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Trop Med Int Health. 2017 Oct 9. doi: 10.1111/tmi.12986. [Epub ahead of print]

Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies.

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Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA.
Department of Emergency Medicine, Harvard Medical School, Boston, USA.
Department of Emergency Medicine, Medical University of South Carolina, Charleston, USA.
Department of Emergency Medicine, Yale University School of Medicine, New Haven, USA.
Division of International Emergency Medicine and Humanitarian Programs, Brigham and Women's Hospital, Boston, USA.
Department of Emergency Medicine, University of Florida, Gainesville, USA.
Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA.



Malnutrition contributes to pediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aims to characterize such interventions and their effects on pediatric mortality, anthropometric measures, and serum markers of nutrition.


A systematic search of OVID Medline, Cochrane Library, and relevant grey literature was conducted. We included all randomized controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18 years) within a disaster or complex emergency. We extracted study characteristics, interventions, and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.


31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High- and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers.


In disasters and complex emergencies, high variability and low quality of controlled studies on pediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger-gaps may offer a generalizable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed. This article is protected by copyright. All rights reserved.


Disasters; Malnutrition; adolescent; child; infant; relief work

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