BACKGROUND: Maternal nutrition interventions are efficacious in improving birth outcomes. It is important to demonstrate that if delivered in field conditions they produce improvements in health and nutrition. OBJECTIVE: Analyses of scaling-up of five program implemented in several countries. These include micronutrient supplementation, food fortification, food supplements, nutrition education and counseling, and conditional cash transfers (as a platform for delivering interventions). Evidence on impact and cost-effectiveness is assessed, especially on achieving high, equitable, and sustained coverage, and reasons for success or failure METHODS: Systematic review of articles on large-scale programs in several databases. Two separate reviewers carried out independent searches. A separate review of the gray literature was carried out including websites of the most important organizations leading with these programs. With Google Scholar a detailed review of the 100 most frequently cited references on each of the five above topics was conducted. RESULTS: Food fortification programs: iron and folic acid fortification were less successful than salt iodization initiatives, as the latter attracted more advocacy. Micronutrient supplementation programs: Nicaragua and Nepal achieved good coverage. Key elements of success are antenatal care coverage, ensuring availability of tablets, and improving compliance. Integrated nutrition programs in India, Bangladesh, and Madagascar with food supplementation and/or behavioral change interventions report improved coverage and behaviors, but achievements are below targets. The Mexican conditional cash transfer program provides a good example of use of this platform to deliver maternal nutritional interventions. CONCLUSIONS: Programs differ in complexity, and key elements for success vary with the type of program and the context in which they operate. Special attention must be given to equity, as even with improved overall coverage and impact inequalities may even be increased. Finally, much greater investments are needed in independent monitoring and evaluation.
BACKGROUND: Maternal nutrition interventions are efficacious in improving birth outcomes. It is important to demonstrate that if delivered in field conditions they produce improvements in health and nutrition. OBJECTIVE: Analyses of scaling-up of five program implemented in several countries. These include micronutrient supplementation, food fortification, food supplements, nutrition education and counseling, and conditional cash transfers (as a platform for delivering interventions). Evidence on impact and cost-effectiveness is assessed, especially on achieving high, equitable, and sustained coverage, and reasons for success or failure METHODS: Systematic review of articles on large-scale programs in several databases. Two separate reviewers carried out independent searches. A separate review of the gray literature was carried out including websites of the most important organizations leading with these programs. With Google Scholar a detailed review of the 100 most frequently cited references on each of the five above topics was conducted. RESULTS: Food fortification programs: iron and folic acid fortification were less successful than salt iodization initiatives, as the latter attracted more advocacy. Micronutrient supplementation programs: Nicaragua and Nepal achieved good coverage. Key elements of success are antenatal care coverage, ensuring availability of tablets, and improving compliance. Integrated nutrition programs in India, Bangladesh, and Madagascar with food supplementation and/or behavioral change interventions report improved coverage and behaviors, but achievements are below targets. The Mexican conditional cash transfer program provides a good example of use of this platform to deliver maternal nutritional interventions. CONCLUSIONS: Programs differ in complexity, and key elements for success vary with the type of program and the context in which they operate. Special attention must be given to equity, as even with improved overall coverage and impact inequalities may even be increased. Finally, much greater investments are needed in independent monitoring and evaluation.
Authors: Naoko Kozuki; Joanne Katz; Anne C C Lee; Joshua P Vogel; Mariangela F Silveira; Ayesha Sania; Gretchen A Stevens; Simon Cousens; Laura E Caulfield; Parul Christian; Lieven Huybregts; Dominique Roberfroid; Christentze Schmiegelow; Linda S Adair; Fernando C Barros; Melanie Cowan; Wafaie Fawzi; Patrick Kolsteren; Mario Merialdi; Aroonsri Mongkolchati; Naomi Saville; Cesar G Victora; Zulfiqar A Bhutta; Hannah Blencowe; Majid Ezzati; Joy E Lawn; Robert E Black Journal: J Nutr Date: 2015-09-30 Impact factor: 4.798
Authors: John B Mason; Roger Shrimpton; Lisa S Saldanha; Usha Ramakrishnan; Cesar G Victora; Amy Webb Girard; Deborah A McFarland; Reynaldo Martorell Journal: Glob Health Action Date: 2014-06-06 Impact factor: 2.640
Authors: Amaap Alagiyawanna; Nick Townsend; Oli Mytton; Pete Scarborough; Nia Roberts; Mike Rayner Journal: BMC Public Health Date: 2015-09-14 Impact factor: 3.295
Authors: Andrew J Milat; Lesley King; Robyn Newson; Luke Wolfenden; Chris Rissel; Adrian Bauman; Sally Redman Journal: Health Res Policy Syst Date: 2014-04-15