Source | Study design Sample | Population age at enrolment | Study duration | Components of integrated nutrition and stimulation interventions | Comparison | Outcome measures | |
Growth outcomes | Developmental outcomes | ||||||
Mckay et al30 | RCT Five treatment arms: 1a, 1b, 2, 3 and 4 based on treatment periods n=449 | Colombia, Undernourished children Age 36 months | February 1971 to August 1974 | Macronutrient and micronutrient supplementation and nutrition education: Protein and calories and vitamin A thiamine, riboflavin, niacin and iron provided to children in three meals daily. Education programme: Provided education to mothers to support language development, social abilities, and psychomotor skills. | Detail not available | HAZ WAZ | Language usage, memory, motor control, manual, dexterity, information and vocabulary, quantitative reasoning, logic, verbal and non-verbal production |
Waber et al44 | RCT Six arms: Nutrition (third trimester to 36 months age), Nutrition (age 6 to 36 months), Nutrition (third trimester to 6 months age), Stimulation, Nutrition+Stimulation and Control n=433 | Colombia, Age 6–36 months | Detail not available | Macronutrient supplementation: Food distribution from local store sufficient for the entire family. Education programme: Offered mothers education about developmental processes to improve their responsiveness towards children. | Detail not available | Length Weight |
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Grantham-McGregor et al45 | RCT Four arms: Nutrition only, Stimulation only, Nutrition+Stimulation and Control n=129 | Jamaica, Stunted children with LAZ <-2 SD Age 9–24 months | Detail not available | Macronutrient supplementation: 1 kg milk-based formula and 20 g protein/d to all children. Psychosocial stimulation: Taught mothers to play with their children in structured play sessions. Lent homemade toys and simple picture books. | Weekly health visit and free medical care | WLZ | Griffiths mental development scale: locomotor, eye-hand coordination, language, performance developmental quotient |
Powell et al31 | Cluster RCT (18 clusters) Two arms n=139 | Jamaica, Undernourished children Age 9–30 months | June 2009 to March 2012 | Nutrition education: Gave nutrition education to mothers through existing health services. Psychosocial stimulation: Demonstrated play activities, used homemade toys and books/materials and discussed parenting issues. | Provide health and nutrition education to mothers and monitor the growth of children. | Height Weight | Griffiths mental development scale: locomotor, eye-hand coordination, hearing and speech, performance developmental quotient |
Gardner et al32 | RCT Four arms: Nutrition only, Stimulation only, Nutrition+Stimulation and Control n=126 | Jamaica, Undernourished children (WAZ≤1.5 SD) Age 9–30 months | February 2010 to December 2011 | Micronutrient supplementation: 10 mg elemental zinc in a flavoured syrup in 7 vials, each containing one dose, was given daily to all children. Psychosocial stimulation: Encouraged play and mother-child interaction, lent homemade toys and exchanged new toys in the next visit. | Placebo and routine care | LAZ WAZ WLZ | Griffiths mental development scale: locomotor, eye-hand coordination, hearing and speech, performance developmental quotient |
Hamadani et al33 | Cluster RCT (20 clusters) Two arms n=206 | Bangladesh, Undernourished children (WAZ <-2 SD) Age 6–24 months | 2000 to 2002 | Macronutrient supplementation: Referred undernourished children to community nutrition centres, where they received food packets. Psychosocial stimulation: Discussed child development and the importance of play, then demonstrated play activities to the mothers using low-cost toys. | They provided food packets to severely undernourished children at Community Nutrition Centres. | HAZ WAZ WHZ |
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Nahar et al34 | Time-lagged controlled study Two arms n=110 | Bangladesh, Undernourished children (<50% WAZ or <70% WLZ or oedema) Age 6 to 24 months | October 2002 to June 2004 | Nutrition education and micronutrient supplementation at Hospital Nutritional follow-up unit (HNFU) to all enrolled children for 6 months. Psychosocial stimulation: Demonstrated play activities to mothers, encouraged them to play and chat with their children, give positive feedback and continue to play between sessions. | Health and nutrition education at HNFU, growth monitoring and micronutrient supplementation | LAZ WAZ WLZ | 1)BSID II: mental development index and motor development index |
Lozoff et al35 | RCT Two arms (infants were stratified by iron-deficient anaemia status) n=277 | Chile, Children with (Iron Deficiency Anaemia) IDA and without IDA Age 6–12 months | – | Micronutrient supplementation: 15 mg ferrous sulphate for 6 months infants and 30 mg of ferrous sulphate for 12 months old infant on a weekly basis. Support mother–child relationship: Modelled positive feedback, provided play activities and information about child development. | Surveillance: Record iron intake, feeding and health information. | LAZ WAZ |
