Global Interventions for Children with Comorbid Diarrhea and Acute Malnutrition: a Systematic Review

Abstract

Globally, more than half a million children die each year from diarrhea, mostly in low- and middle-income countries (LMICs). Young children with acute malnutrition, are at particularly high-risk of death. Current diarrhea management strategies for children presenting to medical care for diarrhea in LMICs focus primarily on the management of acute illness which have important benefits for reducing acute diarrheal disease severity, recurrence and mortality risk, but the evidence to support their impact on improving longer term outcomes is limited. An electronic literature search was performed to identify randomized controlled trials (RCTs) published between January 1, 1980 and March 31, 2020 in Pubmed. Search terms relating to wasting, diarrhea and/or dysentery, and treatment/interventions were used with filters related to clinical trials, locations (in low- and middle-income settings, and age groups (under 18 years). The predefined search criteria yielded a total of 197 articles. After exclusions at the title, abstract, and full-text stages, 17 articles containing interventions for managing diarrhea and malnutrition in children. The 17 trials included eight food-based interventions, four probiotic interventions, three Vitamin A studies, and two antibiotic studies. While there are some promising interventions, such as probiotics and some food-based interventions, adequately powered, double-blind, placebo-controlled trials are needed before recommendations to guidelines can be made. Further, the paucity of evidence conducted recently highlights the need to generate evidence that is likely to improve outcomes in children living in LMICs today and in the near future