Evidence Aid Bulletin (evidence summaries): 21 October 2021

21 October, 2021

Hello everyone

We are pleased to send you this October 2021 bulletin from Evidence Aid, containing three of our recently uploaded evidence summaries.

Please forward this to anyone who might be interested. If they would like to receive these bulletins directly, they should contact Claire Allen (callen@evidenceaid.org<mailto:callen@evidenceaid.org>) and anyone with questions about our work should also contact Claire. We will send our regular newsletter with all Evidence Aid’s news at the end of the month. If you would like to stop receiving our bulletins or newsletters, please contact Claire.

Sexual and reproductive health interventions in conflict settings<https://evidenceaid.org/resource/sexual-and-reproductive-health-interven... (from our Resilient Health Systems Collection<https://evidenceaid.org/evidence/resilient-health-systems/>)

Munyuzangabo M, Khalifa DS, Gaffey MF, et al. Delivery of sexual and reproductive health interventions in conflict settings: a systematic review<https://gh.bmj.com/content/5/Suppl_1/e002206>. BMJ Global Health. 2020;5(Suppl 1):e002206.

Building resilience into health systems should help them to function during and after health emergencies and disasters, and contribute to equitable provision of health care. This may be especially important for delivering sexual and reproductive health care for women in conflict-affected settings. In this systematic review, the authors searched for studies on conflict-affected populations in low- and middle-income countries (LMICs) which described a sexual and reproductive health intervention delivered during or within 5 years after the end of a conflict. They restricted their searches to articles published in English and did the search on indexed literature published between 1 January 1990 and 31 March 2018, and grey literature published between 1 January 2013 and 30 November 2018. They included 110 studies, most of which were conducted in sub-Saharan Africa, followed by the Middle East and North Africa, and East Asia and the Pacific region.

What was found:

* Most sexual and reproductive health interventions were delivered in hospitals and clinics by doctors and nurses.

* Barriers to the delivery of sexual and reproductive health interventions included security, population movement and lack of skilled health staff.

* Facilitators to the delivery of sexual and reproductive health interventions included multistakeholder collaboration, community engagement and use of community and outreach workers.

* Most of the interventions delivered were for HIV prevention and treatment, including behavioural education for HIV and sexually transmitted infections (STIs). Prevention education for HIV was more common than for STIs.

* Healthcare providers were mostly trained in gender-based violence (GBV) interventions and behavioural education activities.

* The delivery of preventative and supportive GBV interventions, such as safe spaces and hygiene kits, and mental health interventions such as support groups, were common.

* Common family planning interventions included the contraceptive pill, condoms and injections, as well as safe abortion and postabortion care.

* Women inside displaced person camps received more frequent interventions (such as behavioural educations and condom distribution activities) than those outside the camps, but no noticeable differences were found in intervention effectiveness between in-camp and out-of-camp populations.

Implications: The authors suggested that there is a need for more research on how best to reach underserved populations and to implement community-based approaches to the delivery of sexual and reproductive health interventions, and to evaluate the effectiveness of these interventions in conflict affected humanitarian settings.

Equity: The authors of the review discuss their findings in the context of education, culture, gender, time-dependent relationship (e.g., conflict).

Breastfeeding support packages for children under 6 months in low- and middle-income countries<https://evidenceaid.org/resource/breastfeeding-support-packages-for-chil... (from our Malnutrition Collection<https://evidenceaid.org/evidence/prevention-and-treatment-of-acute-malnu...)

Rana R, McGrath M, Sharma E, et al. Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review<https://www.mdpi.com/2072-6643/13/2/681>. Nutrients. 2021;13(2):681.

Mortality and morbidity are significantly higher in children under 6 months of age who present with wasting, underweight or growth-failure. Breastfeeding support is provided for mothers, especially in low- and middle-income countries (LMICs), to try to prevent these problems. In this systematic review, the authors searched for comparative effectiveness studies of breastfeeding support packages for mothers of children under 6 months of age in LMICS. They restricted their searches to articles published in English before 18 July 2018. They included 41 studies from 22 LMICs.

What was found:

* Counselling or educational supports were found to be the most effective interventions for improving breastfeeding practices.

* Breastfeeding training, promotion or peer support helped with breastfeeding practices.

* Breastfeeding education enhanced caregivers’ skills and knowledge.

Community interventions for improving access to food in low‐ and middle‐income countries<https://evidenceaid.org/resource/community-interventions-for-improving-a... (from our Malnutrition Collection<https://evidenceaid.org/evidence/prevention-and-treatment-of-acute-malnu...)

Durao S, Visser ME, Ramokolo V, et al. Community‐level interventions for improving access to food in low‐ and middle‐income countries<https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011504.pub3/.... Cochrane Database of Systematic Reviews. 2020;(8):CD011504.

Global undernourishment is increasing and is worst in low‐ and middle‐income countries (LMICs), particularly in areas of Africa and Asia. Community-level interventions are used to try to decrease food insecurity in these areas. In this systematic review, the authors searched for studies of the effects of community‐level interventions to improve access to food for whole communities, at-risk individuals or groups within a community in LMICs. They did not restrict their searches by language or type of publication and did the most recent search in February 2020. They included 59 studies.

What was found:

* Unconditional food vouchers improved food security but made little or no difference to cognitive function and development.

* Conditional cash transfers made little to no difference to the proportion of household expenditure spent on food but slightly improved cognitive function in children (high certainty evidence).

* Income generation interventions made little or no difference to stunting or wasting (moderate certainty evidence).

* Food vouchers probably reduce stunting in children (moderate certainty evidence).

* Community grants (social support interventions) made little or no difference to wasting (moderate certainty evidence).

* The effects of unconditional cash transfers on the proportion of household expenditure spent on food and on wasting are uncertain.

* The effects of interventions that addresses food prices (food and nutrition subsidies) on household expenditure on spent on healthy foods as a proportion of total expenditure on food are uncertain.

* The effects of village savings and loans on food security and dietary diversity are uncertain.

Implications: The authors noted a need for studies to address infrastructure and transportation that can affect physical access to food outlets, the social environment and the prevalence of undernourishment at the areas of the intervention.

Claire Allen, Operations Manager

Evidence Aid: Championing evidence-based humanitarian action.

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Email: callen@evidenceaid.org<mailto:callen@evidenceaid.org> | Skype: claireallencochrane | Website: www.evidenceaid.org | Twitter: @EvidenceAid | Facebook/Instagram: EvidenceAid

Our evidence collections can be found here: https://evidenceaid.org/evidence/

HIFA profile: Claire Allen is Operations Manager at Evidence Aid, UK. Professional interests: Evidence Aid (www.evidenceaid.org) provides evidence for people in disaster preparedness and response to make better decisions. Areas of interest = humanitarian crises, natural disasters and major healthcare emergencies (disaster = when a country is unable to cope with the disaster/crisis or emergency). She is a member of the HIFA Working Group on Access to Health Research. http://www.hifa.org/working-groups/access-health-research Email: callen AT evidenceaid.org