Cochrane Systematic Review published: 28 July 2020 (republished open access 5 August 2020)

Review question
We looked at the effect of community‐level interventions to improve access to nutritious food in low‐ and middle‐income countries (LMICs) on people, households and communities.

Background
Food security exists when people have physical, social and economic access to sufficient, safe, nutritious foods to be healthy. The number of people who do not have enough to eat in the world has started increasing since 2015. Most of these people live in LMICs, especially in Asia and Africa. Not being able to access nutritious food, either because of not having enough money or because of not having somewhere to shop or find food near where people live, affects the health and socioeconomic situation of people and societies, both in the short and long term. Strategies focusing on communities may be important for increasing access to food in LMICs.

Study characteristics
We found 59 studies assessing different interventions in LMICs, including 214 to 169,485 participants and 300 to 124,644 households, mainly in Africa and Latin America. Many studies assessed cash transfers, which are welfare programmes where money is provided to households. Of these, 21 studies evaluated unconditional cash transfers, where there are no conditions for receiving the money, and 14 studies assessed conditional cash transfers, where there are specific conditions required to meet in order to receive the money. Seventeen studies looked at income generation interventions (for example, livestock management or self‐help groups), four studies at food vouchers, four studies at providing food and nutrition subsidies, and two studies looked at social support interventions such as village savings and loans and community grant programmes.

Search date
The evidence is current to February 2020.

Key results

Interventions that improved buying power:
Unconditional cash transfers improve food security and make little or no difference to cognitive function (thoughts and understanding) and development (high‐quality evidence), may increase dietary diversity (variety of the foods that people or households eat from different food groups) and reduce stunting (poor growth) (low‐quality evidence). It is very uncertain whether UCTs reduce the proportion of household expenditure on food and reduce wasting. Regarding adverse outcomes, evidence from one trial indicates that UCTs reduce the proportion of infants who are overweight.

Conditional cash transfers make little to no difference in the proportion of household expenditure on food and slightly improve cognitive function in children (high‐quality evidence), probably slightly improve dietary diversity (moderate‐quality evidence), and may make little to no difference to stunting or wasting (low bodyweight) (low‐quality evidence). Evidence on adverse outcomes (two studies) shows that CCTs make no difference to the proportion of overweight children.

Income generation strategies make little or no difference to stunting or wasting (moderate‐quality evidence), may result in little to no difference to food security and may improve dietary diversity in children but not for households (low‐quality evidence).

Interventions that addressed food prices:
Food vouchers probably reduce stunting (moderate‐quality evidence), may slightly improve dietary diversity and may result in little to no difference in wasting (low‐quality evidence).

Food and nutrition subsidies may improve dietary diversity among school children (low‐quality evidence). We are very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food (very low‐quality evidence).

Interventions that addressed the social environment:
Social support interventions such as community grants probably make little to no difference to wasting (moderate‐quality evidence) and may make little or no difference to stunting (low‐quality evidence). We are very uncertain about the effects of village savings and loans on food security or dietary diversity (very low‐quality evidence).

None of the included studies addressed the intervention category of infrastructure changes and none of the included studies reported on one of the primary outcomes: prevalence of undernourishment.

Some limitations of the review include not having all necessary information about what was measured (outcomes), judgements that had to be made regarding which outcome measures to report and inability to pool the results of all studies reporting on the same outcome. Another limitation was that we were unable to find out what specific intervention features enable or impede the effective implementation of the intervention.

Read the full review here