Background Poor birth outcomes are an important global public health problem. Social assistance p... more Background Poor birth outcomes are an important global public health problem. Social assistance programs that provide cash or in-kind transfers, such as food or vouchers, hold potential to improve birth outcomes but the evidence on their effectiveness has not been reviewed. Objectives We systematically reviewed studies that used experimental or quasi-experimental methods to evaluate the impacts of social assistance programs on outcomes in low- and middle-income countries. Methods The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to assess the certainty of the evidence for birth weight and neonatal mortality (most common outcomes reported). We summarized the evidence on hypothesized nutrition and health pathways of impact. Results We included 6 evaluations of 4 different cash transfer programs and 1 evaluation of a community-based participatory learning and action program that provided food and cash transfers. The 4 studies that assessed ...
The World Health Organization (WHO) has a mandate to promote maternal and child health and welfar... more The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important p...
in 1975, provides research-based policy solutions to sustainably reduce poverty and end hunger an... more in 1975, provides research-based policy solutions to sustainably reduce poverty and end hunger and malnutrition. IFPRI's strategic research aims to foster a climate-resilient and sustainable food supply; promote healthy diets and nutrition for all; build inclusive and efficient markets, trade systems, and food industries; transform agricultural and rural economies; and strengthen institutions and governance. Gender is integrated in all the Institute's work. Partnerships, communications, capacity strengthening, and data and knowledge management are essential components to translate IFPRI's research from action to impact. The Institute's regional and country programs play a critical role in responding to demand for food policy research and in delivering holistic support for country-led development. IFPRI collaborates with partners around the world.
Background Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) redu... more Background Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. Objectives We aimed to identify the effect of SQ-LNSs on prevalence of severe wasting (weight-for-length z score < −3) and severe stunting (length-for-age z score < −3). Methods We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6–24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. Results SQ-LNS provision led to a relative reduction of 31% in severe wasting [prevalence ratio (PR): 0.69; 9...
Studies conducted in past decades showed little or no population-level linear catch-up growth (de... more Studies conducted in past decades showed little or no population-level linear catch-up growth (defined as reductions in absolute height deficit) in children after 2 y of age. Recent studies, howeve...
International Development (USAID), under terms of Cooperative Agreements GHN-A-00-08-00001-00, AI... more International Development (USAID), under terms of Cooperative Agreements GHN-A-00-08-00001-00, AID-OAA-A-11-00014, and AID-OAA-A-12-00005 through the Food and Nutrition Technical Assistance III Project (FANTA), managed by FHI 360. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States
ABSTRACTBackgroundMeta-analyses have demonstrated that small-quantity lipid-based nutrient supple... more ABSTRACTBackgroundMeta-analyses have demonstrated that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce stunting and wasting prevalence among infants and young children. Identification of subgroups who benefit most from SQ-LNS may facilitate program design.ObjectiveOur objective was to identify study-level and individual-level modifiers of the effect of SQ-LNS on child growth outcomes.MethodsWe conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 months of age in low- and middle-income countries (n=37,066). We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models, with random-effects models as sensitivity analyses. We used random effects meta-regression to examine study-level effect modifiers. Heterogeneity was assessed using I2 and Tau2 statistics. Sensitivity analyses were conducted to examine whether results d...
ABSTRACTBackgroundFood-assisted maternal and child health and nutrition programs are a widely use... more ABSTRACTBackgroundFood-assisted maternal and child health and nutrition programs are a widely used approach to address undernutrition. Little is known about the effects of these programs’ combined household and individual food rations on household and individual food consumption. Tubaramure in Burundi targeted women and children during the first 1000 d of life, and included: 1) food rations (corn-soy blend and micronutrient-fortified vegetable oil); 2) health services strengthening and promotion of their use; and 3) behavior change communication on nutrition, hygiene, and health practices.ObjectivesThe objectives were: 1) to assess Tubaramure’s impact on household food consumption and food security, maternal dietary diversity, and infant and young child feeding practices; 2) to explore the role of the food rations; and 3) assess 6–8 mo impacts around 8 mo after the end of the program.MethodsWe used a 4-arm cluster-randomized controlled repeated cross-sectional design (11,906 observa...
