Abstract

Background: South Asian Association for Regional Cooperation (SAARC) Countries, consisting of low-income and lowand middle-income countries in Indian Subcontinent have high burden of malnutrition among children under 5 years of age. Multiple studies have been conducted to test various interventions for improving the nutrition status of children under 5 years of age. However, limited work is done on identifying what are the best practices that emerged through various studies, which can be scaled up or can be integrated with national programs.
Objective: The objective of this study is to systematically identify best practices compared against standard care.
Materials and Methods: A systematic literature search was carried from online databases including: Medline, Embase, Jstor, J-gate, Ovid, and Cochrane Library. The search was limited to English language, studies carried out in SAARC countries and limited to studies carried out over past 10 years. Search strategy yielded 2884 results, after screening through title for language, geography, and duration. Eleven studies were included for meta-analysis. Studies were classified into four categories of special nutrition programme (SNP) to children interventions, IEC interventions, Maternal SNP interventions, and Micronutrient interventions. Data on outcome were measured as per the World Health Organization standards for Z score for Stunting, Wasting, and Underweight. Data were abstracted and entered into RevMan 5.3 for meta-analysis. Study quality was analyzed using Child Health Epidemiology Reference Group adaptation of the GRADE checklist. Inverse variance using random effects models was drawn for pooled effects along with test with heterogeneity.
Results: For SNP to Children interventions, overall effect for underweight marginally favors commercially available or internationally produced SNPs over locally produced SNPs with mean difference of 0.08, (95% confidence interval [CI] 0.04, 0.11), I2 = 12%. Overall effects for wasting were marginally favoring International SNP over local SNP with mean difference of 0.08, (95% CI 0.04, 0.12), I2 = 31%. For Maternal SNPs, overall effect for underweight inclines for Standard Maternal Care over Maternal SNP with mean difference of 0.14, (95% CI 0.07, 0.21), I2 =0%. Overall effect for stunting inclines for Standard Maternal Care over Maternal SNP with mean difference of 0.10, (95% CI 0.05, 0.14), I2 = 0%. IEC interventions presented inconclusive results. Micronutrient interventions had heterogenous data. Conclusion: From our study, the identification of best practices did not provide evidence to back any specific intervention over standard practice. The standard care offered through Integrated Child Development Programme provides all-inclusive coverage in management of malnutrition among children under 5 years of age.