Table 6 Findings on the interventions and its impacts on addressing different forms of malnutrition in Vietnamese children aged 0–18 years old

Nutrition sensitive intervention studies

 Hop and Khan 2002 [3]

Follow-up of national nutrition strategy

1995–2000

0–5 years

National

Child living in included area

National Plan of Action for Nutrition (NPAN), poverty reduction, infrastructure improvement, financial support, agriculture and aquaculture extension, health care, credit & education

Weight and height

Stunting decreased from 58% to 37.3%

Underweight decreased from 51.5% to 25%

Medium

 Mackintosh et al. 2002 [69]

Follow-up study to assess effectiveness of PANP (1993–1995) after 3 4 years (1998–1999)

4–6 years (older)

1–3 years (younger group)

55

Families who previously participated in the PANP study and 1 younger child who had not received any PANP exposure

Control group: no previous exposure to PANP

Poverty alleviation and nutrition program (PANP): growth monitoring and promotion, positive deviance inquiry, nutrition education and rehabilitation programme, and revolving loan program

(n = 46 household, 142 children)

Control group: no intervention

(n = 25 household)

Weight, height and WAZ

After 24 months: severe malnutrition (using WAZ) had reduced from 23 to 6%

No significant difference in WAZ between the groups

Intervention group were ‘nutritionally better off’, had better feeding habits and weaning practices

Medium

 Watanabe et al. 2005 [70]

Uncontrolled trial and follow up (2004)

5 years total

Intervention: 4–5 years

Follow up: 6.5–8.5 years

313

Living in a commune with a high prevalence of malnutrition, poor socioeconomic conditions, no prior intervention programme, and leaders being interested in the project

Nutrition intervention group: including growth monitoring, nutrition education rehabilitation programme, nutrition-seeking and health-seeking behaviours, feeding children locally available nutritious foods, antenatal care, home gardening, savings & credit programme (n = 172)

Nutrition programme (as above) & early childhood development (ECD) group: follow up to the prior intervention

Parental training: care and development. (n = 141)

Height, weight, HAZ, WAZ, WHZ,

maternal and household characteristics

No statistically significant differences between intervention groups for anthropometric measures, or levels of stunting, wasting or underweight status

Longitudinal results: significant decrease in stunting prevalence in both the nutrition intervention group (13.4%, p < 0.01) and ECD & nutrition group (16.3%, p < 0.01). Severe stunting was only reduced in the ECD & nutrition group by 7.8% (p < 0.01)

Medium

 Pachon et al. 2002 [71]

Longitudinal, RCT

2 years

5–25 months

239

Malnourished children matched with healthy children

Save the Children: positive deviance children interviewed to find key ‘good foods’ & behaviours. This included bimonthly nutrition rehabilitation for 9 months to identify ‘good foods,’ increase food quantity, and promote breastfeeding; and

monthly growth monitoring and promotion sessions for 2 years (n = 119)

Control group: no intervention (n = 119)

Weight, height, BMI, WAZ, HAZ, WHZ and breastfeeding status

At 12 months, intervention children consumed 20% more food than control group (p < 0.01), and were fed more times a day than the control group (p < 0.01)

No statistically significant results for WAZ at 12 months

At months 2–6, for children < 15 months, 44.6% control group were undernourished compared to 68.8% (p < 0.05)

However, children > 15 months, the intervention group (45.2%) had more well-nourished children than the control group (29.6%, p < 0.01)

Low

Nutrition specific intervention studies

 Wieringa et al. 2007 [72]

Double blinded, RCT

6 months

4–6 months

784

No chronic or severe illness, severe clinical malnutrition, anaemia, congenital anomalies

Supplementations for 7 days/week:

Zinc (Zn): 10 mg/day (n = 196)

Iron (Fe): 10 mg/day (n = 196)

Iron + zinc: 10 mg each/day (n = 196)

Control group: unfortified syrup (n = 196)

Weight, height, BMI, WAZ, HAZ, WHZ

Hb, SF and serum zinc

The Fe and Fe + Zn groups had significantly higher levels of Hb and SF, and lower prevalence of anaemia, than the Zn and placebo groups (p < 0.0001). Iron supplementation significantly increases Hb levels (p < 0.0001)

The Zn and Fe + Zn groups had significantly higher levels of zinc than the placebo and Fe groups (p < 0.0001). After baseline value adjustment, Zn levels were significantly higher in the Zn group compared to the Fe + Zn group (p = 0.02)

Zinc supplementation had a negative effect on Hb concentrations, independent of iron supplementation (-2.5 g/L, p < 0.001, p-interaction = 0.25)

Low

 Hall et al. 2007 [73]

