Evidence on Strategies for Integrating Nutrition Interventions with Health and Immunization Systems in Conflict-affected Areas of Low- and Lower-middle-income Settings—A Systematic Review
Bibliographic record
Abstract
CONTEXT: Pervasive conflict and war adversely affect a nation's sustainable development. Health and health systems deteriorate, causing long-lasting impacts on diets and nutrition. For the most vulnerable, integrated models of delivery of essential nutrition interventions are critical for the efficiency and sustainability of programs in these settings. OBJECTIVE: The objective of this systematic review was to provide evidence on coverage, utilization, and impact of integrated programs in conflict-affected, low- and middle-income countries (LMICs). DATA SOURCES: A database search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL from January 1, 2000 to February 14, 2024. Gray literature was also reviewed. DATA EXTRACTION: Quantitative and qualitative studies, including observational or intervention designs, and reviews and program evaluations conducted in LMICs, focusing on women (≥19 years) and children (0-19 years) were included. Data extraction and risk-of-bias assessment were conducted independently by 2 investigators using a standardized tool. DATA ANALYSIS: In total, 93 studies (103 reports) were included from 25 countries, including 32 unique gray literature records. The conflict-affected regions included South-East Asia (n = 27), Eastern-Mediterranean (n = 8), Africa (n = 58), and the Americas (n = 1). The review distinguished programs based on nutrition-specific, nutrition-sensitive, and health components. Although the coverage and utilization of integrated nutrition and health programs has been substantial, the impact of the strategies on health and nutrition has been limited. The meta-analysis found no significant differences in rates of wasting among children under 5 years; however, it showed that children who received an integrated strategy experienced a 28% lower risk of underweight (P = .007) and a 12% reduced risk of stunting (P = .05) compared with those who did not. CONCLUSION: This review has provided an in-depth insight into integrated nutrition and health strategies in conflict-affected settings, identifying key facilitators and barriers that can inform future policy and program design. Integrating nutrition programs into health systems and enhancing government and community ownership could enhance efficiency and sustainability, given challenging environments. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. CRD42022373993.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".