Malnutrition is a condition in which a person's body has an imbalance of nutrients, whether a deficiency or excess (Setyoningsih, 2024). By 2022, stunting continues to decline last decade, with 148.1 million, or 22.3% percent of children under five years of age worldwide impacted in 2022 it is estimated that there will be 45 million children under five (6.8%) affected by wasting, of which 13.6 million (2.1%) suffer from severe wasting. More than three-quarters of all children with severe wasting lives in Asia, and another 22% live in Africa. There are about 37 million overweight children under five in the world, up almost 4 million since 2000 (W.H.O., 2023).

According to UNICEF's State of the World's Children report, malnutrition is the hidden cause of the disabilities that affect hundreds of millions of children globally (De & Chattopadhyay, 2019). Malnutrition in children under five can present in several forms, such as stunting, underweight, and wasting (with or without edema, formerly referred to as marasmus and kwashiorkor), which can ultimately lead to severe health consequences, including death (NB et al., 2017). To prevent and address malnutrition, several approaches, including community-based intervention, programs to increase food availability and quality, and supplemental feeding programs, have been developed (Achmad, 2023).

The community-based intervention focuses on four categories of community-based projects based on the implicit construction of community used by researchers: community as a setting, community as a target, community as an agent, and community as a resource (McLeroy et al., 2003). Target groups who are difficult to reach, including those who are socially disadvantaged or have health issues, can be reached through a community-based strategy without being stigmatised in daily life (Bader et al., 2023). Communities can serve as both agents of change and resources in health promotion efforts. When empowered, communities are capable of addressing health-related living conditions by adapting to various socio-economic and environmental challenges (Peters et al., 2022). This adaptability is crucial in regions where malnutrition is prevalent, as community engagement allows for the tailoring of interventions to meet local needs effectively (Chapman et al., 2024). Moreover, community-based interventions enable access to hard-to-reach groups, including those facing social disadvantages, by using inclusive approaches that enhance overall health outcomes (Bader et al., 2023).

As communities gain the capacity to modify and adapt to diverse health-related living conditions, they can significantly contribute to reaching this target group (Ehlen & Rehaag, 2018). Community-based interventions provide the capability of dealing with malnutrition and enhance health results for children under five years. However, understanding these interventions' content, implementation, and effectiveness still needs to be improved. So, further review is required regarding community-based interventions for malnutrition. This scoping review aimed to identify community-based interventions for malnutrition in children under five.

Authors identified peer-reviewed literature reporting unintentional community-based interventions for malnutrition in children under five Between February 2024 and July 2024. This scoping review used the framework Arksey and O' Malley (2005) and this scoping review, and there is no review or registration protocol carried out.

A comprehensive search strategy was applied to identify relevant studies. Three databases were systematically searched, yielding a total of 4846 articles. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, duplicate records (n = 469) were removed using reference management software (Mendeley). Next, the titles and abstracts of the remaining studies (n = 4377) were screened by independent reviewers to assess eligibility. Studies were included based on predetermined criteria, and 11 articles were selected based on title, abstract, and full-text suitability (Figure 1).

The included studies were published between 2014 and 2024 and conducted in Guatemala, India, Mexico, Zambia, Pakistan, Ecuador, Malawi, China, and Ethiopia. Table 1 provides a summary of the characteristic studies included in the scoping review. Table 1. Characteristic Studies (n=11).

The research results obtained various community-based interventions. Based on these results, there are five community-based interventions for malnutrition. First is health education, which covers topics such as nutrition, child feeding practices, the process of cooking and recommending food based on age and what children need, and Hepatitis B vaccination and vitamin A supplementation (Kang et al., 2017)(Liang et al., 2018)(Pavithra et al., 2019)(Roche et al., 2017)(Wang et al., 2017). The second community-based intervention is empowerment. Empowerment is conducted based on a socio-ecological model and empowerment for caregivers (Juarez et al., 2021)(Perdomo et al., 2019).

