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Cited by 103Child Nutrition and Water AccessPublic Health and NutritionGlobal Maternal and Child Health

Effectiveness of interventions for managing acute malnutrition in children under five years of age in low-income and middle-income countries: a systematic review and meta-analysis

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Das, Jai K., Salam, Rehana A., Saeed, Marwah, Kazmi, Faheem Ali, Bhutta, Zulfiqar A.·2020·Nutrients
DOI 10.3390/nu12010116PMC PMC7019612
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Abstract

Childhood malnutrition is a major public health concern, as it is associated with significant short- and long-term morbidity and mortality. The objective of this review was to comprehensively review the evidence for the management of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) according to the current World Health Organization (WHO) protocol using facility- and community-based approaches, as well as the effectiveness of ready-to-use therapeutic food (RUTF), ready-to-use supplementary food (RUSF), prophylactic antibiotic use, and vitamin A supplementation. We searched relevant electronic databases until 11 February 2019, and performed a meta-analysis. This review summarizes findings from a total of 42 studies (48 papers), including 35,017 children. Limited data show some benefit of integrated community-based screening, identification, and management of SAM and MAM on improving recovery rate. Facility-based screening and management of uncomplicated SAM has no effect on recovery and mortality, while the effect of therapeutic milk F100 for SAM is comparable to RUTF for weight gain and mortality. Local food and whey RUSF are comparable to standard RUSF for recovery rate and weight gain in MAM, while standard RUSF has additional benefits to CSB. Prophylactic antibiotic administration in uncomplicated SAM improves recovery rate and probably improves weight gain and reduces mortality. Limited data suggest that high-dose vitamin A supplementation is comparable with low-dose vitamin A supplementation for weight gain and mortality among children with SAM.

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  • Critical public health improvements such as in water, sanitation, and hygiene might have contributed to decreases in enteric deaths.

    “Alongside the provision of oral rehydration solution and rotavirus vaccines, critical public health improvements such as in water, sanitation, and hygiene might have contributed to decreases in enteric deaths.35, 36”

    From Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [35]

    The Results (§3.4) discuss diarrhea and mortality as outcomes of acute-malnutrition interventions, not changes in enteric deaths attributable to water, sanitation, or hygiene. Searches for those improvements and for oral rehydration, rotavirus vaccines, and enteric deaths found no passage addressing the claim in our copy. (LLM, conf=0.78)

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  • The reductions in childhood mortality associated with diarrhoeal diseases that have occurred across many parts of Africa can be partly explained by many combined local efforts in improved immunisation, access to water, sanitation, and hygiene facilities, breastfeeding, oral rehydration therapy, and zinc supplementation, alongside global initiatives.

    “The reductions in childhood mortality associated with diarrhoeal diseases that have occurred across many parts of Africa35, 40, 41, 42 can also be partly explained by many combined local efforts in improved immunisation;43 access to water, sanitation, and hygiene facilities;12, 44 breastfeeding;45 oral rehydration therapy;46 and zinc supplementation,15 alongside global initiatives”

    From Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [35]

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References 74 · Cited by 103

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Authors
Das, J. K., Salam, R. A., Saeed, M., Kazmi, F. A., & Bhutta, Z. A.
Affiliations
  • Aga Khan University Hospital (PK)
  • Aga Khan University (PK)
Corresponding author
Bhutta, Zulfiqar A.
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2020-01-01
Volume
12
Issue
1
Pages
116
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu12010116
PMC
PMC7019612
OpenAlex
W2997423466
Cited by
103
References
74
Citations by year
2026: 11 · 2025: 14 · 2024: 26 · 2023: 17 · 2022: 14 · 2021: 18 · 2020: 3
FWCI
1.59
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Bill and Melinda Gates Foundation (OPP1137750)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
severe acute malnutrition, moderate acute malnutrition, children under five, ready-to-use therapeutic food, ready-to-use supplementary food, antibiotic prophylaxis, vitamin A supplementation, community management, recovery rate, mortality, weight gain
MeSH terms
Severe Acute Malnutrition, Child, Preschool, Developing Countries, Female, Food, Fortified, Humans, Infant, Infant, Newborn, Male, Poverty, Child Nutrition Disorders, Treatment Outcome, Dietary Supplements, Nutrition Therapy

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