Community health posts and home visits provided a platform to make health care services more accessible (109, 110, 124). Community-based platforms for the delivery of health services included community center and home visits from community health workers, mobile clinics, community support groups, mobile phones, and mass media campaigns (105, 110). Community-based services were effective in reducing maternal mortality and managing HIV (106). However, 1 review found that community-based interventions were only effective in reducing maternal morbidity and not mortality (107, 110). In high-income settings, community-based services were associated with hypertension and diabetes management, and cervical and breast cancer screening (106). We found no references for the use of community-based integrated care to address women's nutrition in low- and middle-income settings. It could be an effective way to reach older women and women of reproductive age who do not regularly engage with health centers. For children, community-based services were effective in improving health outcomes, particularly among the poorest wealth quintiles (13, 110). More research is needed on the potential of community-based services to reduce inequities in delivery of care to women in different settings and across different socioeconomic statuses.
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WHO (1948). "WHO definition of Health". Archived from the original (Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.) on 7 July 2016. Retrieved 6 July 2016., in WHO (2016)
However, many fortification programs in low- and middle-income countries are regional or voluntary and, thus, might have a limited nutritional impact at the national level (76). Although many efficacy trials show benefits of fortification interventions, scaling up fortification is limited by inadequate coverage and resources (13, 77, 78). Evidence for impact is also affected by suboptimal programming, low-bioavailability fortificants (e.g., reduced iron powder), poor consumption rates, weak enforcement mechanisms, and inadequate monitoring (76, 79, 80). More research is needed to evaluate the long-term impact of fortification and biofortification programs (75). In addition, there is also growing concern about fortifying and promoting food vehicles that have adverse health consequences when consumed in excess, such as salt and sugar, given the rising prevalence of overweight, obesity, and noncommunicable disease (81–83).
Schools (“condition” and delivery platform) ↑ food expenditures, ↑/NC food share, ↑ HH food consumption, ↑ dietary diversity, ↑ HH intake of fruits, vegetables, and ASF, ↑/NC intake of fats and sweets ↑ knowledge about health and nutrition, ↑ food expenditures, ↑/NC food share, ↑ HH food consumption, ↑ dietary diversity, ↑ HH intake of fruits, vegetables, and ASF, ↑/NC intake of fats and sweets, ↑ participation in social networks, ↑ self-confidence, ↑ control HH resources ↑ knowledge about health and nutrition, ↑ HH food security, ↑ food expenditures, ↑/NC food share, ↑ HH food consumption, ↑ dietary diversity, ↑ HH intake of fruits, vegetables, and ASF, ↑/NC intake of fats and sweets, ↑ participation in social networks, ↑ self-confidence, ↑ control over resources ↑ knowledge about health, NC hypertension, ↓ missed meals, ↑ health care utilization
Nutrition-sensitive approaches are difficult to link to women's nutritional status (5, 102). This is due to limited measurement of benefits to program beneficiaries, families, households, and communities, limited timeframes to evaluate long-term impact, logistical and political realities that make implementation difficult, and different priorities of different stakeholders in multisectoral programs (102). Many nutrition-sensitive approaches, as will be described, thus focus on more distal measures of impact (e.g., coverage, knowledge) and not more proximal measures of women's nutritional status (e.g., BMI, anemia status, etc.).