Food interventions and nutritional status of undernourished children ages 0-5 years old in southern Philippines: a systematic review and meta-analysis

Abstract

Abstract This review aims to provide a comprehensive synthesis and determine pooled effectiveness of food interventions on the nutritional status of undernourished children ages 0-5 years old in low- and middle-income countries. Specific objectives include identification, selection, and appraisal of interventions that target undernourished children ages 0-5 years old. This study included Randomized Controlled Trials, Pre-post Interventional, Case-Control, and Cohort Studies that were conducted from 2016-2019 that target Undernourished children, 0-5 years old. The outcome is improvement in Nutritional Status: Weight-for-age, Length-for-age, Weight-for-length, Weight Gain, Mean Weight, Mid-Upper Arm Circumference, Length (cm). The search and identification of studies, supplemented with the inclusion and exclusion criteria, was done through an online database (Pubmed, Ebscohost, ScienceDirect, and Google Scholar) and in the Department of Agriculture Library. The study used four (4) tools in appraising the studies. The four tools differed in terms of their indication of use by study design: Risk of Bias-2 for Randomized Controlled Trials (RCTs), Risk of Bias in Non-Randomized Studies- of Interventions for Non-Randomized Studies (NRSI), and Heller’s Public Health Checklist for quasi-experimental (within-group) designs. Out of thirty-one (31) studies, this paper compiled seven (7) interventions. The interventions are local and homemade food, nutritional education, food production, milk-based formula, reduced dose of RUTF, rehabilitation programs, and positive deviance approach. Risk of Bias: (ROB-2) 100% of the studies have low risk in random sequence generation, blinding of outcome assessment, and selective reporting domains. Only 10% of the studies demonstrated unclear or moderate risk under attrition bias due to incomplete outcome data. Roughly 20% of the studies also showed unclear or moderate risk under selection and performance bias. (ROBINS-I) 67% (6/9) of the included studies are low risk for overall bias. (Heller) Studies were appraised by Heller’s checklist where identification of strengths and weaknesses were identified. This review found that local and homemade food improves the nutritional status of undernourished children below five years old. Findings show that nutrition education has little to no effect, while food production needs more studies to increase its certainty. Other interventions mentioned need more similar studies to obtain a pooled effectiveness. This review has excluded studies that are of high risk of bias to minimize low certainty of evidence. However, this review was unable to examine adverse effects of the interventions. This review has some studies not pooled due to missing values such as standard deviations and confidence interval.