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Knop MR, Nagashima-Hayashi M, Lin R, Saing CH, Ung M, Oy S, Yam ELY, Zahari M, Yi S. Impact of mHealth interventions on maternal, newborn, and child health from conception to 24 months postpartum in low- and middle-income countries: a systematic review. BMC Med 2024; 22:196. [PMID: 38750486 PMCID: PMC11095039 DOI: 10.1186/s12916-024-03417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have been harnessed in low- and middle-income countries (LMICs) to address the intricate challenges confronting maternal, newborn, and child health (MNCH). This review aspires to scrutinize the effectiveness of mHealth interventions on MNCH outcomes during the pivotal first 1000 days of life, encompassing the period from conception through pregnancy, childbirth, and post-delivery, up to the age of 2 years. METHODS A comprehensive search was systematically conducted in May 2022 across databases, including PubMed, Cochrane Library, Embase, Cumulative Index to Nursing & Allied Health (CINAHL), Web of Science, Scopus, PsycINFO, and Trip Pro, to unearth peer-reviewed articles published between 2000 and 2022. The inclusion criteria consisted of (i) mHealth interventions directed at MNCH; (ii) study designs, including randomized controlled trials (RCTs), RCT variations, quasi-experimental designs, controlled before-and-after studies, or interrupted time series studies); (iii) reports of outcomes pertinent to the first 1000 days concept; and (iv) inclusion of participants from LMICs. Each study was screened for quality in alignment with the Cochrane Handbook for Systematic Reviews of Interventions and the Joanne Briggs Institute Critical Appraisal tools. The included articles were then analyzed and categorized into 12 mHealth functions and outcome domain categories (antenatal, delivery, and postnatal care), followed by forest plot comparisons of effect measures. RESULTS From the initial pool of 7119 articles, we included 131 in this review, comprising 56 RCTs, 38 cluster-RCTs, and 37 quasi-experimental studies. Notably, 62% of these articles exhibited a moderate or high risk of bias. Promisingly, mHealth strategies, such as dispatching text message reminders to women and equipping healthcare providers with digital planning and scheduling tools, exhibited the capacity to augment antenatal clinic attendance and enhance the punctuality of child immunization. However, findings regarding facility-based delivery, child immunization attendance, and infant feeding practices were inconclusive. CONCLUSIONS This review suggests that mHealth interventions can improve antenatal care attendance and child immunization timeliness in LMICs. However, their impact on facility-based delivery and infant feeding practices varies. Nevertheless, the potential of mHealth to enhance MNCH services in resource-limited settings is promising. More context-specific implementation studies with rigorous evaluations are essential.
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Affiliation(s)
- Marianne Ravn Knop
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ruixi Lin
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mengieng Ung
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sreymom Oy
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Esabelle Lo Yan Yam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Marina Zahari
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA.
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Mousavi Ezmareh F, Bostani Khalesi Z, Jafarzadeh Kenarsari F, Maroufizadeh S. The impact of complementary feeding education for mothers using mobile phone applications on the anthropometric indices of Iranian infants. Digit Health 2024; 10:20552076241272558. [PMID: 39139189 PMCID: PMC11320705 DOI: 10.1177/20552076241272558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
Background Maternal education is often linked to improved awareness. This study aimed to determine the impact of complementary feeding education for mothers using mobile phone applications on the anthropometric indices of Iranian infants. Methods This quasi-experiment study involved 86 eligible women divided into two groups-intervention (n = 43) and control (n = 43)-using a multistage sampling method. A researcher-designed questionnaire collected demographic data from parents and infants. Education was delivered through a mobile phone application. Infant anthropometric indices (weight-for-age, length-for-age, and weight-for-length) were measured before and 3 months after the intervention. Statistical analysis included independent t-tests, paired t-tests, chi-square tests (or Cochran-Armitage tests), and analysis of covariance. Results The mean weight-for-age Z-scores of the infants in the intervention group were significantly different before (0.07 ± 0.52) and after the intervention (0.37 ± 0.53) (p < .001), while this difference was not significant in the control group. The mean infant weight-for-length Z score in the intervention group was significantly different before (0.09 ± 0.72) and after the intervention (0.29 ± 0.63) (p = .015); however, in the control group, the difference was not statistically significant. The mean length-for-age Z score in the intervention group was significantly different before (0.12 ± 0.68) and after the intervention (0.40 ± 0.76) (p = .006). In contrast, in the control group, the mean length-for-age Z score after the intervention (-0.03 ± 0.84) decreased compared to that before the intervention (0.38 ± 0.75) (p < .001). Conclusion The study demonstrated that educating mothers on complementary feeding through mobile phone applications positively impacted infant anthropometric indices. Healthcare providers are encouraged to use this educational approach to prevent infant growth disorders.
