Table 1.
Author and Year | Country | Study Design | Study Population and Sample Size |
Policy/intervention type | Length of intervention/ policy | Stunting reduction (yes/no) | Impact on stunting | Economic indicators | Impact on economic indicators |
---|---|---|---|---|---|---|---|---|---|
Amouzou, A. et al., 2012 [32] | Niger | Case Study |
Children under 5 in Niger n = N/A |
Multisectoral programmes and policies focused on maternal, newborn and child health | On-going since 1996 | Yes | Decrease in stunting prevalence for children aged 24–35 months from 67 to 54% in 2009 (13% reduction) | Childhood mortality | 5.1% annual reduction in U5MR with 10% of this reduction attributed to reductions in stunting prevalence. |
Huicho, L. et al., 2016 [37] | Peru |
Children under 5 in Peru n = N/A |
Policies and programmes for reducing poverty, reforming the health sector, and improving reproductive health, nutrition and maternal and child health. | On-going since 2005 | Yes |
Stunting prevalence decreased from 30% in 2000 to 17.5% in 2013 Calculate % reduction |
Under 5 mortality decreased by 58% (from 2000 to 2013). | ||
Kanyuka, M. et al., 2016 [29] | Malawi | Children under 5 in Malawin = N/A | Policies, programmes and funding allocation that aimed to increase coverage of high-impact interventions that addressed the main causes of childhood mortality | On-going since 1990’s | Yes | Stunting deceased by 11.1% between 2000 and 2013 | Under 5 mortality fell from 247 deaths/1000 livebirths to 71/1000 from 1990 to 2013 with 8.6% of this reduction attributed to reductions in stunting prevalence. | ||
Ruducha, J., 2017 [26] | Ethiopia |
Children under 5 in Ethiopia n = N/A |
Policies and programmes for reducing poverty and improving agricultural productivity, food security, water supply, and sanitation. | On-going since before 2000’s | Yes | Stunting prevalence decreased from almost 60% in 2000 to 40% in 2014 (20% decrease) | Under 5 mortality decreased from 205 deaths/1000 livebirths in 1990 to 64 deaths/1000 livebirths in 2013 with 44% for this reduction attributed to reductions in stunting prevalence. | ||
Andersen, T. et al., 2015 [38] | Peru | Prospective cohort study |
Children 7–8 in Peru n = 1960 |
Conditional Cash Transfer programme (CCT) “Juntos” | On-going since 2005 | Yes | Only in boys exposed to CCT for 2y or more: 0.43-point increase in HAZ score [95% CI: 0.09–0.77], p < 0.01) | Language development and school achievement | No significant effects observed. |
Fernald, L.C.H. et al., 2008 [39] | Mexico | Retrospective cohort study | Children 24–68 months old who were exposed to “Opportunidades” their whole lives n = 2449 children | Conditional Cash Transfer programme “Opportunidades” | On-going since 1998 | Yes |
Doubled cash transfer associated with: 0.2 [95%CI: 0.09–0.30], p < 0.0001) increase in HAZ score, 10% 0(p < 0.0001) decrease in stunting |
Cognitive, motor and language development |
Doubled cash transfer associated with: 0.06 (p = 0.67) points higher in motor skill and 1.15 (p = 0.001) higher in endurance; 0.12 (p = 0.002) point higher in long-term memory, 0.13 (p < 0.0001) points higher in short-term memory and 0.08 (p = 0.02) point higher in visual integration;: 0.18 (p < 0.0001) higher language score |
Fernald, L.C.H. et al., 2009 [40] | Mexico | Retrospective cohort study |
Children 8–10 years who were part of an early vs. late (18 mo. difference) introduction to Conditional Cash Transfer programme “Opportunidades” n = 1793 |
Conditional Cash Transfer programme “Opportunidades” | On-going since 1998 | Yes |
Additional 18 mo. Of CCT for children of uneducated mothers: 1.5 cm (p = 0.029) increase in HAZ/ 0.23-point HAZ increase (95% CI = 0.23–0.44) |
Cognitive, language and socioemotional development | Early vs. late treatment: Reduced behavioural problems (mean score − 0·09 vs. 1·03 (p = 0·0024) |
Hoddinnott, J. et al., 2008 | Guatemala | Retrospective Cohort Study |
Adults 25–42 exposed to supplementation trial from ages 0 to 7 n = 1338 |
nutritional supplementation (protein supplementation beverage “atole”) | 8 years | Yes |
- Stunting to < 20% (from baseline of 45%) -2.4 cm (p < 0.005) increase in length of children at 3 years of age |
Annual income, hours worked, average hourly wages |
For exposure at 0–24 months only: 0.665 US$/h (p = 0.009) higher |
Hoddinott, J. et al., 2013 | Guatemala | Retrospective cohort study |
Adults 25–42 exposed to supplementation trial from ages 0 to 7 n = 1338 |
Nutritional supplementation (protein supplementation beverage “atole”) | 8 years | Yes | - Stunting to < 20% (from baseline of 45%)-2.4 cm (p < 0.005) increase in length of children at 3 years of age | Schooling-related outcomes, health outcomes, labor market outcomes |
