PT - JOURNAL ARTICLE AU - Muttaquina Hossain AU - Nuzhat Choudhury AU - Khaleda Adib Binte Abdullah AU - Prasenjit Mondal AU - Alan A Jackson AU - Judd Walson AU - Tahmeed Ahmed TI - Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review AID - 10.1136/archdischild-2016-311050 DP - 2017 Oct 01 TA - Archives of Disease in Childhood PG - 903--909 VI - 102 IP - 10 4099 - http://adc.bmj.com/content/102/10/903.short 4100 - http://adc.bmj.com/content/102/10/903.full SO - Arch Dis Child2017 Oct 01; 102 AB - Objective We systematically evaluated health and nutrition programmes to identify context-specific interventional packages that might help to prioritise the implementation of programmes for reducing stunting in low and middle income countries (LMICs).Methods Electronic databases were used to systematically review the literature published between 1980 and 2015. Additional articles were identified from the reference lists and grey literature. Programmes were identified in which nutrition-specific and nutrition-sensitive interventions had been implemented for children under 5 years of age in LMICs. The primary outcome was a change in stunting prevalence, estimated as the average annual rate of reduction (AARR). A realist approach was applied to identify mechanisms underpinning programme success in particular contexts and settings.Findings Fourteen programmes, which demonstrated reductions in stunting, were identified from 19 LMICs. The AARR varied from 0.6 to 8.4. The interventions most commonly implemented were nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. A programme was considered to have effectively reduced stunting when AARR≥3%. Successful interventions were characterised by a combination of political commitment, multi-sectoral collaboration, community engagement, community-based service delivery platform, and wider programme coverage and compliance. Even for similar interventions the outcome could be compromised if the context differed.Interpretation For all settings, a combination of interventions was associated with success when they included health and nutrition outcomes and social safety nets. An effective programme for stunting reduction embraced country-level commitment together with community engagement and programme context, reflecting the complex nature of exposures of relevance.PROSPERO registration number CRD42016043772.