Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review

被引:19
作者
Balhara, Kamna S. [1 ]
Silvestri, David M. [2 ]
Winders, W. Tyler [3 ]
Selvam, Anand [4 ]
Kivlehan, Sean M. [5 ]
Becker, Torben K. [6 ]
Levine, Adam C. [7 ]
机构
[1] Univ Texas Hlth Sci Ctr San Antonio, Dept Emergency Med, San Antonio, TX 78229 USA
[2] Harvard Med Sch, Brigham & Womens Hosp, Massachusetts Gen Hosp, Dept Emergency Med,Harvard Affiliated Emergency M, Boston, MA USA
[3] Med Univ South Carolina, Dept Emergency Med, Charleston, SC USA
[4] Yale Univ, Sch Med, Dept Emergency Med, New Haven, CT USA
[5] Harvard Med Sch, Brigham & Womens Hosp, Div Int Emergency Med & Humanitarian Programs, Dept Emergency Med, Boston, MA USA
[6] Univ Florida, Dept Emergency Med, Gainesville, FL USA
[7] Brown Univ, Dept Emergency Med, Warren Alpert Med Sch, Providence, RI 02912 USA
关键词
disasters; malnutrition; relief work; child; infant; adolescent; USE THERAPEUTIC FOOD; MODERATE ACUTE MALNUTRITION; RANDOMIZED CONTROLLED-TRIAL; CHILDREN AGED 6; MICRONUTRIENT POWDER; COST-EFFECTIVENESS; MALAWIAN CHILDREN; FEEDING PROGRAMS; CASH TRANSFERS; GROWTH;
D O I
10.1111/tmi.12986
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
OBJECTIVES Malnutrition contributes to paediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aimed to characterise such interventions and their effects on paediatric mortality, anthropometric measures and serum markers of nutrition. METHODS A systematic search of OVID MEDLINE, Cochrane Library and relevant grey literature was conducted. We included all randomised controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18years) within a disaster or complex emergency. We extracted study characteristics, interventions and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS A total of 31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High- and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers. CONCLUSION In disasters and complex emergencies, high variability and low quality of controlled studies on paediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger gaps may offer a generalisable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed.
引用
收藏
页码:1464 / 1492
页数:29
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