This journal supplement summarizes the many contributions of the Oriente Study to scientific know... more This journal supplement summarizes the many contributions of the Oriente Study to scientific knowledge. This article asks whether this knowledge has actually translated into program and/or policy changes. It describes 2 key areas where this is the case: 1) in defining the "window of opportunity" for nutrition interventions and changing policy regarding the targeting of nutrition interventions; and 2) in building the economic argument for investing in early childhood nutrition. It concludes that the study contributed most of the research evidence supporting the change in policy adopted by the U.S. government in 2009, which encourages the targeting of food-assisted maternal and child health and nutrition programs to pregnant mothers and children under 2 y of age. The paper reviews the process and the complementary evidence that led to this policy change. The Oriente Study also provides the first direct, and the strongest, evidence supporting the economic argument in favor of investing in early child nutrition. The results show a direct link between improved nutrition in early childhood and persistent benefits in adult physical status, schooling, cognitive skills, and economic productivity. It is hoped that, given the multiple shocks currently affecting the poor, these powerful results will help stimulate greater investments in maternal and child nutrition in the short term.
ABSTRACT This chapter reviews current knowledge and experience with using food-based approaches i... more ABSTRACT This chapter reviews current knowledge and experience with using food-based approaches in reducing vitamin A and iron deficiencies. It reviews recently published literature, highlights some lessons learned, and identifies knowledge gaps and research priorities. The main strategies reviewed are food-based interventions that aim at: (1) increasing the production, availability, and access to vitamin A and iron-rich foods through the promotion of home production and (2) plant breeding strategies that have the potential to increase the content of vitamin A and iron in diet as well as their bioavailability. The review highlights the fact that significant progress has been achieved in the past few decades in the design and implementation of food-based approaches. Evaluations however remain weak, and without rigorous, carefully conducted evaluations the real potential of food-based approaches in addressing micronutrient malnutrition cannot be fully understood. Plant breeding strategies, although they are at a much earlier stage of development, hold great promise because of their enormous potential to improve the dietary quality of populations relying mainly on cereal staples. Studies on human bioavailability are the next crucial step to help understand the potential contribution of plant breeding towards alleviating micronutrient malnutrition. Our review suggests that food-based interventions could be an essential part of the long-term global strategy for the fight against micronutrient malnutrition, but their real potential is still to be explored.
Background Poor birth outcomes are an important global public health problem. Social assistance p... more Background Poor birth outcomes are an important global public health problem. Social assistance programs that provide cash or in-kind transfers, such as food or vouchers, hold potential to improve birth outcomes but the evidence on their effectiveness has not been reviewed. Objectives We systematically reviewed studies that used experimental or quasi-experimental methods to evaluate the impacts of social assistance programs on outcomes in low- and middle-income countries. Methods The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to assess the certainty of the evidence for birth weight and neonatal mortality (most common outcomes reported). We summarized the evidence on hypothesized nutrition and health pathways of impact. Results We included 6 evaluations of 4 different cash transfer programs and 1 evaluation of a community-based participatory learning and action program that provided food and cash transfers. The 4 studies that assessed ...
The World Health Organization (WHO) has a mandate to promote maternal and child health and welfar... more The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important p...
in 1975, provides research-based policy solutions to sustainably reduce poverty and end hunger an... more in 1975, provides research-based policy solutions to sustainably reduce poverty and end hunger and malnutrition. IFPRI's strategic research aims to foster a climate-resilient and sustainable food supply; promote healthy diets and nutrition for all; build inclusive and efficient markets, trade systems, and food industries; transform agricultural and rural economies; and strengthen institutions and governance. Gender is integrated in all the Institute's work. Partnerships, communications, capacity strengthening, and data and knowledge management are essential components to translate IFPRI's research from action to impact. The Institute's regional and country programs play a critical role in responding to demand for food policy research and in delivering holistic support for country-led development. IFPRI collaborates with partners around the world.
Background Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) redu... more Background Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. Objectives We aimed to identify the effect of SQ-LNSs on prevalence of severe wasting (weight-for-length z score < −3) and severe stunting (length-for-age z score < −3). Methods We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6–24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. Results SQ-LNS provision led to a relative reduction of 31% in severe wasting [prevalence ratio (PR): 0.69; 9...
Studies conducted in past decades showed little or no population-level linear catch-up growth (de... more Studies conducted in past decades showed little or no population-level linear catch-up growth (defined as reductions in absolute height deficit) in children after 2 y of age. Recent studies, howeve...
