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Regional Systematic Map to guide decision-making on the current landscape of research on World Health Assembly indicators in West Africa
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A new study by Transform Nutrition West Africa identifies the trends and gaps in research that cover the World Health Assembly indicators across West Africa. These are potentially valuable insights for nutrition decision makers in the region. This presentation is to be used as a freely accessible resource for decision-makers at all levels.
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Regional Systematic Map to guide decision-making on the current landscape of research on World Health Assembly indicators in West Africa
- The Current Landscape of Research on World Health Assembly Indicators in West Africa: A Systematic Map to Guide Decision-Making
- 2 The West Africa (WA) Region has been one of the slowest in reducing its many burdens of malnutrition. The World Health Assembly’s (WHA) 2025 nutrition targets were developed to track countries’ nutritional situations, and measure progress in reducing malnutrition. These indicators are therefore essential to guide decision making. Understanding the regional and in-country dynamics are an essential first step to highlight gaps and trends in evidence in the region. Introduction This study aimed to identify and catalogue peer-reviewed research on the WHA indicators in West Africa, and create a map of recent research evidence to inform decision-making for nutrition policies and programs in the region. Objective
- Search terms were developed to capture evidence on the prevalence, drivers, programs (Randomized Controlled Trials), and policies relating to the WHA indicators. These include stunting, wasting and overweight in children under 5, low birth weight (LBW), exclusive breastfeeding (EBF) up to 6 months, and anemia in women of reproductive age (WRA) Data were extracted at abstract level. No quality appraisal of publications was undertaken. A systematic approach was applied to literature searches, developing inclusion criteria, screening, coding, taxonomy, data extraction, and study synthesis The MEDLINE database was searched for research published on World Health Assembly (WHA) indicators from 2010 to April 2018 Methods
- References identified through systematic search (n=6,630) References excluded (n=2,581) - Not WA region (n=130) - Not target population (n=172) - Disease specific/not nutrition related (n=1729) - Nutrition related but not WHA specific (n=337) - Additional program studies (n=75) - RCT Protocol (n=9) - Other (n=129) Duplicates removed (n=3,669) References retrieved after title and abstract screening (n=380) - Primary studies (n=359) - Reviews (n=21) References retrieved for title and abstract screening (n=2,961) References included in mapping (n=363) Primary Studies (n=340) Reviews (n=23) Excluded at extraction level (n=17) Flow chart of search approach
- Results for West Africa
- Analysis General characteristics Characteristics of WHA indicators Characteristics of focus of research Results
- 21 39 4 12 10 86 5 5 5 15 18 147 14 8 2 1 Benin Burkina Faso Cape Verde Cote d'Ivoire Gambia Ghana Guinea Guinea- Bassau Liberia Mali Niger Nigeria Senegal Sierre Leone Togo WA region Number of publications per country
- Publications per year in four focal countries 0 2 4 6 8 10 12 14 16 18 20 22 24 26 2010 2011 2012 2013 2014 2015 2016 2017 Nrofpublications Nigeria Ghana Burkina Faso Senegal
- Publications by study setting 139 31 14 13 13 82 39 5 4 0 20 40 60 80 100 120 140 160 Not specified National District Village Community Hospital Health facility Primary health care centre Other Nr of publications
- 58 % 14 % 3% 23% 6% 1% 41% 10% 14% 2% Percent of publications per study design (n=340) Other Not specified Case-control Case series Cross-sectional Cohort Publications by study design Hierarchy of evidence
- Analysis General characteristics Characteristics of WHA indicators Characteristics of focus of research Results
- Publications per indicator category 0 20 40 60 80 100 120 140 160 180 200 Benin Burkina Faso Cape Verde Cote d'Ivoire Gambia Ghana Guinea Guinea- Bassau Liberia Mali Niger Nigeria Senegal Sierre Leone Togo WA Region Stunting Wasting LBW Overweight Anaemia EBF
- Publications per indicators category 40% 11% 21% 28% Percent of publications per WHA indicators (n=340) U5NS EBF Anaemia WRA More than 1 WHA indicator 15% 19% 61% 5% Breakdown of publications within U5NS (n=137) U5 Stunting U5 Wasting LBW U5 Overweight
- Analysis General characteristics Characteristics of WHA indicators Characteristics of focus of research Results
- Publications per focus of research in focal countries 20 77 138 8 18 8 4 1 4 7 11 5 0 20 40 60 80 100 120 140 160 180 Burkina Faso Ghana Nigeria Senegal Nrofpublications Policy Program Problem
- Publications per indicator category and focus of research 189 36 17 34 8 12 90 9 5 0 20 40 60 80 100 120 140 160 180 200 Problem Program Policy U5NS EBF Anaemia WRA
- Program studies by intervention type and outcome 19 4 7 8 3 6 5 1 1 2 0 2 4 6 8 10 12 14 16 18 20 U5NS EBF Anaemia Nrofpublications Supplementation Counseling/Health promotion Cash transfers Screening/Treatment Malaria Homestead food production WASH Antibiotic administration
- Key Messages Most publications report on the prevalence and drivers of World Health Assembly indicators, and very few on programs or policy. The majority of research publications report on under 5 nutritional status; within this, low birth weight is heavily reported on but very few report on under 5 overweight. The majority of the publications were identified through the search report on Anglophone countries. Supplementation is the most common program to address World Health Assembly indicators; followed by counseling/health promotion, and screening/treatment of malaria interventions.
