Main Research Findings

A cluster randomized controlled trial examining the effect of an integrated school garden and home garden intervention on anemia among school-aged children in Nepal showed that these interventions can potentially improve health outcomes in low-income countries, especially for school-aged children and in reducing anemia. 7

A randomized controlled trial protocol for foot and ankle exercises for children with Charcot-Marie-Tooth disease (CMT) found that CMT, a commonly inherited neuromuscular disease, lacks effective treatment options. Interventions focusing on maintaining and increasing strength may offer solutions for the significant foot and ankle weakness experienced by children with CMT. 2

A quasi-experimental assessment on the effectiveness of an egg-based intervention for improving nutrition in poor school-age children in China revealed that while egg-based interventions effectively alleviate undernutrition in infants and toddlers, their effectiveness for children in remote and impoverished areas of China remains understudied. This study aimed to investigate the impact of providing one hard-boiled egg daily to school-age children in less developed areas of China. 11

A cross-sectional study on child nutrition outcomes and maternal nutrition-related knowledge in rural localities of Mbombela, South Africa, highlighted poor nutrition among children as a significant public health concern, primarily attributed to inadequate feeding practices and inconsistent maternal nutrition-related knowledge. This study aimed to assess the association between nutrition outcomes in children under two years old, their feeding practices, and maternal nutrition-related knowledge in Mbombela, South Africa. Mothers' nutrition knowledge was evaluated using an adapted structured questionnaire encompassing colostrum, breastfeeding continuation, diarrhea prevention and treatment with oral rehydration solutions, immunization, and family planning, scored as excellent (80-100), good (60-79), average (40-59), and fair (0-39). This data was collected alongside questions about socio-demographic factors, obstetric history, and anthropometric measurements. Child nutrition outcomes were estimated based on WHO classifications using z-scores for stunting (length-for-age [LAZ]), underweight (weight-for-age [WAZ]), and thinness (body mass index-for-age [BAZ]). The study involved 400 pairs of children (8 ± 6 months) and their mothers (29 ± 6 years) residing in a low socio-economic environment, analyzed using STATA 17. Half of the children were stunted (50%), and over half (54%) were obese, while mothers were underweight (39%) and overweight (34%). In addition to one-third of mothers reporting obstetric complications, two-thirds initiated breastfeeding within one hour of delivery, 30% exclusively breastfed, 48% introduced early complementary feeding, and 70% practiced mixed feeding. Twenty-eight percent (28%) of mothers had fair nutrition-related knowledge, 66% had average knowledge, 6% had good knowledge, and none had excellent knowledge. A chi-square test demonstrated a significant association between mothers' nutrition-related knowledge and child stunting. The final hierarchical logistic regression revealed significant associations of stunting with mothers' nutrition-related knowledge (average: AOR = 1.92, 95%CI: 1.12-3.29), child's age (6-11 months: AOR = 2.63, 95%CI: 1.53-4.53 and 12-23 months: AOR = 3.19, 95%CI: 1.41-7.25), and education (completing Grade 12: AOR = 0.36, 95%CI: 0.15-0.86). Contextual and intensified interventions, including continuous education for mothers to acquire accurate information about nutrition-related knowledge and feeding practices, could potentially enhance child nutrition outcomes in less affluent settings. Consequently, efforts should be made to ensure appropriate provision of nutrition knowledge based on the stages of child growth from 0 to 2 years, extending beyond infancy into school age. 8

A randomized pilot study investigating the role of an adjuvant Crohn's disease exclusion diet alongside enteral nutrition in asymptomatic pediatric Crohn's disease with biochemical activity discovered that while conventional therapy can achieve remission in mild-moderate pediatric Crohn's disease (CD), some patients experience a loss of response to biological drugs despite dosage increases. 9

A systematic review and meta-analysis on probiotic supplementation for growth promotion in undernourished children suggested that probiotic supplementation could serve as a therapeutic intervention to improve growth outcomes in children experiencing undernutrition. The review aimed to synthesize the current evidence on probiotic supplementation for promoting growth in undernourished children. 6

An evaluation of inpatient and outpatient treatment provided by a specialist infant nutrition foundation in Las Heras, Mendoza, Argentina, effectively reduced child malnourishment. The study assessed the impact of this treatment and identified factors influencing nutritional recovery. 13

