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.

Keywords: Integration; Multi-sectoral programme; Nutrition outcome; Nutrition sensitive; Nutrition specific.

Fig. 1

Shows a framework for determinants of nutrition outline the key drivers of malnutrition in society. Adapted from studies entitled ‘Synthesis of Evidence of Multisectoral Approaches for Improved Nutrition’ [7]

Fig. 2

Prisma flow diagram. shows the process of selecting relevant studies from 13,138 records. After removing 476 duplicates, 12,662 records were screened; 12,602 of the records were excluded based on the title and abstract. Full texts of 60 potential eligible articles were retrieved and reviewed for inclusion. Of the 60 records, 44 studies met our inclusion criteria and 16 studies were excluded

Fig. 3

Integrated program on complementary feeding nutrition intervention. Shows the effect of integrated program on complimentary feeding practices compared to the non-integrated program among children aged 6–9 months

Fig. 4

Integrated program on exclusive breastfeeding nutrition intervention. Shows the effect of integrated program on exclusive breastfeeding practices among children younger than 6 months compared to the non-integrated program

Fig. 5

Integrated program on stunting. Shows the effect of integrated program in stunting among children aged 24–59 months compared to the non-integrated program

Fig. 6

Integrated program on wasting. Shows the effect of integrated program on wasting among children aged 0–23 months (<− 2 WHZ) compared to the non-integrated program

Fig. 7

Integrated program on breastfeeding initiation. Shows the effect of integrated program on early breastfeeding initiation practices within 1 h of delivery compared to the non-integrated program

Fig. 8

Integrated program on underweight. Shows the effect of integrated program toward underweight of children > 2 years compared to the non-integrated program