Research Snapshots

Postnatal interventions for infants undersix months: A systematic review
This is a summary of the following paper: Rana R, Sirwani B, Mohandas S et al (2024)
Effectiveness of postnatal maternal or caregiver interventions on outcomes among infants
under six months with growth faltering: A systematic review. Nutrients, 16, 6, 837.
https://doi.org/10.3390/nu16060837

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arly life growth faltering (also referred to as failure to thrive) andmalnutrition are major global publichealth problems. Infants aged undersix months with growth faltering are a particularly vulnerable group. These first six monthsof life are a period of rapid maturation anddevelopment with unique dietary needs. The
mother or carer thus plays a critical role in fulfilling the child’s nutritional requirements.
To inform the updated World Health Organization (WHO) guidelines on the prevention and management of growth faltering
among infants under six months, this review examined the effectiveness of postnatal
maternal or caregiver interventions on seven domains. Anthropometric recovery, childdevelopment, anthropometric outcomes,mortality, readmission, relapse, and non-response among infants aged under six months
were all considered.

A total of 13 studies with preterm and/or low
birth weight infants contributed to the final synthesis, which assessed the effects of breastfeedingcounselling or education (n = 8), maternal nutrition supplementation (n = 2), mental health (n =1), relaxation therapy (n = 1), and cash transfer(n = 1) interventions. Overall, the evidence fromthese studies had serious indirectness and a highrisk of bias.
The evidence was limited in scope and primarily ranged from 'low' to 'very low' certainty. Breastfeeding counselling or education compared to standard care might increase infant
weight at one month, weight at two months, andlength at one month, but with very uncertain
evidence (very low quality). Maternal nutrition
supplementation, in comparison to standard
care, may not result in increased infant weightat 36 weeks postmenstrual age and may not reduce infant mortality by 36 weeks postmenstrual age (low quality).

Moreover, interventions for maternal mental health compared to standard care might notincrease infant weight, length, and head circumference at two months, with the evidence ranging from low to very low quality. The effects ofrelaxation therapy versus standard care on infant
weight, length, and head circumference at threemonths are highly uncertain (very low quality). Lastly, the evidence regarding cash transfers compared to standard care on child development scores at three months, changes in weightand head circumference z-score from birth to
three months post-discharge, and readmission
by three months remains highly uncertain, withvery low-quality evidence.
Based on review findings, strong new WHO
recommendations for maternal interventions for
infants under six months with growth faltering
will be challenging to make because these needa more secure underpinning evidence base. TheWHO guidelines of 2013 and 2023 both recommend providing counselling and support, including mental health support, to mothers or caregivers of infants with severe malnutrition, both for
inpatient and outpatient care. Given that the 2023
guidelines are still based on ‘low’ to ‘very low’
quality evidence, with little change since 2013,
the authors urged the need for well-designed,
well-targeted future trials assessing postnatal maternal or caregiver interventions on infants aged
under six months with growth faltering, statingthat this is more urgent than ever.

Rwanda: Before and after study of a nationalCommunity health workers use a measuring mat tohelp identify stunting in Western Province, Rwanda

supplementary feeding programmeThis is a summary of the following paper: Hebert K, Nsengiyumva E, Kayitesi C et al (2024)
Before and after study of a national complementary and supplementary feeding programmein Rwanda, 2017–2021. Maternal and Child Nutrition. https://doi.org/10.1111/mcn.13648

To address the high burden of malnutrition among children from the most vulnerable households, and in addition to other ongoing nutrition-related interventions, thegovernment initiated a national food supplementation programme. This study assessed the effectiveness of locally produced
nutrient-dense fortified blended foods (FBF),
which were provided to children aged 6–23
months and pregnant and lactating women
living in vulnerable households in Rwanda,
on stunting prevalence among children. Thisinitiative was a unique example of the successful nationwide distribution of fully subsidised
FBF products for poor households.
Survey data collected in 2017, 2018, and 2021
included anthropometric and biochemical data,demographic and socioeconomic status, food security, and feeding practices – including the provision of FBF. Primary statistical analysis compared the nutritional status of children before
and after FBF introduction. There was a reduction in stunting from 47% (2017–2018) to 35%(2021), equivalent to a 42% reduction in theodds of being stunted (p<0.001). At baseline, ahigh proportion of children were anaemic andiron deficient, and there was a significant reduction in the odds of these at endline.
The remarkable reduction in stunting overa five-year period can be attributed to several
factors. Notably, the study highlights the use ofa targeted approach to reach the most vulnerable children and a high rate of daily and weekly consumption of the FBF during the last three
years of the evaluation (2018– 2021). General
improvements over time to sociodemographic and household markers, as well as substantial efforts by the government to improve live-© WFP/John Paul SesongaA

ccording to the National Institute ofStatistics of Rwanda and the Ministry of Health, 33% of all Rwandanchildren aged under five years arestunted. Stunting prevalence rises from 23% inchildren aged under six months to 39% at 18–
23 months of age, showing a marked increaseduring the window of time when complementary foods are typically introduced. Many
households struggle to access energy- and nutrient-dense complementary foods and only
22% of children aged 6–23 months are fed inaccordance with all recommended infant andyoung child feeding practices.

lihoods, health, and wellbeing over the same
period, were also important.
One of the study’s limitations was the absenceof a control group for comparing the intervention effects, as it was deemed unethical to withhold FBF from households. Further, the study
was only conducted in the lowest tier of Rwanda’s social support scheme households, limiting
the generalisability of the results to only households with similar characteristics.

FIELD EXCHANGE ISSUE 73, July 2024 www.ennonline.net/fex

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