The impact of nutritional interventions targeting infants and children in Sub-Saharan Africa: a systematic review and...

Malnutrition among African children remains a critical public health issue, with high stunting, wasting, and underweight rates. Despite nutritional interventions, gaps persist in long-term effectiveness, scalability, and contextual adaptability. This review synthesizes evidence on the impact of nutritional interventions including both standalone nutrition education and integrated multi-component interventions targeting infants and children in Sub-Saharan Africa.

Through systematic searches in Scopus, PubMed, Cochrane Library, and additional sources, eligible randomized controlled trials evaluating behavioural change communication, infant and young child feeding practices, nutritional status, and associated health outcomes were identified. Two reviewers independently handled study screening, data extraction, and bias assessment with Cochrane RoB-2, resolving conflicts by consulting a third party. A total of 15 randomized controlled trials (13 high-quality, 2 medium-quality) were included. A random-effects model meta-analysis pooled odds ratios for three outcome categories: (1) infant and young child feeding practices, (2) behavioural change, and (3) nutritional status along with other health indicators. Heterogeneity was evaluated using the I² statistic, while publication bias was assessed via funnel plots and Egger's test. All analyses were performed with Comprehensive Meta-Analysis (v3.7), focusing exclusively on intention-to-treat randomized controlled trials to reduce potential bias.

A review of 15 randomized controlled trials from 10 Sub-Saharan African countries (N = 12,613) revealed that both standalone and integrated nutrition interventions significantly improved infant and young child feeding (IYCF) practices (pooled OR = 1.997, 95% CI: 1.643-2.428, p < 0.001; I² = 0%). A positive association was also observed for improved dietary diversity (pooled OR = 1.41, 95% CI: 1.12-1.77, p = 0.003) with substantial heterogeneity (I² = 77.8%). Furthermore, nutritional interventions promoted positive behavioral change among caregivers (pooled OR = 3.786, 95% CI: 2.395-5.986, p < 0.001). Despite these improvements, no statistically significant reductions were observed in child stunting (pooled OR = 0.936, 95% CI: 0.754-1.162, p = 0.551), wasting, or underweight. No significant publication bias was detected.

Integrated nutrition and behavior change interventions improve feeding practices, but not short-term child nutrition. Programs should combine education, food security, and community engagement, tailored to local contexts. Policymakers must prioritize multi-sectoral approaches to address malnutrition's root causes effectively. Systematic review PROSPERO registration number: CRD42025642826.