AbstractSmall-quantity lipid-based nutrient supplements (SQ-LNS) were designed to provide multiple micronutrients within a food base that also provides energy, protein and essential fatty acids, and were targeted towards the prevention of malnutrition in low- and middle-income countries. Previous meta-analyses have demonstrated beneficial effects of SQ-LNS on child growth, anemia and mortality. To further examine efficacy and effectiveness of SQ-LNS, and explore study-level and individual-level modifiers of the effects, we conducted an individual participant data (IPD) meta-analysis of 14 randomized controlled trials of SQ-LNS provided to infants and young children 6 to 24 mo of age (n > 37,000). We examined growth, development, anemia and micronutrient status outcomes. Children who received SQ-LNS had a 12-14% lower prevalence of stunting, wasting and underweight, were 16-19% less likely to score in the lowest decile for language, social-emotional, and motor development, and had a 16% lower prevalence of anemia and 64% lower prevalence of iron-deficiency anemia, compared to control group children. For most outcomes, beneficial effects of SQ-LNS were evident regardless of study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact or average reported compliance with SQ-LNS. For certain outcomes, targeting based on population-level socioeconomic status or undernutrition may be worthwhile, as the benefits of SQ-LNS for iron status, anemia and child development were larger in sub-groups with a greater potential to benefit. A greater impact of SQ-LNS might be possible by co-packaging it with interventions that reduce constraints on response, such as prevention and control of pre-and postnatal infections, improving maternal nutrition, improving health care access, and promotion of early child development. Policy-makers and program planners should consider including SQ-LNS in strategies to reduce child mortality, stunting, wasting, anemia, iron deficiency and developmental impairments. This study was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592, CRD42020159971 and CRD42020156663.
The use of games in health education in order to prevent iron deficiency anemia in infancy: the role of the nurse