Micronutrient impact of multisectoral programs focusing on nutrition: examples from conditional cash transfer, microcredit with education, and agricultural programs

Abstract

Millions of people in low and middle income countries suffer from micronutrient (MN) deficiencies as a consequence of monotonous diets based on plant-based staple foods. MN deficiencies affect the survival, health, development, and well-being of individuals, especially those with high requirements such as children and women of reproductive age. The most commonly used strategies to combat MN deficiencies are MN supplementation and fortification, breastfeeding promotion, behavior change and communication strategies to improve complementary feeding practices, and health interventions aimed at reducing infectious diseases. Common to all of these strategies is the fact that they address the immediate causes of MN malnutrition. The sustainability of these direct MN interventions, however, is questionable if they do not simultaneously address key underlying determinants of malnutrition. Malnutrition is rooted in poverty, food insecurity, gender inequity, and lack of access to health and other services. The failure to address these underlying causes of malnutrition – or the global context in which malnutrition occurs – is likely to weaken the long-term impacts of interventions limited to addressing the immediate determinants of nutrition. This paper reviews the evidence regarding the MN impact of multisectoral programs that combine targeted nutrition interventions (i.e, addressing the immediate causes), with poverty-alleviation, food security enhancement, and/or income-generating approaches (the underlying causes). The three types of programs reviewed are conditional cash transfers (CCT), microcredit with education (MCE), and agricultural interventions. The review uses a program theory framework to synthesize evidence of impact as well as evidence regarding potential pathways of impact of these programs. Our main focus is the MN status of children. Page 4 of 91 Ov