International Development (USAID), under terms of Cooperative Agreements GHN-A-00-08-00001-00, AI... more International Development (USAID), under terms of Cooperative Agreements GHN-A-00-08-00001-00, AID-OAA-A-11-00014, and AID-OAA-A-12-00005 through the Food and Nutrition Technical Assistance III Project (FANTA), managed by FHI 360. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States
ABSTRACTBackgroundMeta-analyses have demonstrated that small-quantity lipid-based nutrient supple... more ABSTRACTBackgroundMeta-analyses have demonstrated that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce stunting and wasting prevalence among infants and young children. Identification of subgroups who benefit most from SQ-LNS may facilitate program design.ObjectiveOur objective was to identify study-level and individual-level modifiers of the effect of SQ-LNS on child growth outcomes.MethodsWe conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 months of age in low- and middle-income countries (n=37,066). We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models, with random-effects models as sensitivity analyses. We used random effects meta-regression to examine study-level effect modifiers. Heterogeneity was assessed using I2 and Tau2 statistics. Sensitivity analyses were conducted to examine whether results d...
ABSTRACTBackgroundFood-assisted maternal and child health and nutrition programs are a widely use... more ABSTRACTBackgroundFood-assisted maternal and child health and nutrition programs are a widely used approach to address undernutrition. Little is known about the effects of these programs’ combined household and individual food rations on household and individual food consumption. Tubaramure in Burundi targeted women and children during the first 1000 d of life, and included: 1) food rations (corn-soy blend and micronutrient-fortified vegetable oil); 2) health services strengthening and promotion of their use; and 3) behavior change communication on nutrition, hygiene, and health practices.ObjectivesThe objectives were: 1) to assess Tubaramure’s impact on household food consumption and food security, maternal dietary diversity, and infant and young child feeding practices; 2) to explore the role of the food rations; and 3) assess 6–8 mo impacts around 8 mo after the end of the program.MethodsWe used a 4-arm cluster-randomized controlled repeated cross-sectional design (11,906 observa...
This journal supplement summarizes the many contributions of the Oriente Study to scientific know... more This journal supplement summarizes the many contributions of the Oriente Study to scientific knowledge. This article asks whether this knowledge has actually translated into program and/or policy changes. It describes 2 key areas where this is the case: 1) in defining the "window of opportunity" for nutrition interventions and changing policy regarding the targeting of nutrition interventions; and 2) in building the economic argument for investing in early childhood nutrition. It concludes that the study contributed most of the research evidence supporting the change in policy adopted by the U.S. government in 2009, which encourages the targeting of food-assisted maternal and child health and nutrition programs to pregnant mothers and children under 2 y of age. The paper reviews the process and the complementary evidence that led to this policy change. The Oriente Study also provides the first direct, and the strongest, evidence supporting the economic argument in favor of investing in early child nutrition. The results show a direct link between improved nutrition in early childhood and persistent benefits in adult physical status, schooling, cognitive skills, and economic productivity. It is hoped that, given the multiple shocks currently affecting the poor, these powerful results will help stimulate greater investments in maternal and child nutrition in the short term.
ABSTRACT This chapter reviews current knowledge and experience with using food-based approaches i... more ABSTRACT This chapter reviews current knowledge and experience with using food-based approaches in reducing vitamin A and iron deficiencies. It reviews recently published literature, highlights some lessons learned, and identifies knowledge gaps and research priorities. The main strategies reviewed are food-based interventions that aim at: (1) increasing the production, availability, and access to vitamin A and iron-rich foods through the promotion of home production and (2) plant breeding strategies that have the potential to increase the content of vitamin A and iron in diet as well as their bioavailability. The review highlights the fact that significant progress has been achieved in the past few decades in the design and implementation of food-based approaches. Evaluations however remain weak, and without rigorous, carefully conducted evaluations the real potential of food-based approaches in addressing micronutrient malnutrition cannot be fully understood. Plant breeding strategies, although they are at a much earlier stage of development, hold great promise because of their enormous potential to improve the dietary quality of populations relying mainly on cereal staples. Studies on human bioavailability are the next crucial step to help understand the potential contribution of plant breeding towards alleviating micronutrient malnutrition. Our review suggests that food-based interventions could be an essential part of the long-term global strategy for the fight against micronutrient malnutrition, but their real potential is still to be explored.
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