The impact of an integrated community-based micronutrient and health programme on stunting in Malawian preschool children

Kalimbira, Alexander; MacDonald, Carolyn; Simpson, Janis Randall

doi:10.1017/s1368980009991753

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…However, it has been shown that multidisciplinary programmes can combat stunting over a longer time period (54) . This finding was confirmed in studies in Malawi, Ethiopia and Haiti evaluating a community-based programme addressing stunting over a period of 5-8 years (55)(56)(57) .…”

Section: Discussionsupporting

confidence: 52%

Short-term nutrition and growth indicators in 6-month- to 6-year-old children are improved following implementation of a multidisciplinary community-based programme in a chronic conflict setting

Simonyan¹,

Sargsyan²,

Balalian

et al. 2019

Public Health Nutr.

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Objective:We investigated short- and long-term indicators of malnutrition and diet before and after the community-based ‘Breaking the Cycle of Poverty’ multidisciplinary intervention.Design:A historically and geographically controlled study using data collected in 2013 and 2016. We compared the prevalence of short-term indicators (anaemia, breast-feeding duration and minimum dietary diversity) and long-term indicators (stunting and wasting) in exposed communities at two time points. We then compared these factors in geographic areas exposed or not exposed to intervention. We conducted logistic regression analyses on the 2016 sample to measure associations between living in intervention communities and child growth indicators.Setting:Berd region, a chronic conflict zone near the north-eastern border of Armenia and Azerbaijan.Participants:Children aged 6 months to 6 years.Results:Analyses included data from 2013 comprising 382 children, and data from 2016 comprising 348 children living in communities where the programme was implemented, and 635 children from unexposed communities. Anaemia prevalence in exposed communities was significantly lower in 2016 v. 2013 (10·9 v. 19·1 %, P < 0·01). Minimum dietary diversity (79·0 v. 68·1 %, P < 0·001) and breast-feeding duration (13·0 v. 11·5 months, P < 0·002) were significantly improved in exposed communities. Prevalences of stunting (11·5 v. 10·2 %, P = 0·57) and wasting (4·8 v. 2·0 %, P = 0·07) were not significantly different. Odds of anaemia were significantly lower (OR = 0·24, 95 % CI 0·16, 0·36) in intervention communities.Conclusions:Exposure to a community-based multidisciplinary intervention reduced the rate of anaemia and improved dietary indicators.

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Section: Discussionsupporting

confidence: 52%

Short-term nutrition and growth indicators in 6-month- to 6-year-old children are improved following implementation of a multidisciplinary community-based programme in a chronic conflict setting

Simonyan¹,

Sargsyan²,

Balalian

et al. 2019

Public Health Nutr.

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“…A few studies [16, 17] carried out in similar settings also reported that counselling mothers on child feeding practices is associated with overall improvement in optimum infant and child feeding practices. Although, some studies found that maternal nutrition counselling results in reduced childhood stunting [19, 20], other studies [43, 44] reported that nutrition counselling were ineffective in reduction of stunting among young children. However, it was also reported through conducting a meta-analysis that nutrition education is effective in reducing stunting among young children when it is complemented with interventions such as food or micronutrient supplementation or nutrition safety net programs [45].…”

Section: Discussionmentioning

confidence: 99%

Maternal nutrition counselling is associated with reduced stunting prevalence and improved feeding practices in early childhood: a post-program comparison study

