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The importance of implementation evaluation. Case study of a review on preschool feeding programmes to improve the health of disadvantaged young children.

Date and Location

Session: 

O4.05.2

Date

Monday 23 September 2013 - 13:30 - 15:00

Location

Presenting author and contact person

Presenting author

Elizabeth Kristja...

Contact person

Elizabeth Kristja...
Abstract text
Background:35% of deaths and another 35% of the disease burden in children under five years old are attributable to under nutrition. Throughout the life cycle, under nutrition contributes to increased risk of infection, lowered cognitive performance, chronic disease, and mortality. It is vital for funders to have evidence about the effectiveness of nutrition interventions for young children Objectives:To understand effectiveness and factors that impact on effectiveness for feeding interventions which provided energy through food or drink to improve the health of disadvantaged children aged three months to five years. Methods: Our implementation analysis was based on our logic model and issues identified in the review process. We included randomized controlled trials, controlled before after and interrupted time series studies that assessed feeding interventions with or without co-intervention. Children had to be aged 3 months to 5 years. Results: 29,387 articles were identified through searches: 290 were retrieved and 29 studies met inclusion criteria; 26 of these from LMIC. The results showed small (0.67 cm. per year) and significant effects on height and small, significant effects on weight (0.25kg per year), and medium effects on psychomotor development (Standardized mean difference = 0.62, 95% C.I = .23 to 1.02). Our implementation analysis was critical in identifying subpopulations for whom the intervention was more effective: children with greater need, girls, and younger children. We also found out that the target children only ingested 36% to 75% of the total energy of the supplement; this was partly due to redistribution within the family. Implementation analysis showed that interventions with greater than 30% of RDA for energy were more effective. Greater supervision increased effectiveness. Conclusions:This review highlights the importance and policy relevance of implementation evaluation as part of a systematic review, and we will discuss implications for how to conduct implementation analysis in other reviews.