of household expenditure on food, and on wasting. Regarding adverse outcomes, evidence from one trial indicates that UCTs reduce the proportion of infants who are overweight. Conditional cash transfers (CCTs) (nine cRCTs, five PCSs): we found high-certainty evidence that CCTs result in little to no difference in the proportion of household expenditure on food and that they slightly improve cognitive function in children; moderate-certainty evidence that CCTs probably slightly improve dietary diversity and low-certainty evidence that they may make little to no difference to stunting or wasting. Evidence on adverse outcomes (two PCSs) shows that CCTs make no difference to the proportion of overweight children. Income generation interventions (six cRCTs, 11 PCSs): we found moderate-certainty evidence that income generation interventions probably make little or no difference to stunting or wasting; and low-certainty evidence that they may result in little to no difference to food security or that they may improve dietary diversity in children, but not for households. Interventions that addressed food prices: Food vouchers (three cRCTs, one RCT): we found moderate-certainty evidence that food vouchers probably reduce stunting; and low-certainty evidence that that they may improve dietary diversity slightly, and may result in little to no difference in wasting. Food and nutrition subsidies (one cRCT, three PCSs): we found low-certainty evidence that food and nutrition subsidies may improve dietary diversity among school children. The evidence is very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food (very low-certainty evidence). Interventions that addressed the social environment: Social support interventions (one cRCT, one PCS): we found moderate-certainty evidence that community grants probably make little or no difference to wasting; low-certainty evidence that they may make little or no difference to stunting. The evidence is very uncertain about the effects of village savings and loans on food security and dietary diversity. None of the included studies addressed the intervention category of infrastructure changes. In addition, none of the studies reported on one of the primary outcomes of this review, namely prevalence of undernourishment. AUTHORS' CONCLUSIONS The body of evidence indicates that UCTs can improve food security. Income generation interventions do not seem to make a difference for food security, but the evidence is unclear for the other interventions. CCTs, UCTs, interventions that help generate income, interventions that help minimise impact of food prices through food vouchers and subsidies can potentially improve dietary diversity. UCTs and food vouchers may have a potential impact on reducing stunting, but CCTs, income generation interventions or social environment interventions do not seem to make a difference on wasting or stunting. CCTs seem to positively impact cognitive function and development, but not UCTs, which may be due to school attendance, healthcare visits and other conditionalities associated with CCTs.
Collapse
Affiliation(s)
- Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Marianne E Visser
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vundli Ramokolo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Amanda Brand
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
6
|
Durao S, Visser ME, Ramokolo V, Oliveira JM, Schmidt BM, Balakrishna Y, Brand A, Kristjansson E, Schoonees A. Community-level interventions for improving access to food in low- and middle-income countries. Cochrane Database Syst Rev 2020; 7:CD011504. [PMID: 32722849 PMCID: PMC7390433 DOI: 10.1002/14651858.cd011504.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND After decades of decline since 2005, the global prevalence of undernourishment reverted and since 2015 has increased to levels seen in 2010 to 2011. The prevalence is highest in low- and middle-income countries (LMICs), especially Africa and Asia. Food insecurity and associated undernutrition detrimentally affect health and socioeconomic development in the short and long term, for individuals, including children, and societies. Physical and economic access to food is crucial to ensure food security. Community-level interventions could be important to increase access to food in LMICs. OBJECTIVES To determine the effects of community-level interventions that aim to improve access to nutritious food in LMICs, for both the whole community and for disadvantaged or at-risk individuals or groups within a community, such as infants, children and women; elderly, poor or unemployed people; or minority groups. SEARCH METHODS We searched for relevant studies in 16 electronic databases, including trial registries, from 1980 to September 2019, and updated the searches in six key databases in February 2020. We applied no language or publication status limits. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster randomised controlled trials (cRCTs) and prospective controlled studies (PCS). All population groups, adults and children, living in communities in LMICs exposed to community-level interventions aiming to improve food access were eligible for inclusion. We excluded studies that only included participants with specific diseases or conditions (e.g. severely malnourished children). Eligible interventions were broadly categorised into those that improved buying power (e.g. create income-generation opportunities, cash transfer schemes); addressed food prices (e.g. vouchers and subsidies); addressed infrastructure and transport that affected physical access to food outlets; addressed the social environment and provided social support (e.g. social support from family, neighbours or government). DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts, and full texts of potentially eligible records, against the inclusion criteria. Disagreements were resolved through discussion or arbitration by a third author, if necessary. For each included study, two authors independently extracted data and a third author arbitrated disagreements. However, the outcome data were extracted by one author and checked by a biostatistician. We assessed risk of bias for all studies using the Effective Practice and Organization of Care (EPOC) risk of bias tool for