Abstract
Objectives
Nutrition sensitive interventions (NSI), which target underlying causes of undernutrition, have been identified as essential to reduce the burden of malnutrition, which disproportionately affects women and children living in low to middle income countries. However, evaluating the impacts of NSI using anthropometry and/or biomarkers remains challenging due to lack of sensitivity. For agriculture NSI in particular, researchers increasingly recommend using indicators that assess dietary changes that lie on the causal pathway to improved biological indicators. We aimed to identify tools and indicators that can be used to assess the impact of agriculture-focused NSI on the diets of women and children.
Methods
Using Pubmed, Web of Science, and Agricola, we conducted a systematic search of the literature for NSI that assessed the impact on the diet of women and children (under 18 years) and were published after 2010. Twenty-three studies representing unique NSI or programs met inclusion/exclusion criteria. We systematically abstracted data from these studies into a standardized form.
Results
Included NSI were conducted in Sub-Saharan Africa (n = 18), South Asia (n = 3), Southeast Asia (n = 3), and Latin America (n = 1), with one conducted in three regions. The most common tools were food frequency questionnaires, 24-hour recalls, and household inventories. Dietary diversity (DD) scores were the most common indicators. These varied on the number of items and the duration of the recall period and included household DD (n = 7), women's DD (n = 5) and children's DD (n = 11); twelve studies assessed more than one outcome. Other indicators of children's diet, such as meal frequency, number of foods or food groups consumed, or minimum acceptable diet were assessed in nine NSI. Two and four studies reported nutrient intakes in women and children, respectively.
Conclusions
Diet assessment tools and indicators have been used successfully to assess the impact of NSI. We recommend including these measurement tools as part of the monitoring and evaluation of NSI, in particular DD was a frequently used indicator that was sensitive to the interventions. It will also be important to improve the reporting of the method used to improve interpretability and comparison across studies.
Funding Sources
Supported by the Bill and Melinda Gates Foundation.
Diagnostic Accuracy of Oral Fluids Biomarker Profile to Determine the Current and Future Status of Periodontal and Peri-Implant Diseases