Third is supplementation, supplementation carryout out by additional complementary foods made from soybean (Wang et al., 2017). CMAM is also an intervention that can be conducted by female health workers (Hussain & Biswas, 2024)(Unknown Author, 2018). Screening and monitoring are divided into monitoring the program and children's health status. Monitoring programs are performed with audits and feedback for front-line workers (Juarez et al., 2021). Monitoring children's health status involves monitoring nutritional status and children's growth and development (Unknown Author, 2018). Other community-based interventions are home visits and group meetings conducted once every two weeks (Rockers et al., 2016)(Unknown Author, 2018).

Based on these results, there are five community-based interventions. Health education can conduct on the topic related to malnutrition (Kang et al., 2017)(Liang et al., 2018)(Pavithra et al., 2019)(Roche et al., 2017)(Wang et al., 2017). Health education can help mothers meet the needs of babies and toddlers, especially regarding nutrition (Prasetyo et al., 2023). The research results show that education through lectures, demonstrations, and brainstorming can increase mothers' knowledge about malnutrition prevention. The knowledge can increase because information from health education can be received and responded to well (Yunitasari et al., 2020). Increasing mothers' understanding of nutrition through education is intended to enhance eating habits. If mothers are able to exclusively breastfeed their children and successfully control the amount of nutrients they receive, including supplemental foods, then conditions like stunting, for example, can be prevented from an early age (Siagian & Ramschie, 2024). Numerous community groups have adopted health education programs to raise awareness of health-related topics, such as nutrition, breastfeeding, the advantages of obtaining health care, and adopting healthy dietary habits (Maizuputri et al., 2024)(Nwachan et al., 2024). Prior studies have demonstrated that gaining knowledge is a crucial first step toward altering one's behavior. Thus, having a basic understanding of nutrition is essential to developing healthy eating habits (Bidira et al., 2022). Focused education can help significantly change children's diets and feeding practices, although sustainability and consistent implementation still need to be overcome.

The results show that caregiver empowerment, especially the role of mothers or other family members, is crucial to the success of nutrition programs (Juarez et al., 2021). Through skills training and capacity building, caregivers can effectively manage children's nutrition, from food selection and preparation to implementing appropriate care practices (Juarez et al., 2021). Women's empowerment factors are essential in improving children's nutrition (Singh & Jha, 2024). Research conducted by (Singh & Jha, 2024) identified several significant predictors of malnutrition in children under five, including gender, higher birth order, lower levels of parental education, a poor wealth index, a mother's lack of access to a bank or savings account, and whether the household owns a mobile phone. Additionally, other research highlights that providing caregiver empowerment support is highly effective in enhancing mothers' capacity to care for their children's nutritional needs (p<0.05) (Umijati et al., 2021). It took six months to empower 13.2% of moms with a minimal knowledge score of 2.5 and 3.1 practice times, respectively-much longer than the counseling technique. Empowered mothers will be able to spot changes in their child's nutritional circumstances (Umijati et al., 2021).

The following factors in the socio-ecological model are correlated with detected malnutrition: family size, diversity, genetics, race, short mothers, breastfeeding status, low maternal education, and rural and urban settlements (Mahmudiono & Rosenkranz, 2019). (Perdomo et al., 2019) carried out caregiver empowerment based on socio-ecological models for four months, and its implementation contributed to an increase in several anthropometric indicators. Empowering caregivers through a socio-ecological approach can strengthen individual and family capacity in managing children's nutrition (Korom et al., 2023). Caregivers need comprehensive programs that will empower them to provide effective care to children (Tsabedze & Habedi, 2024). According by (Saadah et al., 2022), the maternal empowerment model in addressing malnutrition focuses on prevention and intervention, particularly through early detection training for stunting, with maternal commitment identified as the most significant factor. Interventions can become more relevant and sustainable by empowering caregivers and integrating them into nutrition-related decision-making. However, challenges in achieving active participation and full adoption of recommended nutrition practices remain obstacles that must be overcome.

