Nutritional interventions for preventing stunting in children (Birth to 59 months) living in urban slums in low-and middle-income countries (LMIC)

摘要: © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background Nutritional interventions to prevent stunting of infants and young children are most often applied in rural areas low-and middle-income countries (LMIC). Few focused on urban slums. literature needs a systematic assessment, as living slums at high risk stunting. Urban complex environments terms biological, social, political variables the outcomes nutritional need be assessed relation these variables. For purposes this review, we followed UN-Habitat 2004 definitions for low-income informal settlements or lacking one more indicators basic services infrastructure. Objectives To assess impact reduce under five years old from LMIC effect other (wasting underweight) non-nutritional (socioeconomic, health developmental) addition Search methods review used sensitive search strategy electronic databases, bibliographies articles, conference proceedings, websites, grey literature, contact with experts authors published 1990. We searched 32 English non-English languages (MEDLINE, CENTRAL, Web Science, Ovid MEDLINE, etc). performed initial November 2015 January 2016, conducted top up searches March 2017 August 2018. Selection criteria Research designs included randomised (including cluster-randomised) trials, quasi-randomised non-randomised controlled before-and-after studies, pre-and postintervention, interrupted time series (ITS), historically studies among LMIC, birth 59 months, were nutrition-specific maternal education. primary length height expressed cm length-for-age (LFA)/height-for-age (HFA) z-scores, weight grams presence/absence low (LBW). Data collection analysis screened then retrieved titles abstracts full text if potentially eligible inclusion. Working independently, author all extracted data selected population, intervention, comparison, outcome parameters two half each. calculated mean selection difference (MD) 95% confidence intervals (CI). intervention-level meta-analyses estimate pooled measures effect, narrative synthesis when not possible. P less than 0.05 statistical significance intervention also considered their biological/ importance. Where sizes small statistically insignificant, concluded there was ’unclear effect’. Main results 15 which 14 trials (RCTs). took place recognised poor periurban areas. study locations mainly Bangladesh, India, Peru. participants 9261 3664 pregnant women. There no dietary studies. All identified nutrient supplementation educational interventions. zinc women (three studies), micronutrient macronutrient (eight nutrition education (two systems strengthening targeting studies) intervention. Six adapted context seven targeted household, community, ’service delivery’ via strengthening. available LFA/HFA, four LBW, nine length. had overall bias 11 only RCTs moderate bias. Overall, evidence report, wide range reported. Consequently, eight findings reported form. certainty very overall. None differential impacts relevant equity issues. Zinc LBW (versus without placebo) RCTs) an (MD-36.13 g, CI-83.61 11.35), moderate-certainty evidence, unclear low-to evidence. Micronutrient HFA meta-analysis low-certainty (MD-0.02, CI-0.06 0.02), inconclusive form Nutrition standard care intervention) positive women, (MD 478.44g, CI 423.55 533.32). (compared care) (one RCT study) HFA, influence 18 Authors’ conclusions reviewed potential decrease stunting, based outside slum contexts; however, (very evidence). Challenges linked programming (high mobility, lack social services, loss follow-up) should taken into account proposed address such environments. More is needed effects multi-sectorial interventions, combining programmes, well ’up-stream’ practices policies governmental, non-governmental organisations, business sector nutrition-related