Mistry

Hossain

Arora

2019

Nutr J

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Background Despite progress, suboptimal feeding practices and undernutrition particularly in the form of stunting still remains a major issue among children aged less than 5 years in Bangladesh. Since mothers are the primary caregivers of young children, maternal nutrition counselling can be effective in improving knowledge and practices on child feeding. The Building Resources Across Communities (BRAC) initiated a nutrition counselling intervention using its essential health care (EHC) skeleton in 114 sub-districts of Bangladesh in 2012. This study assessed the role of this intervention on the prevalence of stunting and feeding practices among children aged less than 5 years. Methods The data was collected as part of a nationwide cross-sectional survey, which followed a two-stage cluster random sampling procedure and was conducted between October 2015 and January 2016. The present study analyzed the information of 3009 mother-children dyads from two selected survey areas: i) areas where the EHC package was delivered (comparison; n = 1452), ii) areas with EHC plus nutrition counselling package (intervention; n = 1557) was delivered. The Chi-square test was done to compare the child feeding practices and stunting prevalence between intervention and comparison. The degree of strength of the association of stunting and the intervention was estimated using a mixed-effect logistic regression model. Results The study revealed that the prevalence of stunting was significantly lower in areas where the intervention was delivered compared to the comparison areas (29% vs. 37%, P < 0.001). Furthermore, after adjusting for administrative zone, household wealth quintile, child’s age, gender, maternal age, education, occupation, cluster disparity, and variation between study groups, it was seen that the risk of stunting was 25% lower in the intervention areas compared to the comparison areas (aOR: 0.75, 95% CI: 0.60–0.94; P = 0.012). Optimal child feeding practices were also more common among mothers from intervention areas than those of the comparison areas (exclusive breastfeeding: 72.7 vs. 59.4%, P = 0.008; feeding 4+ food groups: 42.9 vs. 34.1%, P < 0.001; having minimum acceptable diet: 31.2 vs. 25.3%, P = 0.017; feeding multiple micro-nutrient powder: 16.2 vs. 7.4%, P < 0.001). Conclusions The study highlighted that nutrition counselling of mothers may be effective in reducing childhood stunting with concomitant improvement in optimal feeding practices in children under 5 years of age. The frontline community health workers can be trained to counsel mothers on optimal child feeding practices and this could help reduce the prevalence of stunting.

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“…However, the same combinations of interventions were not similarly effective in Ethiopia, Haiti, India, Malawi or Mexico. 20 26 28 30 31 The difference may be explained by the need for more secure targeting of younger children from rural household, and also the effects of other programmes or interventions in either the same or a neighbouring community. It is clear that in addition to geographical location, the organisation, administration and delivery of the intervention, as well as the population being targeted has an effect on the overall effectiveness of the intervention.…”

Section: Discussionmentioning

confidence: 99%

Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review

et al. 2017

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ObjectiveWe systematically evaluated health and nutrition programmes to identify context-specific interventional packages that might help to prioritise the implementation of programmes for reducing stunting in low and middle income countries (LMICs).MethodsElectronic databases were used to systematically review the literature published between 1980 and 2015. Additional articles were identified from the reference lists and grey literature. Programmes were identified in which nutrition-specific and nutrition-sensitive interventions had been implemented for children under 5 years of age in LMICs. The primary outcome was a change in stunting prevalence, estimated as the average annual rate of reduction (AARR). A realist approach was applied to identify mechanisms underpinning programme success in particular contexts and settings.FindingsFourteen programmes, which demonstrated reductions in stunting, were identified from 19 LMICs. The AARR varied from 0.6 to 8.4. The interventions most commonly implemented were nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. A programme was considered to have effectively reduced stunting when AARR≥3%. Successful interventions were characterised by a combination of political commitment, multi-sectoral collaboration, community engagement, community-based service delivery platform, and wider programme coverage and compliance. Even for similar interventions the outcome could be compromised if the context differed.InterpretationFor all settings, a combination of interventions was associated with success when they included health and nutrition outcomes and social safety nets. An effective programme for stunting reduction embraced country-level commitment together with community engagement and programme context, reflecting the complex nature of exposures of relevance.PROSPERO registration numberCRD42016043772.

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The impact of an integrated community-based micronutrient and health programme on stunting in Malawian preschool children

Abstract: Objective: To assess the impact of the 1996-2005 integrated community-based micronutrient and health (MICAH) programme on linear growth retardation (stunting) in Malawian preschool children living in rural areas.

Cited by 10 publications

References 9 publications

Short-term nutrition and growth indicators in 6-month- to 6-year-old children are improved following implementation of a multidisciplinary community-based programme in a chronic conflict setting

Short-term nutrition and growth indicators in 6-month- to 6-year-old children are improved following implementation of a multidisciplinary community-based programme in a chronic conflict setting

Maternal nutrition counselling is associated with reduced stunting prevalence and improved feeding practices in early childhood: a post-program comparison study

Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review

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