Supplementary feeding for improving the health of disadvantaged infants and children: what works and why?
Effective implementation ensures that children receive supplementary foods as planned, and that programmes are tailored in the context of their needs as well as those of their caregivers.
The objective of the realist review, done alongside this systematic review, was to determine the mechanisms supporting effective implementation of supplementary feeding programmes among infants and children in Low and Middle Income countries (LMICs). This review of experimental and quasi-experimental studies identified five key mechanisms supporting effective implementation: (1) the supplement matched the child’s needs; (2) measures were in place to ensure that the child received and consumed the supplement as well as the usual diet; (3) the caregiver was capable of learning and changing in response to any intervention; (4) the caregiver was receptive and responsive to the particular intervention offered; and (5) programme staff were motivated and capable of maintaining the supply chain, supporting caregivers in delivering the supplement and adapting their efforts in accordance with local progress data. The philosophies underpinning feeding programmes are generally sound, with biological evidence to support the use of supplementary feeding for undernourished children; however, effective implementation of these programmes is crucial in achieving the desired outcomes. Because the evidence is largely derived from studies of varying methodologies and quality, there remains a need for high quality mixed methods research on the effectiveness, sustainability and implementation of large scale supplementary food programmes in LMICs.