We reviewed interventions that affect maternal and child
undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements;
micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of
malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on
stunting is small. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25 (95% CI 0.01-0.49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41 (0.05-0.76). Management of
severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0.45, 0.32-0.62), and recent studies suggest that newer commodities, such as ready-to-
use therapeutic foods, can be used to manage
severe acute malnutrition in community settings. Effective
micronutrient interventions for pregnant women included supplementation with
iron folate (which increased haemoglobin at term by 12 g/L, 2.93-21.07) and
micronutrients (which reduced the risk of low
birthweight at term by 16% (relative risk 0.84, 0.74-0.95). Recommended
micronutrient interventions for children included strategies for supplementation of
vitamin A (in the neonatal period and late infancy), preventive
zinc supplements,
iron supplements for children in areas where
malaria is not endemic, and universal promotion of
iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce
stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with
stunting, severe wasting,
intrauterine growth restriction, and
micronutrient deficiencies by about 25%. To eliminate
stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of
undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment.