The impact of preschool feeding programmes on the growth of disadvantaged young children in developing countries: a systematic review of randomised trials

Abstract

Background: Childhood malnutrition in developing countries contributes to developmental delays, as well as increased morbidity and mortality. The effectiveness of feeding programmes as a strategy to improve childhood malnutrition has been questioned. Objective: A systematic review was undertaken to examine the effectiveness of preschool feeding programmes in fostering the growth of children in developing countries. Design: A systematic literature search was undertaken to identify published studies that related to the objective. Studies had to be randomised intervention studies that reported on the growth outcomes of children from birth to six years of age in order to be included. Setting: An initial literature search yielded 59 studies, of which 44 were excluded based on initial screening. Five more were omitted based on detailed data extraction. Ten studies met the inclusion criteria. The results of these studies were compared and narratively described in the context of the objective. Results: The studies showed a great level of heterogeneity with regard to sample characteristics, intervention and reporting of results. In the context of recovery from malnutrition, most studies reported there to be a positive effect from feeding programmes. In studies that reported on weight gain, those that employed a supervised intake of food supplements resulted in higher rates of weight gain. Micronutrient fortification was described as having a positive influence on the rate of linear growth in studies that reported on linear growth. Intensive nutrition education aimed at mothers and caregivers is a sustainable way in which to change child feeding behaviour and may contribute to the effectiveness of nutrition intervention. Conclusion: The limitations of the study included the following: there was a low number (59) of identified studies in the initial search because of the use of limited search terms, assessment of risk of bias was carried out by only one reviewer using a self-designed grading system, there were high levels of heterogeneity, and less than half of the individual studies were rated to be of a high quality. In view of these limitations, no firm conclusion can be drawn. Additional research, aimed at determining the impact of supplementary feeding programmes in supporting the growth of disadvantaged children, is encouraged.