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Aboud et al36 | Cluster RCT (45 clusters) Three arms: Nutrition only, Nutrition+Stimulation and Control n=302 | Bangladesh, Very poor population Age 8–20 months | – | Multiple micronutrient supplementation (Sprinkles) provided to all enrolled children, one sachet daily with a meal. Responsive Feeding and Stimulation (RFS): Demonstrated responsive stimulation and responsive feeding and coaching as the mothers practiced with their children. | Regular health, nutrition, and child development programme. | LAZ WAZ |
3) Mother–child picture talk task: mother-child responsive talk |
Ogunlade et al37 | RCT, Two arms n=151 | South Africa, Children with Hb≤12.5 g/dL Age 36–79 months | September to November 2008. | Macro- and micronutrient supplementation: Enrolled children received stiff maize-meal porridge with added micronutrient powder (<8 g). Psychosocial stimulation: All children attended preschool for 52 days. | Received soft maize-meal porridge with added placebo powder (<8 g) containing only maize maltodextrin. | HAZ WAZ | KABC-II: learning scale, sequential scale, simultaneous scale, mental processing index, nonverbal index. |
Nahar et al19 | RCT Five arms: Nutrition only, Stimulation only, Nutrition+Stimulation and Control n=507 | Bangladesh, Severely malnourished children (WAZ <-3 SD) Age 6–24 months | – | Macronutrient supplementation: Supplied food packets (Pushti Packet) during clinic visits for the first 3 months. Play sessions and education: Offered play sessions and parental education using a semistructured curriculum. | Routine clinical management: growth monitoring and promotion, health education, micronutrient supplementation and immunisations. | LAZ WAZ WLZ | BSID II: mental development index and psychomotor development index |
Vazir et al38 | Cluster RCT (60 clusters) Three arms: Nutrition only, Nutrition+Stimulation and Control n=600 | India Age 3 months | – | Nutrition education: Provided nutrition education on breastfeeding and complementary feeding using PAHO/WHO guidelines. Playgroup and educational session: Provided messages and skills on responsive feeding and developmental stimulation messages. | Standard of care: received ICDS services programme | Height Weight | BSID II: mental and motor development index |
Aboud et al39 | Cluster RCT (47 clusters) Two arms n=463 | Bangladesh Age 6–12 months and 12–24 months | November 2010 to February 2012 | Nutrition education: Provided 10 min of counselling on feeding and child development. Parenting programme: Discussed parenting practices related to communication, play and nutrition. | Standard care: Sharing messages about feeding and hygiene. | LAZ | BSID III: cognitive, receptive language and expressive language, fine motor |
Tofail et al46 | Cluster RCT (30 clusters) Two arms (infants in each group stratified by their iron status) n=434 | Bangladesh, Children with mild to moderate IDA. Age 6–24 months | – | Micronutrient supplementation: One bottle of 35 mL ferrous sulphate syrup to children with IDA, parent, fed their child 5 mL syrup daily for first 6 months (seven doses). Psychosocial stimulation: Provided mothers with demonstrations of how to play with toys and interact with their children. | Weekly visit in a control group to ask the mother about the health status of their child. | HAZ WAZ WHZ |
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Yousafzai et al40 | Cluster RCT (80 clusters) Four arms: Nutrition only, Stimulation only, Nutrition+Stimulation and Control n=1489 | Pakistan Age birth to 24 months | June 2009 to March 2012 | Multiple micronutrient supplementation (Sprinkles) daily for 33 months for all children and nutrition education (strengthened existing nutrition education services) Responsive stimulation: Illustrated play and communication activities, encouraged parents to practice activities with their child through play and communication counselling, provided coaching and feedback. | Standard-of-care services: health, hygiene, and basic nutrition education and immunisation through a monthly home visit and occasional group meetings. | HAZ WAZ WHZ | BSID III: cognitive, language, motor and socioemotional development |
Attanasio et al47 | Cluster RCT (96 clusters) Four arms: Nutrition only, Stimulation only, Nutrition+Stimulation and Control n=1429 | Colombia Age 12–24 months | February 2010 to December 2011 | Multiple micronutrient supplementation (Sprinkles) for all children for 18 months. Psychosocial stimulation: Demonstrated play activities using low-cost or homemade toys, picture books and form boards to improve maternal-child interactions, changing play materials weekly. | Cash payments for complying with regular health check-ups for children<6 years age and regular school attendance for children>5 years age | Height Weight | BSID III: cognition, receptive language, expressive language, fine motor and gross motor |
