title: Impact of education and provision of complementary feeding on growth and morbidity in children less than 2 years of age in developing countries: a systematic review.
abstract: BACKGROUND
  About one third of deaths in children less than 5 years of age are due to underlying undernutrition. According to an estimate, 19.4% of children <5 years of age in developing countries were underweight (weight-for-age Z score <-2) and about 29.9% were stunted in the year 2011 (height-for-age Z score <-2). It is well recognized that the period of 6-24 months of age is one of the most critical time for the growth of the infant.
  
  
  METHODS
  We included randomized, non-randomized trials and programs on the effect of complementary feeding (CF) (fortified or unfortified, but not micronutrients alone) and education on CF on children less than 2 years of age in low and middle income countries (LMIC). Studies that delivered intervention for at least 6 months were included; however, studies in which intervention was given for supplementary and therapeutic purposes were excluded. Recommendations are made for input to the Lives Saved Tool (LiST) model by following standardized guidelines developed by Child Health Epidemiology Reference Group (CHERG).
  
  
  RESULTS
  We included 16 studies in this review. Amongst these, 9 studies provided education on complementary feeding, 6 provided complementary feeding (with our without education) and 1 provided both as separate arms. Overall, education on CF alone significantly improved HAZ (SMD: 0.23; 95% CI: 0.09, 0.36), WAZ (SMD 0.16, 95% CI: 0.05, 0.27), and significantly reduced the rates of stunting (RR 0.71; 95% CI: 0.56, 0.91). While no significant impact were observed for height and weight gain. Based on the subgroup analysis; ten studies from food secure populations indicated education on CF had a significant impact on height gain, HAZ scores, and weight gain, however, stunting reduced non-significantly. In food insecure population, CF education alone significantly improved HAZ scores, WAZ scores and significantly reduced the rates of stunting, while CF provision with or without education improved HAZ and WAZ scores significantly.
  
  
  CONCLUSIONS
  Complementary feeding interventions have a potential to improve the nutritional status of children in developing countries. However, large scale high quality randomized controlled trials are required to assess the actual impact of this intervention on growth and morbidity in children 6-24 months of age. Education should be combined with provision of complementary foods that are affordable, particularly for children in food insecure countries.
authors.forename: Zohra S
authors.initials: ZS
authors.lastname: Lassi
authors.forename: Jai K
authors.initials: JK
authors.lastname: Das
authors.forename: Guleshehwar
authors.initials: G
authors.lastname: Zahid
authors.forename: Aamer
authors.initials: A
authors.lastname: Imdad
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
mesh_terms: D001835:Body Weight; D002657:Child Development; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006266:Health Education / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D066088:Infant Death / Q000517:prevention & control*; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D018977:Micronutrients / Q000627:therapeutic use*; D009752:Nutritional Status; D011322:Primary Prevention / Q000458:organization & administration*; D015430:Weight Gain
chemical_list: D018977:Micronutrients