Community-based supplementary feeding for promoting the growth of young children in developing countries

 

Abstract

Background

Supplementary feeding is defined as the provision of extra food to children or families beyond the normal ration of their home diets. The impact of food supplementation on child growth merits careful evaluation in view of the reliance of many states and NGOs on this intervention to improve child health in developing countries.

Objectives

To evaluate the effectiveness of community-based supplementary feeding for promoting the physical growth of pre-school children in developing countries.

Search methods

Searches of CENTRAL 2005 (Issue 2), MEDLINE 1966 to 2005, EMBASE 1980 to 2005, CINAHL 1982 to 2005, LILACS 1982 to 2005, Social Science Citation Index 1956 to 2005, and Dissertation Abstracts International (late 1960s to 2005) were conducted.

Selection criteria

Randomised controlled trials evaluating supplementary feeding in children aged 0-5 years old in developing countries.

Data collection and analysis

Data were extracted and analysed independently by two authors.

Main results

Four trials met the inclusion criteria for this review. No meta-analysis is currently appropriate due to the clinical heterogeneity among the included studies. We group these trials into two categories: a) studies without formally assessment of malnourishment at baseline and, b) studies involving children formally assessed as malnourished.

a) A cluster RCT conducted in Indonesia in 1991(20 Day Care Centres, n = 113 children), found no benefit in weight-for-age and height-for-age z-scores of the intervention group compared to controls after three months of intervention. A study in Guatemala reported the length of 3-yr-old children was based on a 'before-after comparison' by village size and type of supplement (exact sample sizes were not provided). According to this analysis, the difference in net change in the large villages was 2.55 cm and in the small villages was 2.35 cm. The mean of these differences is 2.45 +- 0.10 cm (mean +- SD).

b) A study conducted in Jamaica (n = 65 children) reported a positive effect on length (cm) in the supplemented group compared to controls [WMD 1.3 (0.03 to 2.57)] after 12 months of intervention. A trial from Indonesia (n = 75 children) found no benefit in growth after 12 months of supplementation.

Authors' conclusions

Based on the small number of available trials, no firm conclusions of the effectiveness of supplementary feeding to the growth of pre-school children could be drawn. Issues of research design such as blinding and sample size calculation need to be addressed in future studies.

 

Plain language summary

Supplementary feeding for young children in low and middle income countries

Undernutrition is one of the leading underlying causes of childhood morbidity and mortality in developing countries. Providing extra food to children or families beyond the normal ration of their home diets is an intervention aimed at supporting the nutritional well-being of the target population. We identified four RCTs that met the inclusion criteria for this review. Based on the published evidence reviewed, no firm conclusions of the benefits of supplementary feeding to the growth of pre-school children could be drawn. The relatively small number of trials indicates a need for further research in this area.

 

摘要

背景

以社區為基礎的食物補給增進發展中國家幼童的生長

食物補給的定義為，對貧窮的孩童或家庭，在其家庭正常的飲食量之外，再給予額外的食物。既然許多國家和非政府組織 (NGOs) 都藉助此方法來改善發展中國家的孩童健康，食物補充對於孩童的成長影響，值得仔細的評估。

目標

評估以社區為基礎的食物補給，對增進發展中國家學齡前孩童生長的效果。

搜尋策略

搜尋下列資料庫: CENTRAL 2005年 (Issue 2) ，MEDLINE 1966年至2005年，EMBASE 1980年至2005年，CINAHL 1982年 至2005年，LILACS 1982年至2005年，Social Science Citation Index 1956年至2005年，和Dissertation Abstracts International (1960年代晚期至2005年) 。

選擇標準

評估發展中國家0至5歲孩童之食物補給的隨機對照試驗。

資料收集與分析

2位作者分別擷取和分析資料。

主要結論

在這篇回顧中，共有4篇試驗符合選擇標準。因為被納入的試驗臨床上的異質性，並不適合進行統合分析。我們把這些試驗分成2類: 1. 基準點時沒有正式營養不良程度評估的試驗，2. 基準點時有評估營養狀況。1. 一組1991年在印尼做的隨機對照試驗 (共有20個日間照護中心，個案數113) ，發現對於年齡相對體重和年齡相對身高部份的z分數，在介入3個月之後，治療組與控制組比較起來沒有益處。在另一個於瓜地馬拉進行的試驗，包括了4個村莊做為分析的基準單位 (實際的樣本大小並未提供) 。3歲孩童的身高，基於村莊大小和補給的種類，做 ‘之前與之後的比較’ 。根據這個分析，淨改變的差異，在大型的村莊是2.55公分，在小型的村莊是2.35公分。這些差異的平均值為2.45加減0.10公分 (平均加減標準差) 。 一個在牙買加做的試驗 (樣本數65個孩童) ，顯示在12個月之後，接受食物補給的組別相較控制組，在身高上有正向的效果 (WMD 1.3 (0.03到2.57)) 。另一個印尼的試驗 (樣本數75名孩童) 顯示，在12個月的補給後，在成長方面並沒有益處。

作者結論

依據試驗得到少量樣本並沒辦法做出食物補給對於學齡前孩童的成長效果確切的結論。在將來的試驗中，研究設計中關於盲法 (binding) 和樣本大小之計算要加強。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

在發展中國家，營養不良是造成孩童發病和死亡的主要基本原因。其平常家庭食用量提供貧窮的孩童或家庭額外的食物，是針對目標族群在營養方面的介入方式。我們在這篇回顧中，找到四個符合選擇標準的隨機對照試驗。根據回顧目前已發表的證據，食物補給對學齡前孩童生長的好處並無有力的結論支持。而相對小型的試驗，顯示在這個領域中，需要更進一步的研究。