Editor's Notes
- Note: Only primary studies are included in the analysis (n=340) 23 reviews have been recorded for use at a later stage
- Transform Nutrition West Africa operates at a regional level, with a special focus on 4 focal countries. These include; Burkina Faso, Ghana, Nigeria and Senegal.
- Note: Each bar in this graph includes publications that reports on one country only (eg. Burkina Faso), as well as publications that report on multiple countries (Burkina Faso and Nigeria and Ghana). We include all of these because we want to capture all evidence that incorporates that specific country (e.g. Burkina Faso). This is why the total is greater than 340 (the number of publications included in this study) because they may be counted twice if it reports on more than 1 country. There are 17 publications that report on more than 1 country Key Messages: Publications are not distributed evenly across the region The majority of publications identified through the search report on Anglophone countries (69%). The Francophone countries are represented in 25 percent of publications, and the Portuguese countries are only represented in one percent of the publications. Nigeria and Ghana represent 65% of the publications in the region.
- Note: This graph includes publications that report on one specific focal country only (e.g Burkina Faso), as well as publications that report on multiple countries, that include the focal country (e.g. Ghana, Burkina Faso and Nigeria). We include all of these because we want to capture all evidence that incorporates each focal country Key messages: Overall the volume of literature has increased over the years, with a decline in 2016 within the focal countries except for Burkina Faso which has increased instead and Senegal which has remained stationary. Ghana has seen the largest increase in volume of publications Nigeria maintains the highest number of publications overall
- Key messages: Most publications do not report the setting at abstract level (n=139). Of those that do, the majority were conducted within a health setting (hospital (n=82) and health facility (n=39)). Other studies specified the geographic coverage of the study including national coverage (31 publications) district coverage (14 publications), and village or community (13 publications each).
- Note: There are 23 systematic reviews identified in this search that have not been included in this analysis. The reviews (n=9) identified in this analysis are not systematic reviews, these are more general reviews relating to policy. Key messages Of the 340 studies included – 14% are experimental and 58% are observational in design (cross-sectional, cohort, case-control, case-series) (n=196) Experimental studies (Randomized control trial (RCT)) only account for 14% (n=47) The remaining are either not specified at abstract level or are of an alternative design Majority of studies are towards the bottom of the evidence pyramid in terms of evidence quality
- Note: Each bar in this graph includes publications that reports on one country only (eg. Burkina Faso), as well as publications that report on multiple countries (Burkina Faso and Nigeria and Ghana) We include all of these because we want to capture all evidence that incorporates that specific country (eg. Burkina Faso). Also, this graph includes publications reporting on one WHA indicator alone (Eg. EBF), as well as multi-indicator publications (eg. EBF and stunting). Therefore studies can be counted twice – Both in the EBF category and the stunting category. Key Messages: Stunting wasting and LBW represent the majority of studies Very few studies report on overweight
- Note: The left pie chart includes studies that report on one indicator only (eg. EBF only). Studies that report on more that one indicator have been brought together into the ‘more than 1 indicator’ category (n=93) The right side pie chart includes studies that report on single indicators only (eg. U5 Stunting). Studies reporting on more than one indicator (eg. Stunting and wasting) have not been included here. U5NS = Under 5 nutritional status grouping of indicators LBW, U5 stunting, U5 wasting, U5 overweight Key Messages: The majority of publications report on U5NS (n=137), followed by Anaemia WRA (n=72), and EBF (n=38). There are 93 publications that report in more than 1 indicator. Within U5NS there is an uneven breakdown between studies. The majority report on LBW (n=83) and very few on U5 overweight (n=7)
- Note: For each country, we included publications that report on specific countries only, as well as publications that report on multiple countries, that include the focal country. This graph includes publications reporting on one area of research only (eg. Policy) as well as multi-areas of research (eg. Policy and problem). Therefore can be counted twice. This is why the total for each country is greater than the number of publications for that country. Key messages: The majority of publications across the four focal countries report on the problem (n=243) (in terms of prevalence and drivers), and very few studies report on policy (n=27) or program (n=31). Burkina Faso has the most even breakdown of studies, and has the most amount of program publications in the region (n=18). Senegal only has 1 program publication.
- Note: This graph includes publications reporting on one indicator category alone (Eg. EBF), as well as multi-indicator publications (eg. EBF and U5 stunting). Therefore studies can be counted twice – Both in the EBF category and the U5NS category. Also, this graph includes publications reporting on one area of research only (eg. Policy) as well as multi-areas of research (eg. Policy and problem). Therefore can be counted twice. Key messages: U5NS has the highest number of publications across all focus of research categories. The highest volume of studies report on the problem (in terms of prevalence and drivers) across all indicator categories Although EBF has the fewest number of publications, it has the most even spread across all focus of research categories.
- Note: This graph includes programs studies that report one indicator category alone (eg. Anaemia WRA), and well as those that report on more than one indicator category (eg. Anaemia WRA and LBW). This is why the total is greater that 45 (the number of program publications identified). Key message: Supplementation is the most common program to address the under five nutrition status outcomes (n=19). There are 8 counseling/health promotion program publications to address EBF. Anemia WRA is generally addressed in two ways, mainly by screening/treatment Malaria (n=5) programs as well as supplementation programs (n=4).
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