Effectiveness of Interventions for Managing Acute Malnutrition in Children under Five Years of Age in Low-Income and Middle-Income Countries: A Systematic Review and Meta-Analysis
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Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan
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Medical Student, Aga Khan University, Karachi 74800, Pakistan
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Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
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Centre for Global Child Health, the Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(1), 116; https://doi.org/10.3390/nu12010116
Received: 27 November 2019 / Revised: 15 December 2019 / Accepted: 22 December 2019 / Published: 1 January 2020
(This article belongs to the Special Issue What Works? Evidence Based Maternal, Child and Adolescent Nutrition Interventions)
Childhood malnutrition is a major public health concern, as it is associated with significant short- and long-term morbidity and mortality. The objective of this review was to comprehensively review the evidence for the management of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) according to the current World Health Organization (WHO) protocol using facility- and community-based approaches, as well as the effectiveness of ready-to-use therapeutic food (RUTF), ready-to-use supplementary food (RUSF), prophylactic antibiotic use, and vitamin A supplementation. We searched relevant electronic databases until 11 February 2019, and performed a meta-analysis. This review summarizes findings from a total of 42 studies (48 papers), including 35,017 children. Limited data show some benefit of integrated community-based screening, identification, and management of SAM and MAM on improving recovery rate. Facility-based screening and management of uncomplicated SAM has no effect on recovery and mortality, while the effect of therapeutic milk F100 for SAM is comparable to RUTF for weight gain and mortality. Local food and whey RUSF are comparable to standard RUSF for recovery rate and weight gain in MAM, while standard RUSF has additional benefits to CSB. Prophylactic antibiotic administration in uncomplicated SAM improves recovery rate and probably improves weight gain and reduces mortality. Limited data suggest that high-dose vitamin A supplementation is comparable with low-dose vitamin A supplementation for weight gain and mortality among children with SAM.
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Keywords:
malnutrition; children; acute malnutrition
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MDPI and ACS Style
Das, J.K.; Salam, R.A.; Saeed, M.; Kazmi, F.A.; Bhutta, Z.A. Effectiveness of Interventions for Managing Acute Malnutrition in Children under Five Years of Age in Low-Income and Middle-Income Countries: A Systematic Review and Meta-Analysis. Nutrients 2020, 12, 116.
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