Maternal-focused interventions to improve infant growth and nutritional status in low-middle income countries: A systematic review of reviews

PLoS ONE

Aug 2021

DOI: 10.1371/journal.pone.0256188

Citations:52

Influential Citations:2

Systematic Reviews / Meta-Analyses

Enhanced Details

Methods

Systematic review of reviews of maternal-focused interventions in LMICs; participants targeted were mothers, pregnant women, or women of reproductive age; study designs across included reviews included randomized controlled trials and observational studies; data synthesized narratively due to heterogeneity.

Results

Findings show that numerous maternal-focused interventions improved infant growth or feeding outcomes in LMICs. Breastfeeding promotion, education, support and counselling consistently improved infant feeding practices and, in some cases, growth measures. Maternal mental health interventions show potential to positively influence infant growth. Additional positive signals come from women’s empowerment, m-health technologies, conditional cash transfers, water, sanitation and hygiene and agriculture interventions, especially when delivered as part of multi-sectoral programs. Most evidence relates to prevention of growth faltering rather than management of existing faltering in infants under 6 months. The evidence supports including mothers in holistic care packages for small and nutritionally at-risk infants (<6 months), with context-specific approaches to support the mother–infant dyad and improve survival and growth.

Limitations

Limitations include heterogeneity of interventions/outcomes, reliance on reviews with potential overlapping primary studies, inclusion of some data from high-income countries, and limited data disaggregated for infants <6 months; many primary studies had small sample sizes or quality concerns.

Abstract

Background Small and nutritionally at-risk infants under 6 months (<6m) are a vulnerable group at increased risk of mortality, morbidity, poor growth and sub-optimal development. Current national and international (World Health Organization) management guidelines focus mainly on infants’ needs, yet growing evidence suggests that maternal factors also influence infant outcomes. We aimed to inform future guidelines by exploring the impacts of maternal-focused interventions on infant feeding and growth. Methods We conducted a systematic review of reviews published since 2008 (PROSPERO, register number CRD 42019141724). We explored five databases and a wide variety of maternal-focused interventions based in low- and middle-income countries. Infant outcomes of interest included anthropometric status, birthweight, infant mortality, breastfeeding and complementary feeding practices. Given heterogenous interventions, we present a narrative synthesis of the extracted data. Results We included a total of 55 systematic reviews. Numerous maternal interventions were effective in improving infant growth or feeding outcomes. These included breastfeeding promotion, education, support and counselling interventions. Maternal mental health, while under-researched, showed potential to positively impact infant growth. There was also some evidence for a positive impact of: women’s empowerment, m-health technologies, conditional cash transfers, water, sanitation and hygiene and agricultural interventions. Effectiveness was increased when implemented as part of a multi-sectoral program. Antenatal supplementation with macronutrient, multiple micronutrients, Vitamin D, zinc, iron folic acid and possibly calcium, iodine and B12 in deficient women, improved birth outcomes. In contrast, evidence for postnatal supplementation was limited as was evidence directly focusing on small and nutritionally at-risk infants; most reviews focused on the prevention of growth faltering. Conclusion Our findings suggest sufficient evidence to justify greater inclusion of mothers in more holistic packages of care for small and nutritionally at-risk infants aged <6m. Context specific approaches are likely needed to support mother-infant dyads and ensure infants survive and thrive. show less