Identifying Priority Countries for Scaling Up Small-Quantity Lipid-Based Nutrient Supplements

IntroductionUndernutrition is a cause of nearly half of all deaths among children under-5. Small-quantity lipid-based nutrient supplements (SQ-LNS) have been shown to prevent child wasting, stunting, anemia and mortality among children 6-23 months of age in low- and middle-income countries (LMICs). Scaling up effective preventive interventions is urgent given the current global food insecurity and nutrition crisis. MethodTo prioritize SQ-LNS scale-up activities, we identified countries with the highest burdens of wasting, stunting, and all-cause mortality among children 6-23 months of age at the national level using the most recent national survey data including the Demographic and Health Survey (DHS) and Multiple Indicator Cluster Surveys (MICS), as well as the Lives Saved Tool (LiST) in LMICs. National-level estimates informed a care cascade model to assess the potential impact of SQ-LNS on all-cause mortality, stunting, and wasting. We also conducted a sub-national level analysis among the 20 highest burden countries with the most recent available survey data to identify the highest burden regions. ResultsOur analysis identified the top 20 countries with the highest burden of the three outcomes as: Niger, South Sudan, Yemen, Sudan, Somalia, Democratic Republic of Congo, Eritrea, Nigeria, Central African Republic, Guinea, Equatorial Guinea, Chad, Papua New Guinea, Benin, Mali, Angola, Pakistan, Timor-Leste, Sierra Leone and Cote dIvoire, although for some countries the survey data were collected > 10 years ago. Some of these countries also ranked high in population estimates of acute food insecurity. The care cascade model demonstrates that a large number of cases of stunting and wasting and deaths could be potentially averted if SQ-LNS is provided. ConclusionMost of the top 20 countries are in Sub-Saharan Africa, with a few in South and Southeast Asia. This geographical concentration underscores the urgent need for targeted interventions in these regions to prevent child malnutrition. What is already known on this topicIt is known that SQ-LNS reduces child wasting, stunting, anemia and mortality among children 6-23 months of age in LMICs. However, survey reports generally estimate stunting, wasting, and mortality rates among all children under 5 years of age, and not specifically for the 6-23 months old age group. What this study addsBy estimating the burden of stunting, wasting and all-cause mortality for the specific age group of 6-23 months old at the national and sub-national level, we identified high burden countries and regions where SQ-LNS will be most impactful. No other study has focused on this age group even though it is a particularly vulnerable period for undernutrition. How this study might affect research, practice or policyOur analysis could help decision-makers and funders to determine where scale-up of SQ-LNS should be prioritized.