Laparoscopy (lap-uh-ROS-kuh-pee): A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.
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For this comprehensive narrative review, we evaluated both nutrition-specific and nutrition-sensitive interventions. Nutrition-specific approaches are those that address the immediate determinants of nutrition (e.g., food and nutrient intake, diet-related practices and behaviors, disease, etc.), whereas nutrition-sensitive approaches are those that address the underlying determinants of nutrition (e.g., food security, access to resources, safe and hygienic environments, adequate health services, etc.) (5, 12). We evaluated the following nutrition-specific interventions described by Bhutta et al. (13, 14): nutrition counseling and education, micronutrient supplementation and fortification, protein and energy supplementation, and lipid-based supplementation. We also included the following nutrition-sensitive approaches described by Ruel and Alderman (5) and Bhutta et al. (14): health care; family planning; water, sanitation, and hygiene (WASH); empowerment; income-generation; education; and social protection. For each intervention, we 1) described the scale and coverage of the intervention, when available; 2) summarized the evidence of effectiveness for women's health and nutrition outcomes; and 3) described and evaluated the target population and delivery platforms, as described in the published articles and as summarized in Table 1. The delivery of interventions included the physical platforms, as well as the adherence and the implementation challenges of the different interventions.
“The more colorful the vegetables — and fruits — the more nutrients you’re going to get in your diet,” says Hincman. And green leafy veggies, like turnip, collard and mustard greens, kale, Chinese cabbage, and spinach, all rich sources of vitamins and minerals, are a great place to start. Many are also a good source of iron, important for women’s health, especially after menopause. One serving of cooked leafy greens — a half a cup — is not a lot, considering that just around two and one half cups of veggies, or five servings in total, is all you need each day.
Our findings identified gaps and limitations in the evaluation, scope, targeting, and delivery platforms of nutrition interventions in low- and middle-income countries. First, the monitoring and evaluation of nutrition programs that reported on women's nutrition outcomes was generally inadequate. Many of the studies we identified included small-scale efficacy trials. Although there were many large-scale programs that targeted women and adolescent girls with nutrition-specific and nutrition-sensitive approaches, they lacked rigorous evaluation. Whether the evidence about women's outcomes was limited because they are not systematically measured or because they are not well reported is not clear. Negative results are often not published, and many evaluations of nutrition interventions that are conducted by the same groups responsible for implementing them are typically presented positively. This may have also skewed our findings. More intentional research-quality program evaluation, including of large-scale programs, would provide a stronger evidence base. Of the studies identified in this review, many reported on short-term findings such as changes in knowledge, dietary behaviors, and program coverage. They were limited in their ability to report clinical and anthropometric outcomes for women, the duration of those outcomes, and the feasibility of scaling up programs. There is also a need for systematic, long-term evaluations of interventions whose effects on nutrition outcomes are more distal (e.g., nutrition education compared with micronutrient supplementation). The effects of multisectoral interventions are even more complex to measure. However, frameworks exist to evaluate complex interventions (102) and could be utilized to evaluate the impact of interventions across the life course.
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