Singla et al41 | Cluster RCT (25 clusters) Two arms n=319 | Uganda Age 12–36 months | December 2012 to November 2013 | Nutrition education: Reviewed messages on a diverse diet. Parent education sessions: Focused on five messages on childcare, including play, talking, diet, hygiene, love and respect and maternal well-being. | Preschools were created for older children with support from Plan Uganda and received nutritional information. | HAZ | BSID III: cognitive and receptive language |
Rockers et al27 | Cluster RCT (30 clusters) Two arms n=526 | Zambia Age 6–12 months | August 2014 to October 2015 | Educational sessions and nutrition education: Discussed parenting skills, child nutrition and cooking demonstration, forms of play, cognitive stimulation and language development activities. | Baseline end line evaluations of health and developmental status of children. | HAZ WAZ |
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Helmizar et al42 | Cluster RCT (40 clusters) Four arms: Nutrition only, Stimulation only, Nutrition+Stimulation and Control n=355 | Indonesia Age 6–9 months | January to December 2013 | Macronutrient supplementation: Formula food packets of formula adjusted for age groups (6–8 months, 9–11 months and >12 months) for children. Psychosocial stimulation: Delivered play sessions, encouraged mother–child interaction and taught mothers or caregivers about responsive stimulation, provided toys and picture books. | Detail not available | HAZ WAZ WHZ | BSID III: cognitive, language and motor development |
Muhoozi et al43 | Cluster RCT (82 clusters) Two arms n=511 | South-western Uganda, Age 6–8 months | October 2013 to May 2015 | Nutrition and stimulation education with routine healthcare: Provided knowledge on nutrition and stimulation, demonstrated cooking and making toys using local resources, provided play activities and counselling. | Routine healthcare | LAZ WAZ WLZ | BSID III: cognitive, language and motor development |
Schneider et al48 | RCT Two arms n=192 | Indonesia Age between 3 and 5 years | 2014 | Macronutrient supplementation: Two servings per day of a fortified milk powder for children for six months. Psychosocial stimulation: Children performed cognitive stimulation task with the assistance of the parent/caregiver. Parent/caregiver was provided standardised learning activities to perform with the child at home. |
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Hamadani et al28 | Cluster RCT (90 clusters) Two arms n=2423 | Bangladesh, Undernourished children (WAZ <-2 SD) Age 5–24 months | November 2014 to April 2015 | Nutrition education: Provided nutrition-related messages during play sessions and provided nutrition cards with a recipe for diets for underweight children. Psychosocial stimulation: Mothers were shown how to support their children’s development through play and interaction. | No extra attention, they used the clinic for treatment as usual, some were immunised. | LAZ WAZ WLZ | BSID III: cognitive, language and motor development |
Galasso et al20 | Cluster RCT (125 clusters) Five arms: Intensive nutrition counselling (1), 1+supplementation (0–5 months age), 1+supplementation (6–11 months age), 1+stimulation and Control n=3738 | Madagascar Age: pregnant women, women with children 0–5 months and 6–11 months | June 2014 to November 2016 | Intensive nutrition counselling and micronutrient supplementation: Lipid-based nutrient supplementation to children 6–18 months and pregnant and lactating mothers. Early stimulation counselling: Stimulation messages were provided to parents. | Standard-of-care programme: community-based health and nutrition services with growth monitoring and education. | LAZ WAZ WLZ | ASQ-I: gross motor, fine motor, problem-solving, socioemotional development, communication skills |
Grantham-McGregor et al29 | Cluster RCT (192 clusters) Four arms: Nutrition only, Nutrition+Stimulation (Home visits), Nutrition+Stimulation (Group sessions), Control n=1449 | India Age 7–16 months | August 2015 to November 2017 | Health and Nutrition Service Link Nutrition education: Education provided to improve feeding and hygiene practices in the household through games, stories and cooking demonstration. Psychosocial stimulation: Demonstrated play activities and encouraged mothers to play with their child using locally available toys. | Health and Nutrition Service Link: Discussed the availability of services such as growth monitoring and food supplementation in the community. | HAZ WAZ | BSID III: cognitive, language and motor development Strengths and difficulties Questionnaire |
ASQ, ages and stages questionnaire; CBCL, child behaviour checklist; ICDS, integrated child development services programme; IDA, iron deficiency anemia; KABC II, Kaufman assessment battery for children-second edition; LAZ/HAZ, length-for-age/height-for-age z score; PAHO, Pan American Health Organization; RCT, randomised control trial; WAZ, weight-for-age z score; WLZ/WHZ, weight-for-length weight-for-height z score; WPPSI, weschler preschool and primary scale of intelligence.