Tackling the drivers of child undernutrition in developing countries: what works and how should interventions be designed?
OBJECTIVE
The present paper presents a synthesis of available evidence to support action on the interventions that can effectively address the main drivers of child undernutrition in developing countries. It also discusses how interventions should be designed and identifies policy-relevant areas for further research.


METHODS
A structured literature review of fifty-eight controlled evaluations and studies in developing countries were selected because they are methodologically sound, recent (reported within the past 10 years), report on nutritional status, cover a wide range of interventions and are implemented by a range of different agencies.


METHODS
Indirect interventions in developing countries, which address the underlying and basic causes of child undernutrition and can potentially be implemented in the short to medium term.


METHODS
Children under 5 years of age and their mothers across a range of developing countries.


RESULTS
Evidence has now accumulated to guide action on a range of indirect interventions that can reduce child undernutrition, but for all these interventions context is all-important. There is less evidence on how these interventions can be effectively implemented on a large scale.


CONCLUSIONS
Efforts should be directed towards improving implementation of effective interventions on a large scale. Donors need to keep commitments both in dollar terms and in terms of the Paris Declaration so that the push for improved nutrition does not become donor driven. At the country level, there is a need for enabling governance structures, institutions and evidence-based decision making. Within countries there is a need for well-trained personnel with delegated authority, accountable to local people. It is essential for chains of accountability to be transparent and for active involvement of households in decision-making processes.
Pridmore
Pat
P
Department of Education, Health and International Development, Institute of Education, University of London, 20 Bedford Way, London WC1H 0AL, UK. p.pridmore@ioe.ac.uk
Carr-Hill
Roy
R
D015362:Child Nutrition Disorders / Q000517:prevention & control*; D002675:Child, Preschool; D003657:Decision Making; D003906:Developing Countries / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006293:Health Promotion / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000517:prevention & control*; D018673:Nutrition Policy; D010043:Outcome and Process Assessment, Health Care; D016730:Program Development; D011634:Public Health