A review of digestive perianastomotic ulcerations (DPAU) after intestinal resection in children revealed DPAU as a rare complication occurring at or near the anastomosis site following intestinal resection and anastomosis. The review summarized the characteristics of DPAU, including etiology, diagnosis and differential diagnosis, clinical manifestations, treatment, and future research. A comprehensive search of recent literature on DPAU was conducted in PubMed, Embase, and Cochrane. The main clinical manifestations of DPAU are gastrointestinal symptoms such as bloody stools and chronic anemia. Diagnosing DPAU is challenging, requiring the exclusion of specific diseases like Crohn's disease. Clear treatment guidelines are absent due to the high variability in drug and surgical responses. Timely medication adjustments and combined treatment approaches are recommended. The underlying mechanism causing DPAU is not fully understood, but proposed mechanisms include scar tissue ischemia and underlying diseases. A high risk of relapses necessitates long-term follow-up. Further research is needed to address the numerous unresolved issues in this area, particularly through more randomized controlled trials and studies to enhance understanding of this disease. 10

A review on ascorbic acid for the treatment of Charcot-Marie-Tooth disease (CMT) revealed that CMT encompasses a broad range of hereditary motor and sensory neuropathies. The molecular basis of several CMT subtypes has been clarified over the last 20 years. As slowly progressive muscle weakness and sensory disturbances are the primary features of these syndromes, treatments aim to improve motor impairment and sensory disturbances to enhance capabilities. Pharmacological treatment trials in CMT are relatively rare. This review was derived from a Cochrane review, Treatment for Charcot Marie Tooth disease, which will be updated through this review and a forthcoming publication titled Treatments other than ascorbic acid for Charcot-Marie-Tooth disease. 3

The fourth paper in a supplement on improving the health and well-being of rural indigenous Maya mothers and children in the Western Highlands of Guatemala, where stunting prevalence is the highest in Latin America and among the highest globally, focused on reducing childhood undernutrition. This objective was part of the Maternal and Child Health Project (2011-2015) implemented by Curamericas/Guatemala. The project's implementation research component aimed to determine if childhood nutritional status improvements were more significant in the project area compared to control areas and whether a dose-response effect existed, indicating greater improvement with longer intervention durations. METHODS: The project provided nutrition-related messages to mothers of young children, conducted cooking sessions using locally available nutritious foods, offered a lipid-based nutrient supplement (Nutributter®) for a brief period (4 months), administered anti-helminthic medication, and conducted repeated growth monitoring and nutrition counseling. Height and weight measurements for calculating the prevalence of underweight, stunting, and wasting in children under two were analyzed and compared with anthropometric data for children in the Northwestern Region and Western Highlands of Guatemala. 12

A cluster randomized controlled trial of a community-based initiative to reduce stunting in rural Indonesia evaluated a $120 million project conducted between 2014 and 2018. The project aimed to reduce stunting through a combination of (1) community-driven development grants focused on health and education outcomes, (2) training for health providers on infant and young child feeding and growth monitoring, and (3) training for sanitarians on a localized variation of community-led total sanitation. This study involved 95 treatment and 95 control subdistricts across South Sumatra, West Kalimantan, and Central Kalimantan provinces. No significant impacts were found on stunting, the study's primary outcome measure (0.5 pp; 95% confidence interval [CI]: -3.0 to 4.1 percentage points [pp]), or other long-term undernutrition outcomes approximately one year after the project's completion. The project had a moderate impact on some secondary, more proximal outcomes related to maternal and child nutrition, including the percentage of mothers consuming the recommended number of iron-folic acid pills during pregnancy (8.7 pp; 95% CI: 4.1-13.3 pp), the proportion of 0-5-month-olds exclusively breastfed (8.7 pp; 95% CI: 1.8-15.6 pp), and the number of recommended meals per day received by 6-23-month-olds (8.5 pp; 95% CI: 3.8-13.2 pp). However, no significant impacts were observed on other proximal outcomes like the number of prenatal and postnatal checkups, child dietary diversity, child vitamin A receipt, or the incidence of child diarrhea. Our findings underscore the challenge of successfully implementing an integrated package of interventions to reduce child stunting in real-world settings. Project design needs to consider implementation reality alongside best practices, for example, by piloting the simultaneous implementation of multifaceted interventions or phasing them in gradually over a longer timeframe. 5

A protocol for a parallel group, two-arm, superiority cluster randomized trial to evaluate a community-level complementary-food safety and hygiene and nutrition intervention in Mali: the MaaCiwara study (version 1.3; 10 November 2022), highlighted that diarrheal disease remains a significant cause of morbidity and mortality among children under five in numerous low- and middle-income countries. Modifying food safety practices and feeding methods around the weaning period, combined with improved nutrition, can significantly reduce the risk of disease and enhance infant development. The protocol describes a cluster randomized trial to assess the effectiveness of a multifaceted community-based educational intervention aimed at improving food safety and hygiene behaviors and enhancing child nutrition. 14

