Increasing the coverage of nutrition-specific interventions will not be enough to accelerate reductions in the burden of malnutrition, and the underlying causes of malnutrition—including poverty, food insecurity, poor education and gender inequity—will need to be addressed if progress is to be made, according to the third paper in The Lancet Series on maternal and childhood malnutrition.
The authors review the evidence for improvements in nutrition resulting from large-scale programmes in four key sectors – agriculture, social safety nets, early child development, and schooling. While each of these sectors has enormous potential to improve nutrition, the authors conclude that, in most cases, evidence for nutritional improvements from existing programmes is scarce, and the potential benefits to nutrition from these sectors are yet to be unleashed.
Despite campaigners' recent calls for increased investment in targeted agricultural programmes, there is currently little evidence of measureable nutritional benefits arising from existing programmes. While this does not imply that the programmes do not confer any benefits (they have been shown to support livelihoods, enhance poor people's access to a nutritionally balanced diet, and empower women, all of which could directly or indirectly reduce the burden of malnutrition), poor quality evaluation has hampered existing programmes, leading to unclear evidence for the optimum ways to improve nutrition through improvements in agriculture.
Similarly, while social safety nets – usually cash or food transfers to the poorest people and disaster victims – have raised income and food security for billions of poor people, there is less evidence that these programs improve nutritional status, probably because they have not reached infants and young children in their first 1000 days, and because of poor quality health services.
The effects of education on nutrition are somewhat clearer, with a consistent positive association between parents' schooling and their children's nutrition. However, despite these positive effects, which appear to arise as a result of general education rather than any concerted focus on nutrition, schools continue to provide an untapped opportunity to address nutrition directly in curricula, and through school-based interventions – including behaviour change strategies – to prevent both undernutrition and obesity.
Furthermore, the evidence reviewed shows that early child development programs which include nutrition interventions can improve children's cognitive and psychosocial development, and in some cases children's nutritional status. Combining early child development and nutrition interventions makes sense programmatically and could lead to gains in cost, efficiencies, and help build human capital, say the authors.
According to the study's lead author, Marie Ruel, "Many of the programmes we review here were not originally designed to improve nutrition, yet have great potential to do so. This potential is real, but is yet to be unleashed, and critically, needs to be supported by rigorous evidence and evaluation. Investments in nutrition-sensitive programmes can have a pivotal role in prevention of the excess stunting, wasting, and impaired child development that the scale-up of nutrition-specific interventions cannot resolve on its own, but new incentives are now needed to support innovations in nutrition-sensitive programmes and unleash their potential to tackle nutrition, which in turn will help them achieve their own goals."