The criteria for consideration of studies for this systematic review
All reports or papers available on the education and complementary feeding effect on the complementary feeding (these will include unfortified and fortified, but not only the micronutrient).
Conducted in LMICs
Included children who are less than two years of age
Studies that for at least six months and above-provided intervention
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The studies where the targeted group was selected deliberately to be acutely malnourished (wasted or stunted) and where the products were tested for treatment purposes.
Studies in which the group selected were provided with supplementary foods instead of complementary foods.
Studies that assessed only micronutrients impacts (where both groups were provided with complimentary feeding)
These information sources were used in searching the literature for review
The electronic reference libraries of the medical journals that are non-indexed
All electronic reference libraries available of medical journals indexed and the analytical reviews
The non-indexed journals that are not available in the electronic libraries
These monographs and pertinent books were identified through hand or electronic searching
Project reports and documents
Evidence on the topic
Four reviews over the past five years have been published on the Effectiveness of complementary feeding and education in fighting malnutrition in children in Pakistan (Perveen et al., 2012; Liaqat et al., 2007; Hanif, 2011; Hirani, 2012; Morisky et al., 2011). Perveen et al. (2012) published a recent review on the subject. It examined the Effectiveness of supplementary feeding provision to children under five years in LMICs. The review included only studies that used supplementary feeding interventions defined as the extra food provision to families and children beyond their normal home diet ratio.
Liaqat et al. (2007), on the other hand, reviewed the link between the mother’s education status and complementary feeding practices in Islamabad. The review results indicated a positive relationship between mothers’ educational status and the infants’ nutritional status. This study revealed that most malnourished infants belonged to no-school education mothers. In summary, mothers’ education significantly increases knowledge receptivity and awareness about their infant’s nutritional requirements.
However, Hanif (2011) reviewed Pakistan’s complementary feeding and breastfeeding trends from 1990 to 2007 to evaluate these programs’ Effectiveness. Estimates on the different proposed WHO indicators for young child and infant feeding were analyzed in light of the Health Survey and Pakistani Demographic (2006-2007 and 1990 to 1991). The results indicated that almost half the optimal and core indicators over the years have modestly improved. Out of the five required indicators in the assessment tool of WHO of child feeding, duration and exclusive breastfeeding fall in the fair category. However, bottle feeding, the introduction of complementary food, and early breastfeeding initiation were in the poor class. This review has attempted to pool effect sizes from different studies based on their intervention scales (effectiveness/efficacy) and the type of food provided. We have considered food security in the population defined (Guldan et al., 2013). Therefore, this review will add to this topic knowledge by attempting the analyses pooled based on various contextual factors.
The review by Hirani (2012) on young Pakistani children’s malnutrition reported that malnutrition among children of Pakistan is prevalent and multiple at the community, family, and even individual levels. Furthermore, the review of the politico-economical, environmental, socio-cultural, maternal, and biological factors indicated that most of them are interrelated and therefore need composite interventions to tackle the issue at the level of Pakistani community families and malnourished children.
The review by Morisky et al. (2011) indicated that both appropriate complementary food provisions (with or without counseling on nutrition) and only nutritional counseling resulted in a weight increase significantly (CL: 0.05, 0.54, WMD 0.30, 95% and CL: 0.11, 0.56 WMD 0.34) and linear growth (CL: 0.01, 0.41 WMD 0.21 95% and CL: 0.08, 0.43 WMD 0.26, 95%).
The conclusion from the evidence
The conclusions from the evidence include the following:
- The linear growth in the children aged between 6 to 24 months (prevalence of stunting, HAZ, height)
- Weight gain among children aged between 6 to 24 years
- malnutrition among children of Pakistan is prevalent and multiple at the community, family, and even individual level
- most of the malnourished infants belonged to the no school education mothers
- Iron status (prevalence of anemia, ferritin, hemoglobin)
- Morbidity among the children (fever, respiratory infections, diarrheas)
- Delivery intervention cost and food product cost
Study objectives arising from the evidence
This systematic review’s specific objective is to:
Collect and synthesize information that is relevant to the education and complementary feeding roles of the children complementary feeding aged 6 to 24 months
Identify interventions with their iron status, Effectiveness on growth, and morbidity
Undertake analysis of the cost of food products and intervention
Grounded on the above, the review will develop current intervention impacts, evidence analytic summary, and come up with recommendations.
Bhat, I.A., Shah, G.N., Dhar, G.M. & Mehnaz, S.A. (2012) Study on the impact of maternal knowledge and practice on the nutritional status of infants. Indian J. Matern. Child Health 3, 12–15
Bhutta ZA, Thaver D, Akram DS, Khan M. (2014)Situation and Program analysis of malnutrition among women and children in Pakistan. In: Bhutta ZA, editor. Maternal and Child Health in Pakistan Challenges and Opportunities. Pakistan: Oxford University Press
David S, ML.(1995). Childhood Diarrhea and Malnutrition in Pakistan, Part I: Incidence and Prevalence. J Pediatr Nurs;10(2):131–7.
Dewey, K. G., & Adu-Afarwuah, S. (April 01, 2008). A systematic review of the efficacy and Effectiveness of complementary feeding interventions in developing countries. Maternal & Child Nutrition, 4, 24-85.
Guldan, G.S., Zeitlin, M.F., Beiser, A.S., Super, C.M., Gershoff, S.N. & Datta, S. (2013) Maternal education child feeding practices in rural Bangladesh. Soc. Sci. Med. 36, 925–935.
Hanif, H. M. (January 01, 2011). Trends in breastfeeding and complementary feeding practices in Pakistan, 1990-2007. International Breastfeeding Journal, 6.
Hirani, S. A. (January 01, 2012). Malnutrition in young Pakistani children. Journal of Ayub Medical College, Abbottabad : Jamc, 24, 2.)
Liaqat, P., Rizvi, M. A., Qayyum, A., & Ahmed, H. (August 01, 2007). Association between complementary feeding practice and mothers education status in Islamabad. Journal of Human Nutrition and Dietetics, 20, 4, 340-344.
Malik, I. A., Azim, S., Good, M. J., Iqbal, M., Nawaz, M., Ashraf, L., & Bukhtiari, N. (January 01, 1991). Feeding practices for young Pakistani children: usual diet and diet during diarrhea. Journal of Diarrhoeal Diseases Research, 9, 3, 213-8.
Morisky DE, Kar SB, Chaudry AA, Chen KR, Shaheen M, Chickering K. (2011).Breastfeeding practices in Pakistan. Pak J Nutr;1:137–42
Perveen Liaqat, Mazhar Abbas Rizvi, Abdul Qayyum, Hajra Ahmed, & Nadia Ishtiaq. (2012). Maternal Education and Complementary Feeding. Asian Network for Scientific Information.
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