Community-based approaches to address childhood undernutrition and obesity in developing countries.

Community-based approaches have been the mainstay of interventions to address the problem of child malnutrition in developing societies. Many programs have been in operation in several countries for decades and originated largely as social welfare, food security and poverty eradication programs. Increasingly conceptual frameworks to guide this activity have been developed as our understanding of the complex nature of the determinants of undernutrition improves. Alongside this evolution, is the accumulation of evidence on the types of interventions in the community that are effective, practical and sustainable. The changing environment is probably determining the altering scenario of child nutrition in developing societies, with rapid developmental transition and urbanization being responsible for the emerging problems of obesity and other metabolic disorders that are largely the result of the now well-recognized linkages between child undernutrition and early onset adult chronic diseases. This dramatic change is contributing to the double burden of malnutrition in developing countries. Community interventions hence need to be integrated and joined up to reduce both aspects of malnutrition in societies. The evidence that community-based nutrition interventions can have a positive impact on pregnancy outcomes and child undernutrition needs to be evaluated to enable programs to prioritize and incorporate the interventions that work in the community. Programs that are operational and successful also need to be evaluated and disseminated in order to enable countries to generate their own programs tailored to tackling the changing nutritional problems of the children in their society.