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Affiliation(s)
- Fariba Mousavi Ezmareh
- Department Midwifery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Bostani Khalesi
- Department Midwifery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Saman Maroufizadeh
- Department of Biostatistics and Epidemiology, School of Health, Guilan University of Medical Sciences, Rasht, Iran
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Harrison L, Padhani Z, Salam R, Oh C, Rahim K, Maqsood M, Ali A, Charbonneau K, Keats EC, Lassi ZS, Imdad A, Owais A, Das J, Bhutta ZA. Dietary Strategies for Complementary Feeding between 6 and 24 Months of Age: The Evidence. Nutrients 2023; 15:3041. [PMID: 37447369 PMCID: PMC10346638 DOI: 10.3390/nu15133041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Suboptimal complementary feeding practices remain highly prevent. This review aims to comprehensively synthesize new emerging evidence on a set of topics related to the selection and consumption of complementary foods. We synthesized evidence related to five key topics focused on nutritional interventions that target the complementary feeding period, based on four systematic reviews that include updated evidence to February 2022. While there have been many studies examining interventions during the complementary feeding period, there is an overall lack of relevant information through which to draw conclusions on the ideal feeding schedule by food type. Similarly, few studies have examined the effects of animal milk versus infant formula for non-breastfed infants (6-11 months), though those that did found a greater risk of anemia among infants who were provided cow's milk. This review highlights a number of interventions that are successful at improving micronutrient status and anthropometry during the complementary feeding period, including fortified blended foods, locally and commercially produced supplementary foods, and small-quantity lipid-based nutrient supplements. Complementary feeding education for caregivers can also be used to improve nutrition outcomes among infants in both food secure and insecure populations.
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Affiliation(s)
- Leila Harrison
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Zahra Padhani
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Rehana Salam
- The Daffodil Centre—A Joint Venture of Cancer Council and The University of Sydney, Sydney, NSW 2006, Australia
| | - Christina Oh
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Komal Rahim
- Internal Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Maria Maqsood
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Anna Ali
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Kimberly Charbonneau
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Emily C. Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Aamer Imdad
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Jai Das
- Division of Women & Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Division of Women & Child Health, Aga Khan University, Karachi 74800, Pakistan
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DeWitt A, Kientz J, Coker TR, Liljenquist K. mHealth Technology Design and Evaluation for Early Childhood Health Promotion: Systematic Literature Review. JMIR Pediatr Parent 2022; 5:e37718. [PMID: 36201391 PMCID: PMC9585442 DOI: 10.2196/37718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent increases in smartphone ownership among underserved populations have inspired researchers in medicine, computing, and health informatics to design and evaluate mobile health (mHealth) interventions, specifically for those supporting child development and growth. Although these interventions demonstrate possible effectiveness at larger scales, few of these interventions are evaluated to address racial disparities and health equity, which are known factors that affect relevance, uptake, and adherence in target populations. OBJECTIVE In this study, we aimed to identify and document the current design and evaluation practices of mHealth technologies that promote early childhood health, with a specific focus on opportunities for those processes to address health disparities and health equity. METHODS We completed a systematic literature review of studies that design and evaluate mHealth interventions for early childhood health promotion. We then analyzed these studies to identify opportunities to address racial disparities in early- and late-stage processes and to understand the potential efficacy of these interventions. RESULTS Across the literature from medical, computing, and health informatics fields, we identified 15 articles that presented a design or evaluation of a parent-facing health intervention. We found that using mobile-based systems to deliver health interventions was generally well accepted by parents of children aged <5 years. We also found that, when measured, parenting knowledge of early childhood health topics and confidence to engage in health-promoting behaviors improved. Design and evaluation methods held internal consistency within disciplines (eg, experimental study designs were the most prevalent in medical literature, while computing researchers used user-centered design methods in computing fields). However, there is little consistency in design or evaluation methods across fields. CONCLUSIONS To support more interventions with a comprehensive design and evaluation process, we recommend attention to design at the intervention (eg, reporting content sources) and system level; interdisciplinary collaboration in early childhood health intervention development can lead to large-scale deployment and success among populations. TRIAL REGISTRATION PROSPERO CRD42022359797; https://tinyurl.com/586nx9a2.
