| Popis: |
Background: The first 1,000 days of life encompasses three important life-stages: pregnancy, exclusive breastfeeding (EBF:0-6mo), and complementary feeding period (CFP:6-24mo). We evaluated the effectiveness of interventions under the domains of micronutrient and balanced energy protein and food supplements, deworming, maternal education, and water sanitation and hygiene (WASH), across the three life-stages. Methods: We applied a Bayesian network analysis. We conducted comprehensive searches and network meta-analyses using RCTs of interventions provided to pregnant women, infants (0-6mo), and children (6-24mo) in LMICs. We compared effects on preterm birth and birthweight for pregnancy, LAZ for EBF, and HAZ for CFP, and probabilities of interventions being superior to standard-of-care (SOC) by at least a minimal clinically importance difference (MCID) for each life-stage. Findings: We found several nutritional interventions that demonstrated effectiveness against SOC. For instance, compared to SOC, maternal supplements of multiple micronutrients (MMN) reduced the odds for preterm birth (OR=0·54; 95%CrI: 0·27, 0·97) and improved mean birthweight (Mean difference=0·36kg; 95%CrI: 0·12, 0·59kg), but not LAZ during EBF (Mean difference=−0·02; 95%CrI: −0·18, 0·14). Supplementing infants and children with MMN improved LAZ (Mean difference=0·20; 95% CrI: 0·03, 0·35) and HAZ (Mean difference=0·14; 95%CrI: 0·02, 0·25). We also found that pregnancy interventions generally had higher MCID probabilities than the interventions for the EBF/CFP. Interpretation: Our analyses highlight the importance of intervening early, during pregnancy if possible. There is a need to combine compelling and evidence-based interventions from multiple domains and test for their effectiveness as a package. Funding Statement: The Bill and Melinda Gates Foundation Declaration of Interests: No authors have any competing interests. |
