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Malnutrition is one of the most common causes of morbidity and mortality among adolescents and is now considered to be one of the largest risk factors responsible for the global burden of disease, along with poor diet. This review assesses the impact of preventive nutrition interventions (including nutrition education and counselling; micronutrient supplementation/fortification and macronutrient supplementation) to improve the health and nutritional status of adolescents aged 10-19 years in low- and middle-income countries (LMICs). This Campbell systematic review summarises findings from 10 studies on preventive nutrition interventions among adolescents in LMICs.

Soil transmitted (or intestinal) helminths and schistosomes affect millions of children worldwide. There are four species of soil transmitted helminths: "Ascaris lumbricoides" (roundworm), "Necator americanus" and "Ancylostoma duodenale" (hookworms), and "Trichuris trichura" (whipworm). The five species of schistosomes which affect humans include: "Schistosoma (S.) mansoni," "Schistosoma japonicum," "Schistosoma mekongi," "Schistosoma intercalatum" (which cause intestinal schistosomiasis) and "Schistosoma haematobium" (which causes urinary schistosomiasis). Mass deworming is applied widely to reduce the consequences of helminth infection, and there have been numerous studies on the effects of deworming on growth, cognition and learning outcomes in children over the past several decades. Systematic reviews and meta-analyses based on aggregate results of the effect of mass deworming on health and education outcomes are conflicting with some showing benefit (Hall, Hewitt et al. 2008; Croke, Hicks et al. 2016) and others not (Taylor-Robinson, Maayan et al. 2015; Welch, Ghogomu et al. 2017). Debate has ensued about whether these conflicting results are due to the influence of variations in effect across individual-level characteristics such as whether children are infected or not and intensity of infection (Hotez, Molyneux et al. 2007; Bundy, Kremer et al. 2009; Montresor, Addiss et al. 2015) as well as setting characteristics such as the sanitation environment and rapidity of reinfection (Campbell, Nery et al.). This meta-analysis will explore the question of whether mass deworming is more effective for subgroups of children defined by characteristics such as infection intensity or status, age or nutritional status. This understanding could help to develop targeted strategies to reach these children better with deworming and guide policy regarding deworming. [The following advisory group members co-authored this article: Robert Black, Celia Holland, Deirdre Hollingsworth, Sue Horton, and Sanjay Wijeseker.]

Context The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood. Objective This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants. Data Sources Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews. Data Extraction Two investigators independently extracted data from the included studies on a standardized data-extraction form. Data Analysis Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score. Conclusion Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed. Systematic Review Registration PROSPERO registration number CRD42020218517. [ABSTRACT FROM AUTHOR]

Background There is widespread, increasing use of magnesium sulphate in obstetric practice for pre-eclampsia, eclampsia, and preterm fetal neuroprotection; benefit for preventing preterm labour and birth (tocolysis) is unproven. We conducted a systematic review and meta-analysis to assess whether antenatal magnesium sulphate is associated with unintended adverse neonatal outcomes. Methods and findings CINAHL, Cochrane Library, LILACS, MEDLINE, Embase, TOXLINE, and Web of Science, were searched (inceptions to 3 September 2019). Randomised, quasi-randomised, and non-randomised trials, cohort and case-control studies, and case reports assessing antenatal magnesium sulphate for pre-eclampsia, eclampsia, fetal neuroprotection, or tocolysis, compared with placebo/no treatment or a different magnesium sulphate regimen, were included. The primary outcome was perinatal death. Secondary outcomes included pre-specified and non-pre-specified adverse neonatal outcomes. Two reviewers screened 5,890 articles, extracted data, and assessed risk of bias following Cochrane Handbook and RTI Item Bank guidance. For randomised trials, pooled risk ratios (RRs) or mean differences, with 95% confidence intervals (CIs), were calculated using fixed- or random-effects meta-analysis. Non-randomised data were tabulated and narratively summarised. We included 197 studies (40 randomised trials, 138 non-randomised studies, and 19 case reports), of mixed quality. The 40 trials (randomising 19,265 women and their babies) were conducted from 1987 to 2018 across high- (16 trials) and low/middle-income countries (23 trials) (1 mixed). Indications included pre-eclampsia/eclampsia (24 trials), fetal neuroprotection (7 trials), and tocolysis (9 trials); 18 trials compared magnesium sulphate with placebo/no treatment, and 22 compared different regimens. For perinatal death, no clear difference in randomised trials was observed between magnesium sulphate and placebo/no treatment (RR 1.01; 95% CI 0.92 to 1.10; 8 trials, 13,654 babies), nor between regimens. Eleven of 138 non-randomised studies reported on perinatal death. Only 1 cohort (127 babies; moderate to high risk of bias) observed an increased risk of perinatal death with >48 versus [less than or equal to]48 grams magnesium sulphate exposure for tocolysis. No clear secondary adverse neonatal outcomes were observed in randomised trials, and a very limited number of possible adverse outcomes warranting further consideration were identified in non-randomised studies. Where non-randomised studies observed possible harms, often no or few confounders were controlled for (moderate to high risk of bias), samples were small (200 babies or fewer), and/or results were from subgroup analyses. Limitations include missing data for important outcomes across most studies, heterogeneity of included studies, and inclusion of published data only. Conclusions Our findings do not support clear associations between antenatal magnesium sulphate for beneficial indications and adverse neonatal outcomes. Further large, high-quality studies (prospective cohorts or individual participant data meta-analyses) assessing specific outcomes, or the impact of regimen, pregnancy, or birth characteristics on these outcomes, would further inform safety recommendations. PROSPERO: CRD42013004451., Author(s): Emily Shepherd 1,2,*, Rehana A. Salam 1,2, Deepak Manhas 3, Anne Synnes 3, Philippa Middleton 1,2, Maria Makrides 2, Caroline A. Crowther 1,4 Introduction Antenatal magnesium sulphate is commonly [...]