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Affiliation(s)
- Akeiylah DeWitt
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Julie Kientz
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Tumaini R Coker
- Seattle Childrens Research Institute, Seattle, WA, United States
| | - Kendra Liljenquist
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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What Is the Impact of Nutrition Literacy Interventions on Children's Food Habits and Nutrition Security? A Scoping Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073839. [PMID: 35409523 PMCID: PMC8997863 DOI: 10.3390/ijerph19073839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 01/04/2023]
Abstract
Introduction: Nutrition literacy is a relatively new concept that seems to have a relevant role on the quality of people’s diets; however, we do not know the role of nutrition literacy interventions on children’s food habits and nutrition security. Methods: We conducted a literature review on four databases (PubMed, Embase, Web of Science, and Cochrane) and we considered studies describing the impact of interventions aimed at improving the quality of children’s diet. Results: A total of six articles were finally included. The total number of participants included in the studies was 4016, and the median study size was equal to 224 participants. Studies included in the review reflected a broad heterogeneity of interventions. Conclusions: The results were contrasting and revealed that the most effective type of nutrition literacy interventions included the following characteristics: technological components, involvement with multiple modalities, duration of more than 4 weeks, and face to face sessions.
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Truong M, Fenton SH. Understanding the Current Landscape of Direct-to-Consumer Health Literacy Interventions. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 19:1e. [PMID: 35692847 PMCID: PMC9123524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Kustiawan TC, Nadhiroh SR, Ramli R, Butryee C. Use of mobile app to monitoring growth outcome of children: A systematic literature review. Digit Health 2022; 8:20552076221138641. [PMID: 36386243 PMCID: PMC9663617 DOI: 10.1177/20552076221138641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/04/2022] [Indexed: 08/20/2023] Open
Abstract
Advances in knowledge and technology have created opportunities to help monitor child growth. Thus, we conducted a systematic review to determine if the use of mobile apps resulted in improved growth outcomes for children. We include articles published related to children's growth with poor nutritional status. The relevant articles were searched from PubMed, ScienceDirect, Scopus, ProQuest, and Google Scholar. Twelve studies were identified, which is the use of the mobile app to monitor growth in undernutrition and obesity in children. Six studies found that the use of mobile apps improved undernutrition child growth and improved parents' and/or front health workers' knowledge to prevent, treat, and monitor children with undernutrition. Six studies stated that the use of mobile app helps overweight/obese children lose weight and motivate them to achieve ideal body weight. Mobile apps for monitoring the growth of children with various standards are likely a promising means for early detection of growth failure and guiding overweight/obese children in gaining normal weight. Studies with large sample sizes and long-term interventions and follow-ups are needed to help assess the effectiveness of mobile app intervention programs and their impact on multiple growth outcomes more comprehensively and accurately.
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Affiliation(s)
| | - Siti Rahayu Nadhiroh
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Roziana Ramli
- Department of Computer System and Technology, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia
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Seyyedi N, Rahmatnezhad L, Mesgarzadeh M, Khalkhali H, Seyyedi N, Rahimi B. Effectiveness of a smartphone-based educational intervention to improve breastfeeding. Int Breastfeed J 2021; 16:70. [PMID: 34544429 PMCID: PMC8454121 DOI: 10.1186/s13006-021-00417-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Exclusive breastfeeding (EBF) is essential during the first six months of life and confers countless benefits to mothers and infants. This study aimed to assess the effectiveness of a smartphone-based educational intervention to improve new mothers’ breastfeeding for infants younger than six months of age in Urmia, Iran. Methods A randomized controlled trial study was conducted from January to December 2019 with 40 new mothers and their first child aged < 3 months, assigned to the intervention (mobile app education + routine care) and control groups (routine care). The mean age of infants was 1.25 and 0.98 months for each group consequently. The designed app content categorized according to seven sections (the importance of breastfeeding, behavioral methods, complementary feeding and EBF, pumping and manual expression, managing common breast-related and breastfeeding problems, breastfeeding tips in special situations, and common queries) for educating the required knowledge to nursing mothers. Results Forty mothers were assessed for primary outcomes in each group. At three months, the mothers’ knowledge, attitude, and practice (KAP) had meaningful differences in the intervention group compared to the control group. In the intervention group, the degree of changes in knowledge and attitude were 5.67 ± 0.94 and 8.75 ± 1.37 respectively more than the control group (p < 0.001, p < 0.001). However, this amount for the practice score was 0.8 ± 0.49 which is considered to be marginally significant (p = 0.063). During the study, the mothers’ breastfeeding self-efficacy showed significant progress in favor of the intervention group. The score enhancement was 26.85 ± 7.13 for the intervention group and only 0.40 ± 5.17 for the control group that was confirmed to be significant (p < 0.001). Conclusion The smartphone-based app for educating new mothers on breastfeeding had a significantly positive effect on breastfeeding self-efficacy and maternal KAP. In future studies, the intervention can be tested in both prenatal and postpartum periods.
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Affiliation(s)
- Navisa Seyyedi
- Student Research Committee, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran.,School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Leili Rahmatnezhad
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Maryam Mesgarzadeh
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Negisa Seyyedi
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahlol Rahimi
- School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran.
