Public Health Nutrition


Tackling the drivers of child undernutrition in developing countries: what works and how should interventions be designed?

Pat Pridmorea1 c1 and Roy Carr-Hilla1

a1 Department of Education, Health and International Development, Institute of Education, University of London, 20 Bedford Way, London WC1H 0AL, UK


Objective The present paper presents a synthesis of available evidence to support action on the interventions that can effectively address the main drivers of child undernutrition in developing countries. It also discusses how interventions should be designed and identifies policy-relevant areas for further research.

Design A structured literature review of fifty-eight controlled evaluations and studies in developing countries were selected because they are methodologically sound, recent (reported within the past 10 years), report on nutritional status, cover a wide range of interventions and are implemented by a range of different agencies.

Setting Indirect interventions in developing countries, which address the underlying and basic causes of child undernutrition and can potentially be implemented in the short to medium term.

Subjects Children under 5 years of age and their mothers across a range of developing countries.

Results Evidence has now accumulated to guide action on a range of indirect interventions that can reduce child undernutrition, but for all these interventions context is all-important. There is less evidence on how these interventions can be effectively implemented on a large scale.

Conclusions Efforts should be directed towards improving implementation of effective interventions on a large scale. Donors need to keep commitments both in dollar terms and in terms of the Paris Declaration so that the push for improved nutrition does not become donor driven. At the country level, there is a need for enabling governance structures, institutions and evidence-based decision making. Within countries there is a need for well-trained personnel with delegated authority, accountable to local people. It is essential for chains of accountability to be transparent and for active involvement of households in decision-making processes.

(Received August 24 2009)

(Accepted May 13 2010)

(Online publication July 19 2010)


c1 Corresponding author: Email