Evidence on Strategies for Integrating Nutrition Interventions with Health and Immunization Systems in Conflict-affected Areas of Low- and Lower-middle-income Settings - A Systematic Review

Context Pervasive conflict and war adversely affect a nation's sustainable development. Health and health systems deteriorate, causing long-lasting impacts on diets and nutrition. For the most vulnerable, integrated models of delivery of essential nutrition interventions are critical for the efficiency and sustainability of programs in these settings. Objective The objective of this systematic review was to provide evidence on coverage, utilization, and impact of integrated programs in conflict-affected, low- and middle-income countries (LMICs). Data Sources A database search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL from January 1, 2000 to February 14, 2024. Gray literature was also reviewed. Data Extraction Quantitative and qualitative studies, including observational or intervention designs, and reviews and program evaluations conducted in LMICs, focusing on women (≥19 years) and children (0-19 years) were included. Data extraction and risk-of-bias assessment were conducted independently by 2 investigators using a standardized tool. Data Analysis In total, 93 studies (103 reports) were included from 25 countries, including 32 unique gray literature records. The conflict-affected regions included South-East Asia (n = 27), Eastern-Mediterranean (n = 8), Africa (n = 58), and the Americas (n = 1). The review distinguished programs based on nutrition-specific, nutrition-sensitive, and health components. Although the coverage and utilization of integrated nutrition and health programs has been substantial, the impact of the strategies on health and nutrition has been limited. The meta-analysis found no significant differences in rates of wasting among children under 5 years; however, it showed that children who received an integrated strategy experienced a 28% lower risk of underweight (P =. 007) and a 12% reduced risk of stunting (P =. 05) compared with those who did not. Conclusion This review has provided an in-depth insight into integrated nutrition and health strategies in conflict-affected settings, identifying key facilitators and barriers that can inform future policy and program design. Integrating nutrition programs into health systems and enhancing government and community ownership could enhance efficiency and sustainability, given challenging environments.