What Works? A Review of the Efficacy and Effectiveness of Nutrition Interventions













Table of Contents


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/


Table of Contents


FOREWORD

EXECUTIVE SUMMARY

AUTHORS

ACKNOWLEDGEMENTS

LIST OF ABBREVIATIONS

GLOSSARY

INTRODUCTION

Undernutrition Throughout the Life Cycle
Research on Interventions to Combat Undernutrition
Conceptual Framework

PREVENTING LOW BIRTHWEIGHT

Definitions and Indicators
Wasting or Stunting in utero
Prevalence of Intrauterine Growth Retardation (IUGR)
Consequences of Low Birthweight

Increased Mortality and Morbidity
Greater Risk of Stunting
Poor Neurodevelopmental Outcomes
Reduced Strength and Work Capacity
Increased Risk of Chronic Disease

Causes of Intrauterine Growth Retardation
Prenatal Food Supplementation

Beneficial Nutrition Interventions
Nonbeneficial Nutrition Interventions

Optimizing Interventions

Targeting Supplements to Undernourished Women
Best Predictors for Women at Greatest Risk of IUGR

Prepregnancy Weight
Attained Maternal Weight at 20, 28 or 36 Weeks of Gestation

Additional, Less Useful Predictors of Women at Greatest Risk of IUGR

Low Maternal Body Mass Index (BMI)
Pregnancy Weight Gain
Maternal Height

Timing of Supplementation
Duration of Supplementation

Micronutrient Supplementation During Pregnancy

Supplementation with Single Micronutrients

Iron
Folic Acid
Zinc
Vitamin A
Calcium
Iodine

Supplementation with Multiple Micronutrients

Non-Nutritional Interventions During Pregnancy
Adolescent Nutrition

Adolescent Growth
Adolescent Pregnancy
Adolescent Nutritional Status
Can Adolescents Catch-Up Incomplete Childhood Growth?

Intervening in Adolescence

Improving Dietary Intake
Improving Iron and Folate Status
Delaying First Pregnancy

Summary and Conclusions

IMPROVING CHILD GROWTH

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 Feeding

Recommendations for Complementary Feeding
Estimating the Amount of Nutrients Needed in Complementary Foods

Improving the Nutrient Content of Complementary Foods

Increasing Energy Intake
Increasing Protein Intake

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

Iron
Zinc
Vitamin A
Calcium
Iodine
Multiple Micronutrients

Summary and Conclusions

PREVENTING AND TREATING ANAEMIA

The Prevalence of Anaemia and of Iron Deficiency
Causes of Anaemia
Consequences of Anaemia
Efficacy Trials of Iron Supplementation

Supplementation in Pregnancy
Iron Supplementation of Infants and Preschool Children
Iron Supplementation of School Children and Adolescents
Frequency, Duration and Prioritization of Iron Supplementation

The Role of Other Micronutrients in Anaemia
Dietary Interventions to Reduce and Prevent Iron Deficiency
Iron Fortification of Foods
Efficacy Trials
Effectiveness Trials

Maize 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

Summary and Conclusions

PREVENTING AND TREATING IODINE DEFICIENCY

Prevalence of Iodine Deficiency
Causes of Iodine Deficiency
Consequences of Iodine Deficiency Disorders

Cretinism
Goitre
Impaired Cognitive Function
Increased Perinatal Morbidity and Mortality

Iodine Efficacy Trials

Effects on Goitre Reduction
Effects on Pregnancy Outcome
Effects on Infant Mortality
Effect on Child Growth
Potential for Iodine Toxicity

Summary and Conclusions

PREVENTING AND TREATING VITAMIN A DEFICIENCY (VAD)

Prevalence of Vitamin A Deficiency
Consequences of Vitamin A Deficiency
Efficacy Trials to Improve Vitamin A Status

Effect on Pregnancy Outcome
Impact on Morbidity and Mortality of Infants and Children
Prevention of Childhood Illness

Benefits of Providing Vitamin A to Infants in the Expanded Programme in Immunization

Improved Growth
Impact on HIV Infection

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 Change

Specific Nutrition-Related Recommendations

Supplementary Feeding of Young Children and Women

School Feeding
Health-Related Services
Complementarities Between Health Service Delivery and Community Nutrition

Effectiveness of Supplementation for the Control of Iron and Vitamin A Deficiency

Iron
Vitamin A

Food-Based Strategies for Control of Iron and Vitamin A Deficiency
Control of Iodine Deficiency Disorders

PRIORITIZING OPTIONS

Benefit-Cost and Cost-Effectiveness Analyses

Determining Unit Costs of Interventions
Cost-Effectiveness

Key “Minimum Packages”
Programme Management Principles

Contextual Success Factors
Programme Success Factors

Role of Programmes in National Nutrition Improvement

REFERENCES

APPENDIX 1. PROFILES OF SOME COMMUNITY-BASED NUTRITION INTERVENTIONS IN ASIAN COUNTRIES, FROM THE ASIAN DEVELOPMENT BANK REGIONAL TECHNICAL ASSISTANCE (RETA) PROJECT 5671 ON “INVESTING IN CHILD NUTRITION IN ASIA” AND OTHER RELEVANT PROJECTS AND STUDIES

Bangladesh
Cambodia
People's Republic of China
India
Pakistan
Sri Lanka
Viet Nam

ACC/SCN NUTRITION POLICY PAPERS

ASIAN DEVELOPMENT BANK NUTRITION AND DEVELOPMENT SERIES

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