1 SD improvement in HAZ leads to: 0.78 (p = 0.003) increase in highest grade attained, 0.28 (p = 0.003) increase in reading score, 0.25 increase in non-verbal cognitive ability (0.002); 5 (p = 0.003) increase in hand strengthBeing stunted at 24 mo. leads to: leaving school 3.14 (p = 0.026) years younger, Achieving 4.64 (p = 0.004) less school grades, 1.26 (0.013) lower reading score, 1.12 (p = 0.006) lower nonverbal cognitive ability score, 22 point (p = 0.008) lower hand strength, 41% (0.017) lower likelihood of being skilled laborer or white collar worker |
Kinra, S. et al., 2008 [41] | India | Retrospective cohort study | 13–18 year-old adolescents who were part of nutrition and public health intervention as children (under 6 years old) n = 1165 adolescents | Nutritional supplementation (protein-calorie supplementation) and public health programmes | 3 years | Yes |
In exposed to intervention: 14 mm (p = 0.07) taller |
Cardiovascular health | 20% (p = 0.02) more favorable insulin resistance index, 3.3% (P = 0.008) more favorable arterial health |
Nkhoma, O.W.W. et al., 2013 [30] | Malawi | Prospective cohort study |
6–8-year-old children in Malawi n = 226 children |
School feeding program (increased micronutrient and caloric intake) | 1 year | No | No significant effects on linear growth in comparison to control school | Cognitive ability | After 9-month exposure to supplement: decrease in errors made in one element of learning from 24.9 in control to 18.5 in intervention (p-interaction = 0.02) |
Stein, A.D. et al., 2008 [36] | Guatemala | Prospective cohort study |
Adults 25–42 exposed to supplementation trial from ages 0 to 7 n = 1448 |
Nutritional supplementation (protein supplementation beverage “atole”) | 8 years | Yes |
- Stunting to < 20% (from baseline of 45%) -2.4 cm (p < 0.005) increase in length of children at 3 years of age |
Reading comprehension, cognitive functioning | Exposure to supplement 0–12 mo.:6.39 [95%CI: 0.79–11.99] increase in reading comprehension score, 2.09 [95%CI: 0.79–3.99] increase in cognitive functioning score. |
Argaw, A. et al., 2018 [27] | Ethiopia | 2 × 2 factorial randomized controlled trial |
Mothers and their children ages 6–12 months in 3 districts of the Jimma zone in Southwest Ethiopia between November 2013 to February 2015 n = 360 mother-infant pairs |
Nutritional supplementation (n-3 long-chain PUFA supplementation) | 12 months | No | No significant effect of the supplementation was observed on linear growth. | Child health | No significant effect on morbidity or systemic inflammation. |
van der Merwe, L.F. et al., 2013 [31] | Gambia | Randomized, double-blind control trial |
Rural Gambian infants (3–9 months old) n = 172 |
Nutritional supplementation (long-chain PUFA supplementation) | 6 months | No | No significant effect of the supplementation was observed on linear growth. | Cognitive development and morbidity in the infants | No significant effects on cognitive development, intestinal function or morbidity were detected. |
Yousafzai, A.K. et al., 2014 [42] | Pakistan | Cluster-randomised 2X2 factorial effectiveness trial |
Children 0–24 months old n = 1489 |
Nutritional supplementation (multiple micronutrient powders) | 3 years | Yes |
Nutritional supplementation resulted in: 0.2 increase in HAZ score (p < 0.0001) at 6 mo. and 0.2 increase in HAZ score (p = 0.02) at 18 months. |
Cognitive, language, motor and social-emotional development and child health |
Nutritional supplementation resulted in: 3.4 higher cognition scores [95%CI: 1.1–5.7], 5.1 higher language scores [95%CI: 2.9–7.3], 2.9 higher motor score [95%CI: 0.5–5.3]. |
Samuel, A. et al., 2018 [28] | Ethiopia | Quasi-experimental matched-control study |
Children 6–23 months old N = 1172 |
Nutritional supplementation (complementary feeding program paired with low iron dose multiple micronutrient powders) | 37 weeks | Yes |
Nutritional supplementation resulted in: 0.18 (SE: 0.05, p < 0.05) significant increase in HAZ score and an odds ratio (OR) for stunting of 0.49 [95% CI: 0.40–0.60] after 37 weeks of intervention (i.e. 51% reduced odds of stunting in the intervention group) |
Child health | No significant positive effects observed on child health. |
Masuda, K. & Chitundu, M., 2019 [33] | Zambia | Two-arm randomized control trial |
Children 6–18 months of age N = 547 |
Nutritional supplementation (Micronutrient supplementation using spirulina platensis) | 12 months | No | No significant effect on linear growth. | Child health and motor development |
Nutritional supplementation resulted in: Reduction in the incidence of cough by 11% [95% CI : -0.23–0.00] and non-significant reductions in incidence of pneumonia (−0.17, [95% CI: −0.17,0.04]), severe fever (− 0.03, 95% CI = − 0.13, 0.06) and fever (− 0.09, [95% CI: − 0.19, 0.02]) Increase in probability of being able to walk alone by 15 months by 8% [95%CI : 0.02–0.14] |