Acceptability, feasibility and equity implications of nutritional supplementation interventions for the prevention of wasting in infants and young children: A rapid qualitative evidence synthesis

Abstract

Background: Child wasting remains a challenge despite global targets to eliminate malnutrition by 2030. While the global nutrition community has traditionally focused on treatment, a range of nutrition-specific interventions to prevent child wasting are available.
Aim: To conduct a rapid qualitative evidence synthesis exploring factors influencing the acceptability, feasibility and equity of preventative interventions to inform a World Health Organization (WHO) guideline on child wasting. This manuscript reports on nutritional supplementation interventions, a subsection of the broader scope of the guideline.
Method: We searched MEDLINE (PubMed) (database inception to 13 June 2022) for eligible studies. We coded and synthesised findings using a ‘best fit’ framework synthesis approach and assessed methodological quality of included studies. We presented fit-for-purpose evidence to complete qualitative evidence-to-decision criteria for the WHO recommendation.
Results: We included 25 articles and identified 27 themes relating to acceptability, feasibility and equity for nutritional supplementation interventions. Nutritional supplementation in children was mostly acceptable, but acceptability was mixed for other recipients. Several barriers to and facilitators of nutritional supplementation across intended recipient groups were identified, with education or information frequently emerging as facilitator. Health beliefs, as well as practical challenges, are notable barriers. Evidence on equity is sparse, but sharing practices and gender roles emerged as exacerbating factors.
Conclusion: Nutritional supplementation interventions are probably acceptable, and there are facilitators of implementation; however, some barriers would also need to be considered. Information regarding equity was relatively sparse.
Contribution: Our findings were used in drafting the WHO guideline recommendations on child wasting.