Cluster randomised trial (CRT), 17 months

6 years

1,080

Children in primary schools who had taken part in a school feeding programme (fortified biscuits & milk)

Intervention group: fortified biscuits and milk, total 300 kcal. Once a day, 5 times a week. Deworming. Nutrition and hygiene information (n = 360)

Control group: no intervention

(n = 720)

Weight, height, BMI, WHZ, WAZ and HAZ

The intervention group gained significantly more weight (3.19 kg vs 2.95 kg, p < 0.001) and height (8.15 cm vs 7.88 cm, p = 0.008) than the control group. After controlling for other limiting factors, the intervention programme was statistically significant for weight gain (p = 0.024), and the most undernourished children at baseline gained the least weight

Low

 Hanieh et al. 2014 [74]

Cluster randomised trial (CRT) & follow up,

1 year

6 months

1,175

Pregnant women

IFA: Iron + folic acid supplement daily (60 mg iron + 0.4 mg folic acid)

(n = 395)

IFA: Iron + folic acid supplement twice weekly (60 mg iron + 1.5 mg folic acid)

(n = 399)

MMN: Multiple micronutrient supplement + Iron and folic acid, twice weekly (60 mg iron + 1.5 mg folic acid + 13 other micronutrients)

(n = 381)

Birthweight, length, and weight

No difference in birth weight as well as infant LAZ at 6 months of age in the twice weekly IFA group compared to the daily IFA group (MD 20.14, CI = 20.29–0.02), nor in the twice weekly MMN group compared to the daily IFA group (MD 20.04, CI = 20.20–0.11)

Low

 Hanieh et al. 2013 [75]

CRT and follow up

1 year

6 months

Follow up: 891

Pregnant women

IFA: Iron + folic acid supplement daily (n = 395) (60 mg iron + 0.4 mg folic acid)

(n = 395)

IFA: Iron + folic acid supplement twice weekly (n = 399) (60 mg iron + 1.5 mg folic acid)

(n = 399)

MMN: Multiple micronutrient supplement + Iron and folic acid, twice weekly (n = 381) (60 mg iron + 1.5 mg folic acid + 13 other micronutrients)

(n = 381)

LAZ, head circumference, and HAZ

Follow up: Inverse association between maternal 25-OHD status and infant HAZ at 6 months (OR = -0.09, CI = -0.12 to -0.02)

Low

 Hop and Berger 2005 [76]

Double blinded, RCT

6 months

6–12 months

306

Not severely wasted, not born prematurely

DDM: daily multiple micronutrient supplement (15 micronutrients including iron)

(n = 76)

WMM: weekly multiple micronutrient supplement (15 micronutrients including iron)

(n = 77)

DI: daily iron supplement (Daily adequate intake)

(n = 75)

Control group (P): daily placebo

(n = 73)

Weight, length, LAZ, WAZ,

plasma Hb, ferritin, zinc, riboflavin, retinol, tocopherol, and homocysteine

LAZ and WAZ worsened significantly in all groups, apart from LAZ in the DDM group which was significantly less than in the P and WMM groups (p = 0.001)

Hb levels increased significantly more in the DMM group (mean = 16.4 g/L, CI = 12.4–20.4) than the P group (mean = 8.6 g/L, CI = 5.0–12.2)

PF levels increased significantly more in the DMM and DI groups than the P and WMM groups

Low

 Huy et al. 2009 [77]

Non-random, non-controlled pragmatic trial

2 years

0–2 years

586

Pregnant women

1: Iron (60 mg) + folic acid supplement (400 µg) (n = 211)

2: Multiple-micronutrient supplement (n = 203)

3: Gender training – maternal care from the family and community during pregnancy, and multiple-micronutrient supplement (n = 172)

All: nutrition education- encouraging more frequent eating during pregnancy

Baby birth weight (LBW < 2500 g)

At 2 years: weight and height

Average birth weight was higher in the two groups receiving multiple-micronutrient supplements than the group receiving iron = folic acid (2: + 166 g 3: + 105 g) than those receiving iron + folic acid (p < 0.05)

LBW prevalence was lower in groups 2 & 3 than in group 1 (4.0%, 5.8% and 10.6% respectively, p < 0.05)

At 2 years: children were taller in groups 2 & 3 than group 1 (p < 0.05) and stunting rates were ~ 10% lower (p < 0.05). No statistical significance for weight indicators

Medium

 Le et al. 2007 [78]

RCT

6 months

6–8 years

425

Anaemic children

Iron fortified noodles, 10.7 mg/day (n = 86)

Iron fortified noodles (10.7 mg/day) + mebendazole (n = 79)

Mebendazole (deworming drug) (n = 79)

Iron tablet (dose not reported) + mebendazole (n = 83)

