Best practices and opportunities for integrating nutrition specific into nutrition sensitive interventions in fragile contexts: a systematic review

Abstract

Background Annually, undernutrition contributes globally to 45% (3.1 million) of preventable deaths in children under 5. Effect following undernutrition i.e. physical growth & cognitive development etc. can be prevented during the first 1000 days also called window of opportunity. There is substantial evidence of positive nutrition outcomes resulting from integrating nutrition-specific interventions into nutrition specific program. However, there is paucity of knowledge on establishing and sustaining effective integration of nutrition intervention in fragile context. The objective of this review is to map and review the integration of nutrition-specific intervention to nutrition sensitive program and its impacts on nutrition outcomes. Methods In the study, we systematically searched the literature on integrated nutrition intervention into multi-sectoral programme in PUBMED, Google’s Scholar, the Cochrane Library, World Health Organisation (WHO), United Nations Children’s Fund (UNICEF), World Bank and trial registers from their inception until Oct 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. This study is registered with PROSPERO (CRD42020209730). Result Forty-four studies were included in this review, outlining the integration of nutrition-specific interventions among children 0–59 months with various existing programme. Most common integration platform in the study included integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non-nutrition outcomes with a number of model of integration which varies according to the context and demands of the particular setting in which integration occurs. Conclusion Overall, existing evidence for nutrition sensitive and specific interventions is not robust and remains limited. It’s worthwhile to note, for future studies/interventions should be based on the context key criteria like relevance, political support, effectiveness, feasibility, expected contribution to health system strengthening, local capacities, ease of integration and targeting for sustainability, cost effectiveness and financial availability.

Effect of integrated nutrition‐sensitive and nutrition‐specific intervention package on maternal malnutrition among pregnant women in Rwanda

“…According to this study, it was found that integrated nutrition‐specific and nutrition‐sensitive interventions were associated with lower maternal undernutrition during pregnancy. This is parallel with the current literature and evidence that supports the notion that integrated nutrition‐sensitive and nutrition‐specific intervention programmes produce a superior effect on nutritional outcomes compared with either nutrition‐sensitive or nutrition‐specific interventions alone (Abdullahi et al, 2021 ). It also supports the 2008, 2013 and 2021 Lancet Series regarding the proposed impact of evidence‐based interventions in reducing maternal undernutrition (Bhutta et al, 2008 , 2013 ; Keats et al, 2021 ).…”

“…Though nutrition‐specific interventions can have a great impact on minimizing undernutrition, alone they may not eradicate malnutrition. However, if it is combined with nutrition‐sensitive interventions, there could be a huge impact on the elimination of undernutrition (Abdullahi et al, 2021 ). The nutrition‐sensitive interventions, which address the underlying causes of malnutrition are believed to reduce malnutrition by 80%, while the direct malnutrition interventions address only 20% even if scaled up to 90% coverage rates (IFPRI, 2016 ).…”

Integration of nutrition assessment counselling and support interventions in health service delivery and respective drivers: A case study of Tororo district, Uganda

“…Follow up care was weakest although lower health facilities tended to perform better than the higher level facilities since they are closer to communities. Similar to several studies, integration in the service delivery function scores highest because most programs are able to offer integrated services through the existing delivery mechanisms [19,20,22]. Consequently, community support systems such as integrated community outreaches, follow up and referral mechanisms, program speci c community resource persons and frequent supervision need to be strengthened for better nutrition outcomes.…”

“…No single successful model of integration has been reported because it varies according to the context and demands of a particular setting in which integration occurs. Similarly, a systematic review revealed that integration had a positive impact on nutrition and non-nutrition outcomes and the model of integration varies according context and demands of a particular setting which integration occurs [20].…”

Mid-term evaluation of Maternal and Child Nutrition Programme (MCNP II) in Kenya

“…This is supported by a study by Levin et al [ 37 ] and Abdulahi et al . [ 38 ] highlighted that multi-sectoral nutrition programmes should explore integration into routine services for economies of scale to lower costs. Similarly, MCNP II made efforts toward health systems strengthening through integrated approaches at the community level.…”