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Scott K, Ummer O, Shinde A, Sharma M, Yadav S, Jairath A, Purty N, Shah N, Mohan D, Chamberlain S, LeFevre AE. Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India. BMJ Glob Health 2021; 6:bmjgh-2021-005868. [PMID: 34312156 PMCID: PMC8327813 DOI: 10.1136/bmjgh-2021-005868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/11/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction Kilkari is one of the world’s largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices. This qualitative research complements the RCT to explore why these findings may have emerged. Methods We used system generated data to identify households within the RCT with very high to medium Kilkari listenership. Mothers (n=29), as well as husbands and extended family members (n=25 interviews/family group discussions) were interviewed about IYCF and family planning, including their reactions to Kilkari’s calls on these topics. Analysis was informed by the theory of reciprocal determinism, which positions behaviour change within the interacting domains of individual attributes, social and environmental determinants, and existing practices. Results While women who owned and controlled their own phones were the Kilkari listeners, among women who did not own their own phones, it was often their husbands who listened. Spouses did not discuss Kilkari messages. Respondents retained and appreciated Kilkari messages that aligned with their pre-existing worldviews, social norms, and existing practices. However, they overlooked or de-emphasised content that did not. In this way, they reported agreeing with and trusting Kilkari while persisting with practices that went against Kilkari’s recommendations, particularly non-exclusive breastfeeding and inappropriate complementary feeding. Conclusion To deepen impact, digital direct to beneficiary services need to be complimented by wider communication efforts (e.g., sustained face-to-face, media, community engagement) to change social norms, taking into account the role of socio-environmental, behavioural, and individual determinants.
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Affiliation(s)
- Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Osama Ummer
- Oxford Policy Management, New Delhi, India.,BBC Media Action, New Delhi, India
| | - Aashaka Shinde
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | - Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Amnesty Elizabeth LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Ojha S, Elfzzani Z, Kwok TC, Dorling J. Education of family members to support weaning to solids and nutrition in later infancy in term-born infants. Cochrane Database Syst Rev 2020; 7:CD012241. [PMID: 32710657 PMCID: PMC7388772 DOI: 10.1002/14651858.cd012241.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Education of family members about infant weaning practices could affect nutrition, growth, and development of children in different settings across the world. OBJECTIVES To compare effects of family nutrition educational interventions for infant weaning with conventional management on growth and neurodevelopment in childhood. SEARCH METHODS We used the standard strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5), MEDLINE via PubMed (1966 to 26 June 2018), Embase (1980 to 26 June 2018), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 26 June 2018). We searched clinical trials databases, conference proceedings, and references of retrieved articles. We ran an updated search from 1 January 2018 to 12 December 2019 in the following databases: CENTRAL via CRS Web, MEDLINE via Ovid, and CINAHL via EBSCOhost. SELECTION CRITERIA We included randomised controlled trials that examined effects of nutrition education for weaning practices delivered to families of infants born at term compared to conventional management (standard care in the population) up to one year of age. DATA COLLECTION AND ANALYSIS Two review authors independently identified eligible trial reports from the literature search and performed data extraction and quality assessments for each included trial. We synthesised effect estimates using risk ratios (RRs), risk differences (RDs), and mean differences (MDs), with 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 21 trials, recruiting 14,241 infants. Five of the trials were conducted in high-income countries and the remaining 16 were conducted in middle- and low-income countries. Meta-analysis showed that nutrition education targeted at improving weaning-related feeding practices probably increases both weight-for-age z scores (WAZ) (MD 0.15 standard deviations, 95% CI 0.07 to 0.22; 6 studies; 2551 infants; I² = 32%; moderate-certainty evidence) and height-for-age z scores (0.12 standard deviations, 95% CI 0.05 to 0.19; 7 studies; 3620 infants; I² = 49%; moderate-certainty evidence) by 12 months of age. Meta-analysis of outcomes at 18 months of age was heterogeneous and inconsistent in the magnitude of effects of nutrition education on WAZ and weight-for-height z score across studies. One trial that assessed effects of nutrition education on growth at six years reported an uncertain effect on change in height and body mass index z score. Two studies investigated effects of nutrition education on neurodevelopment at 12 to 24 months of age with conflicting results. No trials assessed effects of nutrition education on long-term neurodevelopmental outcomes. AUTHORS' CONCLUSIONS Nutrition education for families of infants may reduce the risk of undernutrition in term-born infants (evidence of low to moderate certainty due to limitations in study design and substantial heterogeneity of included studies). Modest effects on growth during infancy may not be of clinical significance. However, it is unclear whether these small improvements in growth parameters in the first two years of life affect long-term childhood growth and development. Further studies are needed to resolve this question.
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Affiliation(s)
- Shalini Ojha
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
- Children's Hospital, University Hospitals of Derby and Burton, Derby, UK
| | - Zenab Elfzzani
- Academic Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | | | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
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