Investigating the delivery of health and nutrition interventions for women and children in conflict settings: a collection of case studies from the BRANCH Consortium

Abstract Background The BRANCH Consortium recently conducted 10 mixed-methods case studies to investigate the provision of health and nutrition interventions for women and children in conflict-affected countries, aiming to better understand the dominant influences on humanitarian health actors’ programmatic decision-making and how such actors surmount intervention delivery barriers. In this paper, the research challenges encountered and the mitigating strategies employed by the case study investigators in four of the BRANCH case study contexts are discussed: Somalia, Mali, Pakistan and Afghanistan. Discussion Many of the encountered research challenges were anticipated, with investigators adopting mitigation strategies in advance or early on, but others were unexpected, with implications for how studies were ultimately conducted and how well the original study aims were met. Insecurity was a fundamental challenge in all study contexts, with restricted geographical access and concerns for personal safety affecting sampling and data collection plans, and requiring reliance on digital communications, remote study management, and off-site team meetings wherever possible. The need to navigate complex local sociopolitical contexts required maximum reliance on local partners’ knowledge, expertise and networks, and this was facilitated by early engagement with a wide range of local study stakeholders. Severe lack of reliable quantitative data on intervention coverage affected the extent to which information from different sources could be triangulated or integrated to inform an understanding of the influences on humanitarian actors’ decision-making. Conclusion Strong local partners are essential to the success of any project, contributing not only technical and methodological capacity but also the insight needed to truly understand and interpret local dynamics for the wider study team and to navigate those dynamics to ensure study rigour and relevance. Maintaining realistic expectations of data that are typically available in conflict settings is also essential, while pushing for more resources and further methodological innovation to improve data collection in such settings. Finally, successful health research in the complex, dynamic and unpredictable contexts of conflict settings requires flexibility and adaptability of researchers, as well as sponsors and donors.

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Delivering health and nutrition interventions for women and children in different conflict contexts: a framework for decision making on what, when, and how

The Lancet ◽

10.1016/s0140-6736(21)00133-1 ◽

2021 ◽

Vol 397 (10273) ◽

pp. 543-554 ◽

Cited By ~ 4

Author(s):

Michelle F Gaffey ◽

Ronald J Waldman ◽

Karl Blanchet ◽

Ribka Amsalu ◽

Emanuele Capobianco ◽

...

Keyword(s):

Decision Making ◽

Nutrition Interventions ◽

Health And Nutrition ◽

Women And Children

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Delivering nutrition interventions to women and children in conflict settings: a systematic review

BMJ Global Health ◽

10.1136/bmjgh-2020-004897 ◽

2021 ◽

Vol 6 (4) ◽

pp. e004897

Author(s):

Shailja Shah ◽

Zahra Ali Padhani ◽

Daina Als ◽

Mariella Munyuzangabo ◽

Michelle F Gaffey ◽

...

Keyword(s):

