PROTOCOL: The effectiveness of community, financial, and technology platforms for delivering nutrition‐specific interventions in low‐ and middle‐income countries: A systematic review

Abstract

BACKGROUND About half of global under-5 child mortality, or about 3 million deaths, are linked to poor nutrition (UN Inter-agency Group for Child Mortality, 2017; UNICEF, 2018). The effects of compromised nutrition at an early age are evident throughout the life course, with physical and cognitive impairments affecting health, learning, and economic potential (Martins, Toledo Florêncio, & Grillo, 2011). Good nutrition is also important beyond the childhood years, with adolescent girls being especially vulnerable to undernutrition because of their higher nutritional requirements, particularly those who might become pregnant. Therefore, a focus on adolescent girls' nutrition is important to ensure adequate prepregnancy nutrition for maternal, fetal, and infant health. Evidence suggests under-5 child mortality can be reduced by 15% with 90% coverage of 10 evidence-based nutrition interventions (Bhutta, Das, & Rizvi, 2013). However, despite evidence of efficacy generated from controlled settings, the potential impacts of what are considered "proven" nutrition interventions are often not realized in real-world environments due to ineffective delivery channels for achieving high and equitable coverage. A review by Ramakrishnan et al. (2014) noted that while prenatal proteinenergy and iron folic acid supplementation have been shown to reduce low birth weight by 20-30% in trial settings, variable implementation has led to uncertain effectiveness. Menon et al. (2014) also acknowledge evidence supporting effective delivery platforms for nutrition-specific interventions remains limited. Of particular concern are gaps in how to successfully reach adolescents with evidence-based nutrition interventions in low-and middle-income countries (LMIC) (Bhutta, Lassi, & Bergeron, 2017; Salam, Hooda and Das, 2016). Our review considers delivery platforms that can improve coverage of nutrition-specific interventions at all stages of the life course from preconception to pregnancy, infancy, childhood, and adolescence. The review is part of a series of concurrent reviews to produce up-to-date evidence on preventive and curative nutrition interventions across the lifecycle. 1.1 | Description of the condition The review will consider platforms for interventions to address a variety of nutrition-specific conditions. We will examine the effects of using community, financial, and technology platforms for delivering evidence-based nutrition-specific interventions to improve nutrition behaviors and outcomes for women, children, and adolescents in LMICs. For the purpose of our review, a "platform" is defined as a modality through which a service is made available to target beneficiaries.

The Effects of Community Home Visit and Peer Group Nutrition Intervention Delivery Platforms on Nutrition Outcomes in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

“…We conducted the systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [23] and according to the study protocol [24]. We searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Scopus, and Web of Science for English-language studies published from 1997 to June 2018 using Medical Subject Heading (MeSH) terms and keywords (MEDLINE search strategy included in Table S1).…”

Persistent Child Malnutrition in Dhaka: Integrating Political Considerations and Multisectoral Interventions for Solutions Moving Forward

“…Also, continuing to utilize and increase community-level partnerships and large-scale community-based approaches can further empower communities and improve nutritional status while also increasing multisectoral coordination and nutrition governance [29]. Similarly, utilizing community delivery platforms can increase the amount of human staff resources available to the system, coverage and breadth of services, and improve the equity of service delivery by reducing access barriers [30][31]. Specifically, building partnerships with voluntary organizations, NGOs, and private relief foundations to transport and distribute essential nutrition services, education, and counseling will help in increasing access for families and children, especially considering their impact in filling voids left by government efforts and during difficult times such as the COVID-19 Pandemic and famines [32][33]45].…”

Availability of national policies, programmes, and survey‐based coverage data to track nutrition interventions in South Asia

“…Key interventions across the life course include counselling and support for exclusive breastfeeding and appropriate complementary feeding, antenatal care, school food policies and programmes, and regulations and enforcement around marketing for unhealthy foods and breast milk substitutes (Keats et al, 2021; Vaivada et al, 2022). Research on which platforms are best suited to deliver packages of care to beneficiaries that are both age‐appropriate and timely is ongoing (Janmohamed et al, 2019). Importantly, there is much dialogue on improving integration and scale‐up of nutrition interventions within health systems (Holschneider et al, 2022; Salam et al, 2019; Subandoro et al, 2021).…”