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Measuring multisector nutrition and health intervention coverage using composite coverage analysis methods: a scoping

Taylor Morrison¹, Nadia Akseer², Rebecca Heidkamp²

¹Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA tmorri45@alumni.jh.edu.

|June 17, 2026

Abstract

Objectives:

Composite indices provide an opportunity to measure the reach of multisector strategies as countries progress towards Sustainable Development Goals and the achievement of nutrition, health and other sectoral targets. Composite measures allow for the measurement of nutrition and health intervention coverage across sectors and can be used to benchmark progress, track nutrition goals and assess inequities of multisector nutrition interventions. Of the many composite indices in use to measure health and nutrition intervention coverage and population status as a means of assessing progress in achieving health and nutrition targets, few have been previously documented in the nutrition and health literature, nor have these indicators been described in detail. This scoping review aimed to identify composite coverage indices that capture nutrition and health intervention coverage or status, summarise their estimation methodologies and validation approaches and evaluate their strengths and weaknesses.

Design:

Scoping review conducted in accordance with the Joanna Briggs Institute Reviewer Manual following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) verification list.

Data Sources:

PubMed, EMBASE, Scopus, Google Scholar and Global Health registries were searched from 1980 to 3 March 2026.

Eligibility Criteria:

We included studies of any design that described, used or developed a composite measurement of health or nutrition intervention coverage or status.

Data Extraction And Synthesis:

One reviewer screened the titles and abstracts and full text using Covidence and abstracted data from each article using Microsoft Excel using standardised methods.

Results:

We retrieved and screened a total of 7120 records of which 154 articles were included. We identified a total of 56 unique indices (25 universal healthcare coverage; 14 reproductive, maternal, newborn, child health (RMNCH) coverage; 10 nutritional status, food security or nutrition intervention coverage; 6 health service coverage and 1 combined universal healthcare, health risk factors and nutrition coverage measure). We identified three major formula construction methodologies: normative (n=34), statistical (n=13) and participatory (n=10). Together, the indices employed six different aggregation methods: weighted linear mean (n=28), geometric mean (n=13), linear mean (n=9), random-effects meta-analysis (n=6), summation (n=2) and weighted geometric mean (n=1). More than one third of the indices identified have not been validated in the literature (n=21).

Conclusions:

Our review identified a significant gap in composite nutrition intervention coverage index availability, methodological frameworks for index design and index validation. There is a need for additional resources for guiding policy and programme actors to develop validated, fit for purpose composite nutrition-specific and nutrition-sensitive coverage indices. We propose that a framework be developed for stakeholders to guide composite index construction for multisectoral nutrition intervention coverage measurement.

Keywords:

Health Equity Health Services Accessibility Health policy

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