Impact of education and provision of complementary feeding on growth and morbidity in children less than 2 years of age in developing countries: a systematic review

Impact of education and provision of complementary feeding on growth and morbidity in children less than 2 years of age in developing countries: a systematic review

About one third of deaths in children less than 5 years of age are due to underlying undernutrition. According to an estimate, 19.4% of children <5 years of age in developing countries were underweight (weight for-age Z score <5 years of age in developing countries were underweight (weightfor-age Z score ><-2) and about 29.9% were stunted in the year 2011 (height-for-age Z score <-2). It is well recognized that the period of 6-24 months of age is one of the most critical time for the growth of the infant.

The study includes randomised, non-randomised trials and programs on the effect of complementary feeding (CF) (fortified or unfortified, but not micronutrients alone) and education on CF on children less than 2 years of age in low and middle income countries (LMIC). Studies that delivered intervention for at least 6 months are included; however, studies in which intervention was given for supplementary and therapeutic purposes are excluded. Recommendations are made for input to the Lives Saved Tool (LiST) model by following standardised guidelines developed by Child Health Epidemiology Reference Group (CHERG).

16 studies are included in this review. Amongst these, 9 studies provide education on complementary feeding, 6 provide complementary feeding and 1 provide both as separate arms. Overall, education on CF alone significantly improve HAZ (SMD: 0.23; 95% CI: 0.09, 0.36), WAZ (SMD 0.16, 95% CI: 0.05, 0.27), and significantly reduce the rates of stunting (RR 0.71; 95% CI: 0.56, 0.91). While no significant impact is observed for height and weight gain. Based on the subgroup analysis; ten studies from food secure populations indicate education on CF had a significant impact on height gain, HAZ scores, and weight gain, however, stunting reduced non-significantly. In food insecure population, CF education alone significantly improve HAZ scores, WAZ scores and significantly reduce the rates of stunting, while CF provision with or without education improve HAZ and WAZ scores significantly.

Complementary feeding interventions have a potential to improve the nutritional status of children in developing countries. However, large scale high quality randomised controlled trials are required to assess the actual impact of this intervention on growth and morbidity in children 6-24 months of age. Education should be combined with provision of complementary foods that are affordable, particularly for children in food insecure countries.

[Adapted from author]