Efficacy of nutrition interventions in ameliorating malnutrition among children: a systematic review
E. E. Payin1 and P. Jacob2
1.	Department of Food and Nutrition Education, Faculty of Home Economics Education
University of Education, P. O. Box 25, Winneba, Ghana and 2. Atlantic International University, Pioneer Plaza, 900 Fort Street Mall 905, Honolulu, HI 96813, Hawaii, USA

Introduction
Malnutrition is a state of deficiencies, excesses, or imbalances in a person’s intake of energy and or nutrients(1). Undernutrition, micronutrient-related malnutrition and overweight, obesity and diet-related non-communicable diseases are the three broad groups of conditions that malnutrition encompasses(2). Around 45% of deaths among children under age 5 years are linked to Undernutrition(1). In 2019, globally, about 144 million children less than 5 years of age suffered from stunting, 47 million children under age 5 were wasted of which 14.3 were severely wasted and 38.3 million were overweight (3). The goal of nutrition intervention is to resolve or improve a nutrition diagnosis or nutrition problem by the provision of advice, counselling, education, or delivery of a food component of a specific diet or meal plan tailored to a patient’s needs(4). Thus the objective of this systematic review was to evaluate the efficacy of the nutrition interventions administered for the treatment of malnutrition among children under the age of 5.

Methods
Design
Systematic review
Data Sources
Maternal and Child Nutrition Journal, BMJ Global Health, The American Journal of Clinical Nutrition, Public Health Nutrition and the Journal of Nutrition studies were identified from Scopus and Schimago database. 

Eligibility Criteria for Selecting Studies
Randomised controlled trials, cohorts and case studies published between January 2013 and September 2020 and that focused on treatment and management of malnutrition among children under the age of 5 were eligible for inclusion. Authors independently extracted the data and assessed the risk of bias of 10 included randomised control trials.

Result
The 13 included studies contained a sample of 45,781 under 5 children from Low and Middle-Income Countries diagnosed with severe acute, moderate acute, global acute, severe wasting, moderate wasting and stunting. Food deliveries, such as therapeutic, supplementary and augmented foods, nutrition counselling and education were the main interventions used. Locally developed therapeutic and supplementary ready-to-use foods were found to have similar high recovery rates from malnutrition as the standardised ones. Interventions (6/8) that combined both food delivery and either nutrition counselling or education yielded higher recovery from malnutrition. Milk, egg, and multiple micronutrient supplementations improved linear growth of +0.23 (95% CI: 0.18, 0.29; P < 0.05) of stunted children. About 90.3% of SAM children treated with RUTF and high dose of vitamin D3 gained ˃ 15% of the baseline body weight. 

Conclusion
This review suggests that locally developed RUTFs and RUSFs can be used as cost-effective alternatives for the treatment of malnutrition among children.  Nutrition education and counselling enhance the overall efficacy of nutrition interventions. 

References
1.	World Health Organization (2020)_https://www.who.int/news-room/fact-sheets/detail/malnutrition.  (Accessed September 2020).
2.	United Nations Children’s Fund (UNICEF) (2009)_ https://www.unicef.org/nutrition/training/2.3/contents.html. (Accessed October 2020). 
3.	United Nations Children’s Fund (UNICEF) World Health Organization, International Bank for Reconstruction and Development/The World Bank (2020) _Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO. https://data.unicef.org/resources/jme-report-2020/ (Accessed October 2020). 
4.	Academy of Nutrition and Dietetics (2014)_ https://www.andeal.org/vault/2440/web/files/20140527-NI%20Snapshot.pdf. (Accessed October 2020).

Efficacy of nutrition interventions in ameliorating malnutrition among children: a systematic review

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