The role of nutrition-sensitive interventions in improving nutritional outcomes: Findings from a systematic review and meta-analysis

Abstract:

Background: Maternal and child undernutrition remains a major global health concern despite modest progress. Accelerating reductions in stunting and wasting will require increased investments in nutrition-sensitive interventions, which target nutrition impacts outside of the healthcare setting.

This review examines the effects of four types of nutrition-sensitive interventions - cash/food transfers, nutrition-sensitive agriculture, water/sanitation/hygiene, and school nutrition on maternal and child nutrition outcomes and dietary diversity.

Methods: We synthesized the evidence using an initial broad search and synthesis for nutrition-sensitive interventions, followed by targeted searches and syntheses for specific interventions and nutrition outcomes. Meta-analyses were performed to evaluate the impacts of cash transfers and agricultural interventions, while a narrative synthesis was produced for additional nutrition-sensitive interventions. Additionally, qualitative synthesis was incorporated to provide insights into the relationship between implementation context and program effectiveness.

Results: Our initial evidence synthesis included 260 quantitative studies, and additional targeted searches produced 72 eligible articles. Meta-analyses reveal positive impacts on dietary diversity for cash transfers without nutrition-specific components (0.14 SMD; 95% CI: 0.06-0.22), and some nutrition-sensitive agricultural interventions (0.24 SMD; 95% CI: 0.11-0.37). Cash transfers have larger effects on dietary diversity when they include behavior change communication or other nutrition-specific elements (0.41 SMD; 95% CI; 0.15-0.66), whereas agriculture programs with nutrition-specific elements do not show larger effects on dietary diversity than those without.

Narrative syntheses indicate that homestead food production interventions may reduce anemia, school feeding interventions may improve anthropometric outcomes, and WASH interventions are most effective when combined with other nutrition initiatives.

Conclusions: We find consistent evidence that nutrition-sensitive programs contribute to dietary diversity and may have small but positive effects on nutrition outcomes, such as anthropometric outcomes and anemia. Integrating nutrition into social protection, agriculture, and education sectors is essential for addressing the underlying causes of malnutrition, such as dietary diversity.

Biography:

Thomas de Hoop directs a research and evaluation portfolio with a focus on the impact, scalability, and cost-effectiveness of self-help groups, savings groups, and education innovations in South Asia and sub-Saharan Africa. He is currently the co-principal investigator for the Evidence Consortium on Women’s Groups, a four-year research project that focuses on synthesizing, strengthening, and disseminating research on the impact and cost-effectiveness of large-scale government-supported women’s groups. As part of the ECWG, Dr. de Hoop leads or co-leads studies on the impact of COVID-19 on the functioning of women’s groups and how self-help groups in India and savings groups in Nigeria and Uganda contribute to mitigating the economic consequences of COVID-19. In addition, he oversees various evidence syntheses, experimental and quasi-experimental studies, and cost-effectiveness analyses on women’s groups. This research guides the Gender Equality team at the Bill & Melinda Gates Foundation in the use of evidence to inform the Foundation’s gender equality strategy.

Dr. de Hoop is also the principal or co-principal investigator for a five-year cluster-randomized controlled trial of a technology-aided instruction program in Zambia, a three-year quasi-experimental study on the impact of a World Bank-funded and government-supported women’s group program in Nigeria, the development of a typology for a handbook on the implementation of self-help groups in South Asia, and a social impact assessment of an organic cotton farming project in India. In addition to designing these studies, he trains and manages teams of researchers, closely engages with funders, governments, foundations, and non-governmental organizations, analyzes data, and authors briefs, reports, and peer-reviewed papers.