Background and objectives: Under-nutrition contributes to five million deaths of children under five each year. Throughout the life cycle, under nutrition contributes to increased risk of infection, lowered cognitive performance, chronic disease in adulthood, and mortality. In order to intervene effectively, we need to understand what works, what doesn’t, and why. The aims of the present study were: 1to assess the effectiveness of feeding programs for children aged three months to five years.2 To undertake an implementation evaluation.
Methods: We included RCTs, CCTs and CBAs. Programs provided energy and nutrients through: hot or cold meals, snacks, take-home or home-delivered rations. Recipients had to be aged three months to five years, from all countries. We used standard systematic review methods and evaluated implementation, including nutritional quality of the food.
Results: Searches identified 29387 papers: 290 were retrieved and 28 studies met inclusion criteria; 26 were from LMIC. Energy provided in 15 studies ranged from 20% to 157% of the recommended daily allowance (RDA) and protein ranged from 18% to 425% of the RDI. Our meta-analyses showed small (.26 cm) significant effects on height gain in RCTs, but no other effects on growth. A few studies showed effects on cognitive ability (SMD = 3.06, 95% CI = 2.6 to 3.6) and psychomotor development (SMD = 1.4, 95% CI .56 to 2.2) in RCTs. We will present results of subgroup analyses by age, initial nutritional status, nutritional adequacy, and delivery mode. Our implementation review identified potential reasons for the ineffectiveness of some programs, including: inadequate energy, redistribution of food within the family, lack of supervision, pipeline breaks, caregiver stress and child disease.
Conclusion: This review provides evidence that feeding programs for young children can work, but that many do not. Our review suggests several ways that program design can be improved.