Topical Area: Policy, Global Nutrition
To summarize the evidence on the impact of nutrition policies on improving health among children in low-, middle- and high-income countries (LMHICs).
Methods : A scoping review was conducted to map and describe peer-reviewed studies evaluating the impact of population-level nutrition policies on child health and undernutrition (using primary data) in LMHICs. We systematically searched Medline, Embase, Web of Science, Scopus, and PAIS Index for public policy, to identify eligible studies. Data on key study characteristics, including research design, type of nutrition policy, time span of policy, child's age at outcome assessment, and types of outcomes assessed, were abstracted. Abstract screening and data abstraction were conducted in duplicate and reconciled.
Results : Of the 5646 abstracts screened, 83 studies were included. The majority of studies were conducted in upper-middle or high-income settings (66%, 54/83 studies) (Figure 1). Most studies were observational study design (49%, 41/83 studies), evaluated regional/sub-national policies (68%, 56/83 studies), reported on mandatory policies (71%, 59/83 studies), were related to micronutrient food fortification and/or supplementation (70%, 58/83 studies), and assessed outcomes among children < 5 years of age (55%, 46/83 studies). Iodine deficiency disorders (40%, 33 studies) and neural tube defects (18%, 15 studies) were the most commonly assessed child health outcomes. The impact of policy intervention on outcomes, such as low birth weight, breastfeeding rates, vitamin A deficiencies, and child growth, were assessed less frequently. Policies were largely implemented between 1990 – 2000 (36%, 30/83 studies) and studies mostly evaluated effects within a year (28%, 23/83) or within 2-5 years since policy implementation (13%, 11/83 studies).
Conclusions : Among the studies reviewed, nutrition policies were commonly associated with improved child nutrition and health. However, current evidence is primarily based on regional studies from high-income settings evaluating the effect of micronutrient food fortification and/or supplementation policies on a narrow set of outcomes. Further research is needed to assess the impact of a broader range of nutrition policies on child health, particularly in LMICs.
Funding Sources : Funding for this research was provided by the 2017 SickKids Centre for Global Child Health Catalyst Grant Competition.
Postdoctoral Research Fellow
Harvard T.H. Chan School of Public Health
Centre for Global Engineering, University of Toronto
Hospital for Sick Children, Canada & University of Toronto, Canada