Control group: Placebo

(n = 82)

Iron status: Hb, SF, sTfR, and haemoglobinopathies analysis

Inflammation: C-reactive protein

Parasite infection status and immunoglobulin E (IgE)

Hb concentration improved, and anaemia prevalence reduced in all groups (p < 0.001). Iron fortification significantly increased levels of Hb, SF and body iron (p = 0.037, p < 0.001 and p < 0.01, respectively), compared to just deworming and the placebo. Deworming showed no increased effect on Hb, iron status or IgE level compared to iron fortification

Low

 Le et al. 2006 [79]

RCT

6 months

6–8 years

425

Anaemic children

Iron fortified noodles, 10.7 mg/day (n = 86)

Iron fortified noodles (10.7 mg/day) + mebendazole (n = 79)

Mebendazole (deworming drug) (n = 79)

Iron tablet (dose not reported) + mebendazole (n = 83)

Control group: Placebo

(n = 82)

Hb, SF, sTfR, and haemoglobinopathies analysis, CRP,

parasite infection status, and immunoglobulin E (IgE)

Iron supplementation was more efficient than fortification to treat anaemia for all iron markers: Supplementation (Hb 6.19 g/L, p = 0.001; SF 117.3 μg/L, p = 0.001; and body iron 4.37 mg/kg, p = 0.001) compared to fortification (Hb 2.59 g/L, p = 0.07; SF 23.5 μg/L, p = 0.006; and body iron 1.37 mg/kg, p = 0.001)

Low

 Ninh et al. 1996 [80]

Double blinded, RCT

5 months

4–36 months

146

Growth-retarded children, paired to healthy children

Zinc supplementation (10 mg) daily (n = 73)

Control group: Placebo (n = 73)

Weight, height, WAZ, HAZ

plasma circulating insulin-like growth factor (IGF-I)

Zinc supplementation increased weight by 0.5 kg (± 0.1 kg, p < 0.001) and height by 1.5 cm (± 0.2 cm, p < 0.001)

Low

 Pham et al. 2020 [81]

RCT

6-month intervention

18-month follow-up

5 months

426

Singleton, breastfed infants

Severe anaemia (Hb < 70 g/L)

FF: instant fortified flour, daily for 6 months

containing 11 vitamins & 12 minerals (n = 157)

FC: complementary fortified food, daily for 6 months

containing 11 vitamins & 12 minerals (n = 135)

Control group (C group): no intervention (n = 134)

Micronutrient status: Hb, PF sTfR, zinc, and retinol

Iron deficiency and iron deficiency anaemia were lower in the FF (13.4% and 6.7%) and FC (15.2% and 3.8%) groups compared to the C group (57.5 and 37.5%, p < 0.0001)

Low

 Phu et al. 2012 [82]

RCT

6-month intervention

18-month follow-up

5 months

377

Severe anaemia (Hb < 70 g/L)

FF: instant fortified flour, daily for 6 months

containing 11 vitamins & 12 minerals (n = 135)

FC: complementary fortified food, daily for 6 months

containing 11 vitamins & 12 minerals (n = 114)

Control group: no intervention (n = 128)

Micronutrient status: Hb, PF, sTfR, zinc, and retinol

Retinol & zinc concentrations didn’t differ significantly among groups. Zinc deficiency was significantly lower in the FF group (36.1%) than C group (52.9%, p = 0.04)

Low

 Thach et al. 2015 [83]

Cluster randomised trial (CRT)

9-month intervention

25-month follow-up

6 months

426

Pregnant women

Daily iron-folic acid (IFA) (60 mg elemental iron and 0.4 mg folic acid) (n = 34 communes)

Twice weekly IFA (60 mg elemental iron and 1.5 mg folic acid) (n = 35 communes)

Twice weekly multiple-micronutrient, iron and folic acid (60 mg elemental iron, 1.5 mg folic acid and MMN) (n = 35 communes)

Weight, length, LAZ and WAZ

The OR of anaemia was significantly lower among infants in the daily IFA (OR = 0.31, CI = 0.22–0.43), weekly IFA (0.38, CI = 0.26–0.54) and MMN (0.33, CI = 0.23–0.48) compared to groups in the observational study

Low

 Berger et al. 2006 [84]

Double blinded, RCT

6 months

4–7 months

915

Breastfed infants aged 4–7 months who free from chronic/ acute illness, severe malnutrition, or congenital abnormalities

Fe-group: daily dose of 10 mg of iron as ferrous sulfate (n = 201)

Zn-group: daily dose of 10 mg zinc as zinc sulfate

(n = 195)

Fe–Zn group: a daily dose of 10 mg iron þ 10 mg zinc

(n = 190)

