evidence-based blog of Filippo Dibari

Posts Tagged ‘cochrane collaboration’

Interventions to improve water quality and supply, sanitat ion and hygiene practices, and their effects on the nutritional status of children (Review)

In Under-nutrition on October 5, 2013 at 1:07 pm

by Dangour AD, Watson L, Cumming O, Boisson S, Che Y, Velleman Y, Cavill S, Allen E, Uauy R

Editorial group: Cochrane Public Health Group. Issue 8, 2013.

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Plain Language Summary

The effect of interventions to improve water quality and supply, provide sanitation and promote handwashing with soap on physical growth in children
In low-income countries an estimated 165 million children under the age of five years suffer from chronic undernutrition causing them to be short in height and 52 million children suffer from acute undernutrition causing them to be very thin. Poor growth in early life increases the risks of illness and death in childhood. The two immediate causes of childhood undernutrition are inadequate dietary intake and infectious diseases such as diarrhoea. Water, sanitation and hygiene (WASH) interventions are frequently imp
lemented to reduce infectious diseases; this review evaluates the effect that WASH interventions may have on nutrition outcomes in children. The review includes evidence from randomised and non-randomised interventions designed to (i) improve the microbiological quality of drinking water or protect the microbiological quality of water prior to consumption; (ii) introduce new or improved water supply or improve distribution; (iii) introduce or expand the coverage and use of facilities designed to improve sanitation; or (iv) promote handwashing with soap after defecation and disposal of child faeces, and prior to preparing and handling food, or a combination of these interventions, in children aged under 18 years.
We identified 14 studies of such interventions involving 22,241 children at baseline and nutrition outcome data for 9,469 children. Meta-analyses of the evidence from the cluster-randomised trials suggests that WASH interventions confer a small benefit on growth in children under five years of age. While potentially important, this conclusion is based on relatively short-term studies, none of which is of high methodological quality, and should therefore be treated with caution. There are several large, robust studies underway in low-income country settings that should provide evidence to inform these findings.
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Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review)

In Under-nutrition on June 2, 2013 at 1:12 pm

by De-Regil LM, Suchdev PS, Vist GE, Walleser S, Peña-Rosas JP

Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Summary

Use of a powder mix of vitamins and minerals to fortify complementary foods immediately before consumption and improve health and nutrition in children under two years of age.

Deficiencies of vitamins and minerals, particularly of iron, vitamin A and zinc, affect approximately half of the infants and young children under two years of age worldwide. Exclusive breastfeeding until six months of age and continued breastfeeding for at least two years are recommended to maintain children’s adequate health and nutrition. After six months of age, infants start receiving semi-solid foods but the amount of vitamins and minerals can be insufficient to fulfil all the requirements of the growing baby.

Micronutrient powders (MNP) are single-dose packets of powder containing iron, vitamin A, zinc and other vitamins and minerals that can be sprinkled onto any semi-solid food at home or at any other point of use to increase the content of essential nutrients in the infant’s diet during this period. This is done without changing the usual baby diet.

This review includes eight good quality trials that involved 3748 infants and young children from low income countries in Asia, Africa and the Caribbean. We found that a variety of MNP formulations containing between five and 15 vitamins and minerals have been given for between two and 12 months to infants and young children aged six to 23 months of age.

The use of MNP containing at least iron, zinc and vitamin A for home fortification of foods was associated with a reduced risk of anaemia and iron deficiency in children under two. The studies did not find any effects on growth. Although the acceptability of this innovative intervention was high, there is no additional benefit to usually recommended iron drops or syrups, however few studies compared these different interventions. No deaths were reported in the trials and information on side effects and morbidity, including malaria, was scarce.

The use of MNP was beneficial for male and female infants and young children six to 23 months of age, independent of whether they lived in settings with different anaemia and malaria backgrounds or whether the intervention was provided for two, six or 12 months. The most appropriate arrangements for use (daily or intermittently), the appropriate vitamin and mineral composition of the mix of powders and the way to deliver this intervention effectively in public health programmes to address multiple micronutrient deficiencies remain unclear.

 

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