The following intervention, nutritional supplementation, such as the use of additional food or nutritional supplements, has shown effectiveness in improving the nutritional status of children. In research by (Wang et al., 2017), providing soy-based complementary foods that contain a supplement called Yingyangbao can reduce stunting and underweight rates. The initiation of complementary breastfeeding from an early age significantly impacts a child's growth, development, and survival (Katepa-Bwalya et al., 2015). The use of supplementation as part of a nutritional intervention provides a significant additional boost to the nutritional status of children, especially in the context of chronic malnutrition. Nutritional supplements such as vitamins, minerals, or additional foods have been proven effective in reducing nutritional deficiencies and increasing child growth (Zhang et al., 2021). However, program sustainability, adequate availability of supplements, and compliance with their use are essential issues that must be managed well.

The World Health Organization (WHO) has recommended the community-based acute malnutrition management (CMAM) program to address acute malnutrition globally (Akuu & Amagnya, 2023). The four primary components of the CMAM program are community outreach programs, community-based management for children with uncomplicated SAM, hospital care for children with complicated SAM, and community-based management for children with mild acute malnutrition (Pati et al., 2018). A study by Maleta and Amadi (2014) conducted in Malawi, Ghana, and Zambia shows that CMAM has significantly expanded the scope of services, and treatment outcomes have improved, with cure rates ranging from 73% in Ghana to 90% in Malawi, while also achieving very low mortality rates.

Monitoring programs are performed with audits and feedback for front-line workers (Juarez et al., 2021). This is in line with (Viajar et al., 2022), which notes that as childhood malnutrition is still a major issue, particularly in developing nations, monitoring data is crucial for efficient management in health and nutrition programs. Consistent monitoring of children's growth, development, and nutritional status is crucial for preventing micronutrient deficiencies and malnutrition, including stunting, wasting, overweight, and obesity (Zsakai et al., 2023). Systematic and continuous monitoring of children's nutritional status is important to evaluating interventions' effectiveness and long-term impact (Scaglioni et al., 2022). Good monitoring allows early detection of needed program changes and provides a strong data basis for decision-making. However, resource challenges, adequate information technology, and health worker capacity may limit effective monitoring at the community level.

Other community-based interventions are home visits and group meetings (Rockers et al., 2016)(Unknown Author, 2018). Based on research by (Rahman et al., 2023), in comparison to carers of children who had not received a health worker visit, parents of children who had received one within the previous year before the follow-up survey were more likely to continue implementing nutritional diversity in their feeding practices. Carers exposed to visits from health workers had 1.57 times greater chances (AOR 1.57; 95% CI 1.14-2.17) of sustaining minimum recommended dietary patterns in feeding practices. Community events and group meetings are organized using activities such as games, discussions, celebrations, cooking demonstrations, and educational film showings. Events include baby shower celebrations, breastfeeding initiation ceremonies, and International Breastfeeding and Nutrition Week (Unknown Author, 2018).

This scoping review shows the role of community-based innovation in addressing child malnutrition. Approaches involving nutritional education, empowerment, supplementation, monitoring, and other interventions (home visits and group meetings) can improve children's nutritional and health status. Targeted nutrition education can increase understanding and good dietary practices, while caregiver empowerment strengthens family capacity in managing their children's nutrition. Nutritional supplementation significantly boosts a child's nutritional status, and appropriate monitoring allows early detection and effective intervention. This study emphasizes that community-based interventions that involve active community participation are more sustainable and prosperous. Recommendations for future program development include improving nutrition education and empowerment, providing adequate supplements, and an effective monitoring system to ensure the sustainability and effectiveness of community-based nutrition interventions.

The authors would like to express gratitude to the Library of Universitas Airlangga for providing access to various essential databases for this research.

Vira Amelia (V.A), Yuni Sufyanti Arief (Y.S.A) , Sylvia Dwi Wahyuni (S.D.W).

Vira Amelia (V.A), Yuni Sufyanti Arief (Y.S.A) , Sylvia Dwi Wahyuni (S.D.W). V.A.: Conceptualization, methodology, data collection, and manuscript writing. Y.S.A.: manuscript review, supervision and editing. S.D.W.: Supervision, critical review, and final approval of the manuscript.

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Ethical approval was not required as this study is a scoping review.

No data are available for this study.

The authors declare no conflict of interest.