Community-Based Interventions for Childhood Undernutrition in Sub-Saharan Africa: A Systematic Review and Network...

Childhood undernutrition remains a major public health challenge in sub-Saharan Africa (SSA), despite global progress. This review evaluated the effectiveness of community-based interventions for treating undernutrition among children aged 6-59 months in SSA. We systematically searched MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane CENTRAL from inception to August 2024, without language restrictions. Randomised controlled trials (RCTs) and cluster RCTs evaluating community-based nutrition-specific or nutrition-sensitive interventions were included. Primary outcomes were weight gain, height/length gain, and mid-upper arm circumference (MUAC). Secondary outcomes were recovery, mortality, and micronutrient status. Forty-eight studies met the inclusion criteria. Interventions included therapeutic and supplementary feeding, dietary and micronutrient supplementation, disease management, breastfeeding and complementary feeding, and multisectoral approaches. Across the evidence base, nutrition-specific therapeutic feeding interventions, particularly lipid-based nutrient supplements (LNS), ready-to-use therapeutic foods (RUTF), and ready-to-use supplementary foods (RUSF), were most consistently associated with improvements in weight gain, MUAC, and recovery. Height gains were observed less consistently, and micronutrient outcomes were infrequently reported. Four comparable studies were eligible for a network meta-analysis (NMA) comparing LNS, corn-soy blend (CSB), and controls. Within this limited evidence network, LNS was associated with greater short-term improvements than controls in weight (+174 g; 95% CI 121-227), height (+0.32 cm; 0.04-0.60), and MUAC (+0.12 cm; 0.05-0.19), and with greater improvements than CSB in weight (+90 g; 29-150) and MUAC (+0.11 cm; 0.06-0.17) (moderate-certainty evidence). Community-based nutrition interventions improve anthropometric outcomes among undernourished children in SSA. Although the NMA suggested a potential benefit of LNS over CSB and controls for short-term anthropometric outcomes, the evidence was limited to four studies. Standardised outcome reporting and longer-term evaluations are needed to strengthen the evidence base and inform context-specific intervention design.