A review on treatment for Charcot-Marie-Tooth disease (CMT) highlighted that CMT encompasses a wide array of motor and sensory neuropathies. The most prevalent forms are demyelinating (CMT1) and axonal (CMT2). The molecular basis of several CMT forms has been clarified over the past 15 years. Muscle wasting and sensory disturbances being the primary features of these syndromes, treatments aim to improve motor impairment and sensory disturbances. Specific treatment trials remain infrequent. 1

A systematic review of the literature on rehabilitation management of Charcot-Marie-Tooth syndrome (CMT) found that CMT causes significant muscle deficits, restricting daily activities (ADL) and leading to severe disability. Although conservative interventions are the sole treatment for the disease, scientific evidence on rehabilitation treatment is lacking. The review aimed to research the best available literary evidence on CMT rehabilitation treatment, critically analyze the outcome, and build an evidence-based work protocol. This systematic review of CMT patient rehabilitation included results from databases such as Pubmed, Medline, Embase, Pedro, Cinahl, and Ebsco discovery. Inclusion criteria included randomized/controlled studies, analytical studies, cross-sectional studies on a cohort of at least 10 individuals, and medium/long-term reports of the results. Eleven studies were included in the final review phase, including trials on physiotherapy CMT treatment (5) and orthosis treatment (6). Despite the wide range of outcomes and proposed interventions, the data suggests that strength or endurance training improves functionality and ADL in affected patients, while the role of orthotics remains unclear. Physiotherapy treatment is a valuable tool for managing CMT; however, more studies on larger numbers of cases are needed to define the utility of orthosis and establish a gold standard for treatment. 4

Treatment Summary

Foot and ankle exercises are a potential treatment for children suffering from Charcot-Marie-Tooth disease (CMT). 2

Egg-based interventions have the potential to improve nutrition in school-age children in impoverished areas of China. 11

Improving maternal nutrition-related knowledge and feeding practices could significantly enhance child nutrition outcomes in rural areas of South Africa. 8

An exclusion diet for Crohn's disease alongside enteral nutrition could potentially lead to remission in asymptomatic pediatric Crohn's disease patients. 9

Probiotic supplementation shows promise as a treatment for improving growth in undernourished children. 6

Benefits and Risks

Benefit Summary

School gardens and home gardens can potentially improve health outcomes in low-income countries. 7

Foot and ankle exercises can help maintain and increase strength in children with CMT. 2

Egg-based interventions can help improve undernutrition in school-age children in impoverished areas of China. 11

Improving maternal nutrition-related knowledge and feeding practices can help improve child nutrition outcomes. 8

An exclusion diet for Crohn's disease alongside enteral nutrition may lead to remission in asymptomatic pediatric Crohn's disease patients. 9

Probiotic supplementation can help promote growth in undernourished children. 6

Risk Summary

No specific risks associated with egg-based interventions have been identified in research. 11

No specific risks associated with probiotic supplementation have been identified in research. 6

Comparison between Studies

Commonalities

Many studies investigate interventions to improve child nutrition, encompassing dietary improvements, nutritional supplements, and education. 7 11 8 6 12 14

Differences

Studies differ in geographic focus, intervention types, and outcome indicators. For instance, the school garden and home garden intervention in Nepal contrasts with the egg-based intervention in China. 7 11

Consistency and Contradictions in Results

Many studies indicate the effectiveness of interventions aimed at improving child nutrition. However, not all studies yielded consistent results. For example, a cluster randomized controlled trial examining a community-based initiative to reduce stunting in rural Indonesia found no significant impacts. 5

Practical Implications and Considerations

The research findings suggest that various interventions, including dietary improvements, nutritional supplements, and education, can potentially improve child nutrition. However, implementing these interventions effectively requires careful consideration of regional and child-specific needs. 7 11 8 6 12 14

Limitations of Current Research

Many studies have been conducted with small sample sizes and short follow-up durations. Therefore, the findings require validation through further research. 7 11 8 6 12 14

Future Research Directions

Larger-scale studies with longer follow-up periods are needed to investigate the effectiveness of various interventions across diverse regions. Research should also focus on the cost-effectiveness and sustainability of these interventions. 7 11 8 6 12 14

Conclusion

These studies suggest that various interventions can potentially be effective in improving child nutrition. However, implementing these interventions effectively requires careful consideration of regional and child-specific needs. Further research is warranted. These studies suggest that various interventions can potentially be effective in improving child nutrition. However, implementing these interventions effectively requires careful consideration of regional and child-specific needs. Further research is warranted. 7 11 8 6 12 14

Treatment List

Foot and ankle exercise, egg-based intervention, Crohn's disease exclusion diet, enteral nutrition, probiotic supplementation