Good implementation key in feeding programmes for young children in low- and middle-income countries.
Receiving the proper nutrients is particularly important in the period between birth and three years, when children are experiencing rapid growth. Although it is sometimes difficult to disentangle the effects of deprivations that children living in poverty are exposed to, childhood undernutrition is linked to lowered cognitive function, poorer school performance, increased risk of infection, chronic diseases in adulthood, and increased risk of mortality. Undernutrition contributes to five million deaths of young children each year, most of which are preventable and with the vast majority of those in low- and middle-income countries.
Intervening in early childhood is important to maximize developmental potential and lifelong health. Supplementary feeding programs aim to do this through providing food or beverages to help fill the energy gap. Substitution and ration-sharing can be a problem with both take-home and on-site feeding programmes, as food may be consumed by other family members.
A team of Cochrane authors, based in Australia, Canada, Norway, and the UK and working with the Cochrane Developmental, Psychosocial and Learning Problems Group, set out to study the effectiveness of supplementary feeding interventions for improving the health of disadvantaged children, aged three months to five years. They also sought out evidence on how and why feeding interventions may work. Included were 32 studies; 21 of these were randomized controlled trials and 11 were from controlled before-and-after studies. The number of children in these studies ranged from 30 to 3166. Most studies were from low- and middle-income countries.
It was found that in low- and middle-income countries, providing additional food to young children led to small gains in weight and height and moderate increases in haemoglobin. A positive impact on the development of coordinated fine motor and physical activity skills was found, but results on the impact of mental development were mixed. Food was often redistributed within the family when feeding was home-delivered. Food given in day care centres or feeding centres had less redistribution, with children taking in 85% of the energy provided in the supplement versus 36% when feeding was home-delivered. There is some evidence that feeding programmes were most effective for children who were younger and/or those who were most undernourished. Implementation factors that enhanced effectiveness were a higher proportion of required daily food for energy in the supplement and careful monitoring of the child’s intake.
“Feeding programmes for young children in low- and middle-income countries do show benefits. Our results indicate that good implementation is key,” said Elizabeth Kristjansson, a researcher at the University of Ottawa, and the lead author of the Cochrane Review. “These findings should help to improve the development, implementation, and monitoring of feeding programs. They are thus important for governments, funding agencies, and nongovernmental organizations.”