Control group: Placebo: a dose of 100 000 IU of vitamin A was given to all infants to avoid VAD

(n = 198)

Stunting HAZ < -2 z-scores; wasting WHZ < -2 z-scores; underweight HAZ < -2 z-scores; anaemia = Hb < 110 g/l; low Fe stores = SF < 12 mg/l;

low Zinc = Zinc < 9.9 mmol/l;

IDA = simultaneous low SF and anaemia

Hb and SF levels significantly increased in both Fe and Fe + Zn groups (22.6 and 20.6 g/l for Hb; 36.0 and 24.8 mg/l for SF, respectively) compared to Zn and placebo groups (Hb: 6.4 and 9.8 g/l; SF: 18.2 and 16.9 mg/l, p < 0.0001). Zn increased more in Zn group (10.3 mmol/l) than in Fe + Zn group (8.0 mmol/l, p < 0.03), and Fe and placebo groups (1.6 and 1.2 mmol/l, p < 0.0001). Adding iron to zinc supplements negates the positive effect that sole zinc supplementation had on weight gain (WAZ) (p = 0.0004) and serum zinc (p = 0.02) showing a significant interaction between zinc and iron co-supplementation

Low

 Vuong et al. 2002 [85]

Controlled trial

30 days

31–70 months

185

Children with low Hb concentration (100–120 g/L)

Vitamin A supplementation: using Momordica coincidences (gac) fruit (locally available)

1: fruit & rice = 3.5 mg β-carotene (n = 62)

2: powder & rice = 5.0 mg synthetic β-carotene (n = 60)

3: Plain rice, no fortification (n = 63)

Weight, height, HAZ, WAZ and plasma β-carotene and Hb concentration

β-carotene concentrations significantly higher in groups 1 & 2 than group 3 (p < 0.0001)

Plasma retinol concentration significantly higher in group 1 (p = 0.0053) than group 2 and (p = 0.0053) group 3

Plasma retinol concentrations were significantly higher in group 1 than group 2 (p = 0.0053) and group 3 (p = 0.006)

Hb concentrations increased in all 3 groups. In anaemic children, Hb levels were significantly lower in group 3 than group 1 (p = 0.017), but not than group 2

Medium

 Xuan et al. 2013 [86]

RCT

5 months

18–36 months

334

Not breastfed, no congenital or chronic diseases, and not consuming prebiotics or probiotics

Intervention group: GAU 1 + milk-isocaloric and isoprotic gum, containing synbiotics, and fortified with vitamins A, C and E, and minerals zinc and selenium, and docosahexaenoic acid (n = 150)

Control group: Fortified gum of sufficient protein, carbohydrates, fats, vitamins, and minerals (n = 184)

Height and weight gain, anaemia, zinc, and vitamin A deficiencies

The growth parameters of the intervention group increased significantly more than the control group:

Weight (+ 0.43, p < 0.01)

Height (+ 1 cm, p < 0.01) and BMI Z-score (+ 0.015, p < 0.05)

MNDs were reduced in both the intervention and control groups, more in the intervention groups, but non-statistically significant, anaemia by 14.9% (p = 0.63), vitamin A by 9.5% (p = 0.05) and zinc by 13.6% (p = 0.44)

Low

 Nguyen et al. 2021 [87]

Uncontrolled trial, 6 months

6–14 years

151

Children from 5 schools in Can Tho with Vitamin D deficiency/ insufficiency/ low BMD

6–9 years: daily 600 mg elemental calcium & 400 IU vitamin D3

10–14 years: daily 1350 mg elemental calcium & 460 IU vitamin D3

BMD, bone turnover markers, vitamin D

level, and PTH

Vitamin D concentration significantly improved (p 0.001)

Prevalence of low BMD significantly reduced by 56.29% (p < 0.05)

Low

 Smuts et al. 2005 [2]

Double blinded, RCT

6 months

6–11 months

1,134

Residents in study location, not born prematurely or low birth weight, not severely wasted nor severely anaemic, no fever

WMM: weekly multiple micronutrient supplements

(n = 283)

DMM: daily multiple micronutrient supplement

(n = 280)

DI: daily iron supplement

(n = 288)

Control group (P): placebo

(n = 283)

CRP, Pb, retinol, Hb, and riboflavin level

The DMM group had a significantly greater weight gain, growing at an average rate of 207 g/mo compared with 192 g/mo for the WMM group, and 186 g/mo for the DI and P groups. DMM had significantly greater reduction in anaemia (-44% vs -35.1% and -29.9%), ID (-17.6% vs -13.7% and 9.3%) and VAD (-10.7% vs -4.3% and -11.4%) compared to DI and P groups (p < 0.05)