Around 200 million people were affected by conflict and natural disasters in 2015. Whereas those populations are at a particular high risk of death, optimal breastfeeding and complementary feeding practices could prevent almost 20% of deaths amongst children less than 5 years old. Yet, coverage of interventions for improving infant and young child feeding (IYCF) practices in emergencies is low, partly due to lack of evidence. Considering the paucity of data generated in emergencies to inform programming, we conducted an evidence map from reviews that included low- and middle-income countries and looked at several interventions: (a) social and behavioural change interpersonal and mass communication for promoting breastfeeding and adequate complementary feeding; (b) provision of donated complementary food; (c) home-based fortification with multiple micronutrient powder; (d) capacity building; (e) cash transfers; (f) agricultural or fresh food supply interventions; and (g) psychological support to caretakers. We looked for availability of evidence of these interventions to improve IYCF practices and nutritional status of infants and young children. We identified 1,376 records and included 28 reviews meeting the inclusion criteria. The highest number of reviews identified was for behavioural change interpersonal communication for promoting breastfeeding, whereas no review was identified for psychological support to caretakers. We conclude that any further research should focus on the mechanisms and delivery models through which effectiveness of interventions can be achieved and on the influence of contextual factors. Efforts should be renewed to generate evidence of effectiveness of IYCF interventions during humanitarian emergencies despite the challenges.
BACKGROUND: This review is part of a European Commission project, MASCOT, aimed at reducing maternal and child health inequalities. The purpose was to identify and describe the literature on community-based interventions on maternal health in high-income countries (HIC) and conceptually map the literature according to country focus, topics addressed, nature of the intervention and the intervention provider, and interventions designed to address inequalities in maternal health.
METHODS: The research protocol for this review was based on a low-income country (LMIC) systematic review protocol within the MASCOT Project. We searched PubMED and CINAHL databases for literature published between January 2000 and April 2013. OECD countries were used to determine the HIC and different terms were used to refer to community based interventions, defined as those "delivered in community settings or any activities occurring outside of health facilities".
RESULTS: 119 publications were selected for inclusion in this mapping study. 95 (80%) were Randomised Control Trials (RCTs) and 24 (20%) were systematic reviews (SRs). We categorised the study topics according to the main interventions covered: breastfeeding assistance and promotion, preventing and treating post-natal depression, interventions to support and build capacity around parenting and child care, antenatal interventions preparing women for birth, postnatal planning of future births and control trials around changing maternal behaviours. The home was used as the most common setting to implement these interventions and health professionals accounted for the largest group of intervention providers.
CONCLUSIONS: This review maps and brings knowledge on the type of studies and topics being addressed in community based interventions around maternal health in HICs. It opens the opportunity for further studies on interventions' effectiveness and knowledge transfer to LMICs settings.
Around 200 million people were affected by conflict and natural disasters in 2015. Whereas those populations are at a particular high risk of death, optimal breastfeeding and complementary feeding practices could prevent almost 20% of deaths amongst children less than 5 years old. Yet, coverage of interventions for improving infant and young child feeding (IYCF) practices in emergencies is low, partly due to lack of evidence. Considering the paucity of data generated in emergencies to inform programming, we conducted an evidence map from reviews that included low- and middle-income countries and looked at several interventions: (a) social and behavioural change interpersonal and mass communication for promoting breastfeeding and adequate complementary feeding; (b) provision of donated complementary food; (c) home-based fortification with multiple micronutrient powder; (d) capacity building; (e) cash transfers; (f) agricultural or fresh food supply interventions; and (g) psychological support to caretakers. We looked for availability of evidence of these interventions to improve IYCF practices and nutritional status of infants and young children. We identified 1,376 records and included 28 reviews meeting the inclusion criteria. The highest number of reviews identified was for behavioural change interpersonal communication for promoting breastfeeding, whereas no review was identified for psychological support to caretakers. We conclude that any further research should focus on the mechanisms and delivery models through which effectiveness of interventions can be achieved and on the influence of contextual factors. Efforts should be renewed to generate evidence of effectiveness of IYCF interventions during humanitarian emergencies despite the challenges.
