Lindsay H. Allen and Stuart R. Gillespie
ACC/SCN NUTRITION POLICY PAPER No. 19
ADB NUTRITION AND DEVELOPMENT SERIES No. 5
United Nations Administrative Committee on
Coordination
Sub-Committee on Nutrition (ACC/SCN)
in collaboration with the
Asian Development Bank (ADB)
September 2001
The Asian Development Bank Nutrition and Development Series
This is the first copublication by the ACC/SCN in its Nutrition Policy Series and the Asian Development Bank in its Nutrition and Development Series. The ADB Nutrition and Development Series, begun in 2001, covers the impact of malnutrition in Asia and the Pacific on poverty and depressed human and economic development. The Series stresses three themes: targeting nutrition improvements at poor women and children, with benefits to families, communities, and nations throughout the life cycle; reviewing and applying scientific evidence about nutrition impact for policies, programmes, and developmental assistance that will raise the quality of human resources; and creating opportunities for public, private, and civil sector partnerships that can raise the dietary quality of the poor, and enhance the learning and earning capability of poor children. The Series is intended for ADB member countries, development partners, and scholars interested in applying science and technology to investment decisions.
This copublication was prepared under ADB's Regional Technical Assistance 5824 - Regional Study of Nutrition Trends, Policies and Strategies in Asia and the Pacific - which was designed and coordinated by Dr. Joseph M. Hunt, ADB's Senior Health and Nutrition Economist, with the support of William Fraser, Manager of the Education, Health and Population Division (East) of ADB, which sponsored the project. For more information, please contact Dr. Joseph M. Hunt, Series Editor: jhunt@adb.org: (632) 636-6830, fax: (632) 636-2407. Address: Asian Development Bank, 6 ADB Avenue, Mandaluyong City, 0421 Metro Manila, Philippines.
Copyright © 2001 Asian Development Bank with the UN ACC Sub-Committee on Nutrition
This publication may be reproduced with prior permission from ADB.
The designations employed and the presentation of material in this publication do not necessarily imply the expression of any opinion whatsoever on the part of ADB or the ACC/SCN or its UN member agencies concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries.
Suggested citation form for this report:
ACC/SCN (2001). What Works? A Review of the Efficacy and Effectiveness of Nutrition Interventions, Allen LH and Gillespie SR. ACC/SCN: Geneva in collaboration with the Asian Development Bank, Manila.
ISBN 971-561-388-8
Publication Stock No. 070901
Published by the Asian Development Bank, P.O. Box 789, 0980 Manila, Philippines
E-mail: adbpub@adb.org; website: http://www.adb.org and
ACC/SCN Secretariat, c/o World Health Organization, 20 Avenue Appia, CH 1211 Geneva 27, Switzerland
E-mail: accscn@who.int; website: http://acc.unsystem.org/scn/
Undernutrition Throughout the Life Cycle
Research on Interventions to Combat Undernutrition
Conceptual Framework
Definitions and Indicators
Wasting or Stunting in utero
Prevalence of Intrauterine Growth Retardation (IUGR)
Consequences of Low BirthweightIncreased Mortality and Morbidity
Greater Risk of Stunting
Poor Neurodevelopmental Outcomes
Reduced Strength and Work Capacity
Increased Risk of Chronic DiseaseCauses of Intrauterine Growth Retardation
Prenatal Food SupplementationBeneficial Nutrition Interventions
Nonbeneficial Nutrition InterventionsTargeting Supplements to Undernourished Women
Best Predictors for Women at Greatest Risk of IUGRPrepregnancy Weight
Attained Maternal Weight at 20, 28 or 36 Weeks of GestationAdditional, Less Useful Predictors of Women at Greatest Risk of IUGR
Low Maternal Body Mass Index (BMI)
Pregnancy Weight Gain
Maternal HeightMicronutrient Supplementation During Pregnancy
Supplementation with Single Micronutrients
Non-Nutritional Interventions During Pregnancy
Adolescent NutritionAdolescent Growth
Adolescent Pregnancy
Adolescent Nutritional Status
Can Adolescents Catch-Up Incomplete Childhood Growth?Improving Dietary Intake
Improving Iron and Folate Status
Delaying First Pregnancy
Growth Patterns of Infants and Children
Stunting
Underweight
Wasting
Causes of Poor Growth
Interactions Between Undernutrition and Diseases
Consequences of Poor Growth
The Fundamental Importance of Care
Exclusive Breastfeeding
Complementary FeedingRecommendations for Complementary Feeding
Estimating the Amount of Nutrients Needed in Complementary FoodsImproving the Nutrient Content of Complementary Foods
Improving the Micronutrient Content (Quality) of Complementary Foods
Increasing the Consumption of Animal Products
Improving the Content and Bioavailability of Nutrients in Plant-Based Complementary Foods
Fortification of Complementary Foods with Micronutrients
Efficacy Trials of Complementary Foods
Micronutrient Supplementation to Improve Growth
PREVENTING AND TREATING ANAEMIA
The Prevalence of Anaemia and of Iron Deficiency
Causes of Anaemia
Consequences of Anaemia
Efficacy Trials of Iron SupplementationSupplementation in Pregnancy
Iron Supplementation of Infants and Preschool Children
Iron Supplementation of School Children and Adolescents
Frequency, Duration and Prioritization of Iron SupplementationThe Role of Other Micronutrients in Anaemia
Dietary Interventions to Reduce and Prevent Iron Deficiency
Iron Fortification of Foods
Efficacy Trials
Effectiveness TrialsMaize and Wheat Flour Fortification
Condiment Fortification
Fortification of Foods for Infants and Children
Safety of Iron Fortification Programmes
Complementary Parasite Control Strategies for Prevention of Anaemia
PREVENTING AND TREATING IODINE DEFICIENCY
Prevalence of Iodine Deficiency
Causes of Iodine Deficiency
Consequences of Iodine Deficiency DisordersCretinism
Goitre
Impaired Cognitive Function
Increased Perinatal Morbidity and MortalityEffects on Goitre Reduction
Effects on Pregnancy Outcome
Effects on Infant Mortality
Effect on Child Growth
Potential for Iodine Toxicity
PREVENTING AND TREATING VITAMIN A DEFICIENCY (VAD)
Prevalence of Vitamin A Deficiency
Consequences of Vitamin A Deficiency
Efficacy Trials to Improve Vitamin A StatusEffect on Pregnancy Outcome
Impact on Morbidity and Mortality of Infants and Children
Prevention of Childhood IllnessBenefits of Providing Vitamin A to Infants in the Expanded Programme in Immunization
The Efficacy of Food-Based Strategies to Improve Vitamin A Status
Summary and Conclusions
EFFECTIVENESS OF LARGE SCALE NUTRITION INTERVENTIONS
Growth Monitoring and Promotion
Integrated Care and Nutrition Interventions
Communications for Behavioural ChangeSupplementary Feeding of Young Children and Women
School Feeding
Health-Related Services
Complementarities Between Health Service Delivery and Community NutritionEffectiveness of Supplementation for the Control of Iron and Vitamin A Deficiency
Food-Based Strategies for Control of Iron and Vitamin A Deficiency
Control of Iodine Deficiency Disorders
Benefit-Cost and Cost-Effectiveness Analyses
Key “Minimum Packages”
Programme Management Principles
Bangladesh
Cambodia
People's Republic of China
India
Pakistan
Sri Lanka
Viet Nam
ACC/SCN NUTRITION POLICY PAPERS