Supplementary feeding for young children in low and middle income countries

Sguassero Y, de Onis M, Carroli G

Published Online:

March 17, 2010

Undernutrition is one of the leading underlying causes of childhood morbidity and mortality in developing countries. Providing extra food to children or families beyond the normal ration of their home diets is an intervention aimed at supporting the nutritional well-being of the target population. We identified four RCTs that met the inclusion criteria for this review. Based on the published evidence reviewed, no firm conclusions of the benefits of supplementary feeding to the growth of pre-school children could be drawn. The relatively small number of trials indicates a need for further research in this area.

Abstract (click to read)

Background:

Supplementary feeding is defined as the provision of extra food to children or families beyond the normal ration of their home diets. The impact of food supplementation on child growth merits careful evaluation in view of the reliance of many states and NGOs on this intervention to improve child health in developing countries.

Objectives:

To evaluate the effectiveness of community-based supplementary feeding for promoting the physical growth of pre-school children in developing countries.

Search strategy:

Searches of CENTRAL 2005 (Issue 2), MEDLINE 1966 to 2005, EMBASE 1980 to 2005, CINAHL 1982 to 2005, LILACS 1982 to 2005, Social Science Citation Index 1956 to 2005, and Dissertation Abstracts International (late 1960s to 2005) were conducted.

Selection criteria:

Randomised controlled trials evaluating supplementary feeding in children aged 0-5 years old in developing countries.

Data collection and analysis:

Data were extracted and analysed independently by two authors.

Main results:

Four trials met the inclusion criteria for this review. No meta-analysis is currently appropriate due to the clinical heterogeneity among the included studies. We group these trials into two categories: a) studies without formally assessment of malnourishment at baseline and, b) studies involving children formally assessed as malnourished.

a) A cluster RCT conducted in Indonesia in 1991(20 Day Care Centres, n = 113 children), found no benefit in weight-for-age and height-for-age z-scores of the intervention group compared to controls after three months of intervention. A study in Guatemala reported the length of 3-yr-old children was based on a 'before-after comparison' by village size and type of supplement (exact sample sizes were not provided). According to this analysis, the difference in net change in the large villages was 2.55 cm and in the small villages was 2.35 cm. The mean of these differences is 2.45 +- 0.10 cm (mean +- SD).

b) A study conducted in Jamaica (n = 65 children) reported a positive effect on length (cm) in the supplemented group compared to controls [WMD 1.3 (0.03 to 2.57)] after 12 months of intervention. A trial from Indonesia (n = 75 children) found no benefit in growth after 12 months of supplementation.

Authors' conclusions:

Based on the small number of available trials, no firm conclusions of the effectiveness of supplementary feeding to the growth of pre-school children could be drawn. Issues of research design such as blinding and sample size calculation need to be addressed in future studies.

This record should be cited as:

Sguassero Y, de Onis M, Carroli G. Community-based supplementary feeding for promoting the growth of young children in developing countries. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD005039. DOI: 10.1002/14651858.CD005039.pub2

Assessed as up to date:

June 15, 2005

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Primary Review Group:

Developmental, Psychosocial and Learning Problems Group

Health topics:

Developmental, psychosocial, and learning problems > Other

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Supplementary feeding for young children in low and middle income countries

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