studies with a separate control group. We conducted meta-analyses if there was a minimum of two studies for interventions within the same category, reporting the same outcome measure and these were sufficiently homogeneous. Where we were able to meta-analyse, we used the random-effects model to incorporate any existing heterogeneity. Where we were unable to conduct meta-analyses, we synthesised using vote counting based on effect direction. MAIN RESULTS We included 59 studies, including 214 to 169,485 participants, and 300 to 124, 644 households, mostly from Africa and Latin America, addressing the following six intervention types (three studies assessed two different types of interventions). Interventions that improved buying power: Unconditional cash transfers (UCTs) (16 cRCTs, two RCTs, three PCSs): we found high-certainty evidence that UCTs improve food security and make little or no difference to cognitive function and development and low-certainty evidence that UCTs may increase dietary diversity and may reduce stunting. The evidence was very uncertain about the effects of UCTs on the proportion of household expenditure on food, and on wasting. Regarding adverse outcomes, evidence from one trial indicates that UCTs reduce the proportion of infants who are overweight. Conditional cash transfers (CCTs) (nine cRCTs, five PCSs): we found high-certainty evidence that CCTs result in little to no difference in the proportion of household expenditure on food and that they slightly improve cognitive function in children; moderate-certainty evidence that CCTs probably slightly improve dietary diversity and low-certainty evidence that they may make little to no difference to stunting or wasting. Evidence on adverse outcomes (two PCSs) shows that CCTs make no difference to the proportion of overweight children. Income generation interventions (six cRCTs, 11 PCSs): we found moderate-certainty evidence that income generation interventions probably make little or no difference to stunting or wasting; and low-certainty evidence that they may result in little to no difference to food security or that they may improve dietary diversity in children, but not for households. Interventions that addressed food prices: Food vouchers (three cRCTs, one RCT): we found moderate-certainty evidence that food vouchers probably reduce stunting; and low-certainty evidence that that they may improve dietary diversity slightly, and may result in little to no difference in wasting. Food and nutrition subsidies (one cRCT, three PCSs): we found low-certainty evidence that food and nutrition subsidies may improve dietary diversity among school children. The evidence is very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food (very low-certainty evidence). Interventions that addressed the social environment: Social support interventions (one cRCT, one PCS): we found moderate-certainty evidence that community grants probably make little or no difference to wasting; low-certainty evidence that they may make little or no difference to stunting. The evidence is very uncertain about the effects of village savings and loans on food security and dietary diversity. None of the included studies addressed the intervention category of infrastructure changes. In addition, none of the studies reported on one of the primary outcomes of this review, namely prevalence of undernourishment. AUTHORS' CONCLUSIONS The body of evidence indicates that UCTs can improve food security. Income generation interventions do not seem to make a difference for food security, but the evidence is unclear for the other interventions. CCTs, UCTs, interventions that help generate income, interventions that help minimise impact of food prices through food vouchers and subsidies can potentially improve dietary diversity. UCTs and food vouchers may have a potential impact on reducing stunting, but CCTs, income generation interventions or social environment interventions do not seem to make a difference on wasting or stunting. CCTs seem to positively impact cognitive function and development, but not UCTs, which may be due to school attendance, healthcare visits and other conditionalities associated with CCTs.
Collapse
Affiliation(s)
- Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Marianne E Visser
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vundli Ramokolo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Amanda Brand
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
7
|
Keats EC, Jain RP, Bhutta ZA. Indirect health sector actions and supportive strategies to prevent malnutrition. Curr Opin Clin Nutr Metab Care 2020; 23:190-195. [PMID: 32167985 DOI: 10.1097/mco.0000000000000653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Malnutrition is a pervasive problem that causes negative acute, long-term, and intergenerational consequences. As we have begun to move from efficacy to effectiveness trials of nutrition interventions, and further still to more holistic case study approaches to understanding how and why nutrition outcomes change over time, it has become clear that more emphasis on the 'nutrition-sensitive' interventions is required. RECENT FINDINGS In this article, we propose recategorizing the nutrition-specific and sensitive terminology into a new framework that includes direct and indirect health sector actions and supportive strategies that exist outside the health sector; an adjustment that will improve sector-specific planning and accountability. We outline indirect health sector nutrition interventions, with a focus on family planning and the evidence to support its positive link with nutrition outcomes. In addition, we discuss supportive strategies for nutrition, with emphasis on agriculture and food security, water, sanitation, and hygiene, and poverty alleviation and highlight some of the recent evidence that has contributed to these fields. SUMMARY Indirect health sector nutrition interventions and supportive strategies for nutrition will be critical, alongside direct health sector nutrition interventions, to reach global targets. Investments should be made both inside and outside the health sector.
Collapse
Affiliation(s)
- Emily C Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Reena P Jain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|