Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

Maternal undernutrition contributes to 800,000 neonatal deaths annually; stunting, wasting, and micronutrient deficiencies are estimated to underlie nearly 3.1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The Lancet Series on Maternal and Child Undernutrition in 2008.

The authors of this paper in the 2013 Lancet Series on Maternal and Child Nutrition provide a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. They modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90 per cent of the world's children with stunted growth. They also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions.

The analysis suggests that:

• the current total of deaths in children younger than 5 years can be reduced by 15 per cent if populations can access ten evidence-based nutrition interventions at 90 per cent coverage
• about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way
• the estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int$9·6 billion per year.

The article concludes that continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches — ie, women's empowerment, agriculture, food systems, education, employment, social protection, and safety nets — they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.

Please note: This paper is accessible upon free registration to The Lancet.