Cochrane systematic review on ‘Community‐level interventions for improving access to food in low‐ and middle‐income countries’

Cochrane Public Health group published a systematic review in August 2020 where the effect of community‐level interventions to improve access to nutritious food in low‐ and middle‐income countries (LMICs) on people, households and communities was established.

The evidence current to February 2020 found 59 studies assessing different interventions in LMICs, including 214 to 169,485 participants and 300 to 124,644 households, mainly in Africa and Latin America. Many studies assessed cash transfers, which are welfare programmes where money is provided to households. Of these, 21 studies evaluated unconditional cash transfers, where there are no conditions for receiving the money, and 14 studies assessed conditional cash transfers, where there are specific conditions required to meet in order to receive the money. Seventeen studies looked at income generation interventions (for example, livestock management or self‐help groups), four studies at food vouchers, four studies at providing food

and nutrition subsidies, and two studies looked at social support interventions such as village savings and loans and community grant programmes.

In the Interventions that improved buying power, Unconditional cash transfers improve food security and make little or no difference to cognitive function (thoughts and understanding) and development (high‐quality evidence), may increase dietary diversity (variety of the foods that people or households eat from different food groups) and reduce stunting (poor growth) (low‐quality evidence). Conditional cash transfers make little to no difference in the proportion of household expenditure on food and slightly improve cognitive function in children (high‐quality evidence), probably slightly improve dietary diversity (moderate‐quality evidence), and may make little to no difference to stunting or wasting (low bodyweight) (low‐quality evidence). Evidence on adverse outcomes (two studies) shows that CCTs make no difference to the proportion of overweight children. Income generation strategies make little or no difference to stunting or wasting (moderate‐quality evidence), may result in little to no difference to food security and may improve dietary diversity in children but not for households (low‐quality evidence).

In the Interventions that addressed food prices, Food vouchers probably reduce stunting (moderate‐quality evidence), may slightly improve dietary diversity and may result in little to no difference in wasting (low‐quality evidence).Food and nutrition subsidies may improve dietary diversity among school children (low‐quality evidence). We are very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food (very low‐quality evidence).

In the Interventions that addressed the social environment, Social support interventions such as community grants probably make little to no difference to wasting (moderate‐quality evidence) and may make little or no difference to stunting (low‐quality evidence). We are very uncertain about the effects of village savings and loans on food security or dietary diversity (very low‐quality evidence).

None of the included studies addressed the intervention category of infrastructure changes and none of the included studies reported on one of the primary outcomes: prevalence of undernourishment.

This body of evidence indicates that UCTs can improve food security. Income generation interventions do not seem to make a difference for food security, but the evidence is unclear for the other interventions. CCTs, UCTs, interventions that help generate income, interventions that help minimise impact of food prices through food vouchers and subsidies can potentially improve dietary diversity. UCTs and food vouchers may have a potential impact on reducing stunting, but CCTs, income generation interventions or social environment interventions do not seem to make a difference on wasting or stunting. CCTs seem to positively impact cognitive function and development, but not UCTs, which may be due to school attendance, healthcare visits and other conditionalities associated with CCTs.

The systematic review can be accessed at https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011504.pub3/full#CD011504-abs-0002