Meta Analysis ◽

Grey Literature ◽

Food Distribution ◽

Sub Saharan Africa ◽

Nutrition Interventions ◽

African Region ◽

Middle Income ◽

Conflict Settings ◽

Low Middle Income Countries ◽

Women And Children

BackgroundLow/middle-income countries (LMICs) face triple burden of malnutrition associated with infectious diseases, and non-communicable diseases. This review aims to synthesise the available data on the delivery, coverage, and effectiveness of the nutrition programmes for conflict affected women and children living in LMICs.MethodsWe searched MEDLINE, Embase, CINAHL, and PsycINFO databases and grey literature using terms related to conflict, population, and nutrition. We searched studies on women and children receiving nutrition-specific interventions during or within five years of a conflict in LMICs. We extracted information on population, intervention, and delivery characteristics, as well as delivery barriers and facilitators. Data on intervention coverage and effectiveness were tabulated, but no meta-analysis was conducted.ResultsNinety-one pubblications met our inclusion criteria. Nearly half of the publications (n=43) included population of sub-Saharan Africa (n=31) followed by Middle East and North African region. Most publications (n=58) reported on interventions targeting children under 5 years of age, and pregnant and lactating women (n=27). General food distribution (n=34), micronutrient supplementation (n=27) and nutrition assessment (n=26) were the most frequently reported interventions, with most reporting on intervention delivery to refugee populations in camp settings (n=63) and using community-based approaches. Only eight studies reported on coverage and effectiveness of intervention. Key delivery facilitators included community advocacy and social mobilisation, effective monitoring and the integration of nutrition, and other sectoral interventions and services, and barriers included insufficient resources, nutritional commodity shortages, security concerns, poor reporting, limited cooperation, and difficulty accessing and following-up of beneficiaries.DiscussionDespite the focus on nutrition in conflict settings, our review highlights important information gaps. Moreover, there is very little information on coverage or effectiveness of nutrition interventions; more rigorous evaluation of effectiveness and delivery approaches is needed, including outside of camps and for preventive as well as curative nutrition interventions.PROSPERO registration numberCRD42019125221.

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Doing better for women and children in armed conflict settings

The Lancet ◽

10.1016/s0140-6736(21)00127-6 ◽

2021 ◽

Vol 397 (10273) ◽

pp. 448-450 ◽

Cited By ~ 3

Author(s):

Zulfiqar A Bhutta ◽

Michelle F Gaffey ◽

Paul B Spiegel ◽

Ronald J Waldman ◽

Paul H Wise ◽

...

Keyword(s):

Armed Conflict ◽

Conflict Settings ◽

Women And Children

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Missed opportunities for delivering nutrition interventions in first 1000 days of life in India: insights from the National Family Health Survey, 2006 and 2016

BMJ Global Health ◽

10.1136/bmjgh-2020-003717 ◽

2021 ◽

Vol 6 (2) ◽

pp. e003717

Author(s):

Phuong Hong Nguyen ◽

Rasmi Avula ◽

Lan Mai Tran ◽

Vani Sethi ◽

Alok Kumar ◽

...

Keyword(s):

Health Survey ◽

Urban Areas ◽

Family Health ◽

Universal Coverage ◽

National Family Health Survey ◽

Nutrition Interventions ◽

Missed Opportunities ◽

Health And Nutrition ◽

National Family ◽

Opportunity Gaps

ObjectivesExisting health and community nutrition systems have the potential to deliver many nutrition interventions. However, the coverage of nutrition interventions across the delivery platforms of these systems has not been uniform. We (1) examined the opportunity gaps between delivery platforms and corresponding nutrition interventions through the continuum of care in India between 2006 and 2016 and and (2) assessed inequalities in these opportunity gaps.MethodsWe used two rounds of the National Family Health Survey data from 2005 to 2006 and 2015–2016 (n=36 850 and 190 898 mother–child dyads, respectively). We examine the opportunity gaps over time for seven nutrition interventions and their associated delivery platforms at national and state levels. We assessed equality and changes in equality between 2006 and 2016 for opportunity gaps by education, residence, socioeconomic status (SES), public and private platforms.ResultsCoverage of nutrition interventions was consistently lower than the reach of their associated delivery platforms; opportunity gaps ranging from 9 to 32 percentage points (pp) during the pregnancy, 17 pp during delivery and 9–26 pp during childhood in 2006. Between 2006 and 2016, coverage improved for most indicators, but coverage increases for nutrition interventions was lower than for associated delivery platforms. The opportunity gaps were larger among women with higher education (22–57 pp in 2016), higher SES status and living in urban areas (23–57 pp), despite higher coverage of most interventions and the delivery platforms among these groups. Opportunity gaps vary tremendously by state with the highest gaps observed in Tripura, Andaman and Nicobar islands, and Punjab for different indicators.ConclusionsIndia’s progress in coverage of health and nutrition interventions in the last decade is promising, but both opportunity and equality gaps remained. It is critical to close these gaps by addressing policy and programmatic delivery systems bottlenecks to achieve universal coverage for both health and nutrition within the delivery system.

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