Nutritional interventions for maternal and child health (MCH) in armed conflict and humanitarian crisis in low income and middle income countries (LMICS): a systematic review of effects and contextual factors
Date of Award
Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)
Community Health Sciences
Women and children suffer from high burden of malnutrition and poor nutritional outcomes in conflict and humanitarian crisis. We conducted an evidence synthesis to assess the current evidence on delivery of nutrition interventions (nutrition-specific and nutrition-sensitive) in armed conflict and humanitarian crisis settings in low and middle income countries (LMICs) to inform policy. Methodology: We performed a systematic search on PsychInfo, Medline, Embase and CINAHL. All the articles were imported to Covidence software, de-duplicated and screened for eligibility. Following title/abstract screening and full text screening, all the included articles were extracted on RedCap software. Descriptive data analysis was performed followed by qualitative synthesis of contextual factors using World Health Organization (WHO) framework of health systems. The quantitative data analysis included estimates of intervention coverage and effectiveness. Results: 51 studies met the inclusion criteria. Four categories of nutritional interventions were identified which included supplementary feeding programs, general food distribution (i.e. food rations), micronutrient supplementation (nutrition-specific) and food vouchers and cash distribution (nutrition sensitive). Most of the studies used outreach delivery approach and services were provided by trained assistants, nutritionists, midwives, and nurses. Most of the programs were implemented by UN agencies, NGOs and government (i.e. Ministry of Vlealth) was mostly invovled in supervision. The studies showed decrease in mortality and prevalence of stunting, wasting and anemia. The coverage of food rations to women and children increased from 30 to 90%, recovery rates of moderate acute malnutrition (MAM) range from 67% - 80% and anemia decreased by 23.4%. Supplementary feeding program showed a 47% reduction in prevalence of global acute malnutrition (GAM) and 80% reduction in prevalence of severe acute malnutrition (SAM) among children under 5 years and increased recovery rate of SAM from 64% to 94% and decreased mortality from 1 to 4%. Vitamin A supplementation at home among children reduced mortality by 12% and stunting from 19.8% to 39.2%. Micronutrient supplementation also reported 85% recovery from micronutrient deficiency among children under 5 years. While food voucher and cash distribution increased food consumption among poor people by 80%. Major barriers included lack of trained staff and funding, blocked roads and destructed healthcare facilities.
Peera, Z. (2018). Nutritional interventions for maternal and child health (MCH) in armed conflict and humanitarian crisis in low income and middle income countries (LMICS): a systematic review of effects and contextual factors (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.