Measuring Cocoverage in Global Health and Nutrition Interventions: A Scoping Review of Analytical Approaches

Multisectoral nutrition (MSN) approaches coordinate interventions across sectors, such as health, agriculture, education, and social protection, to improve nutrition outcomes and have gained prominence in low- and middle-income countries (LMICs). Measuring cocoverage-the clustering of multiple interventions at the individual and household level-remains uncommon yet offers a viable method for tracking MSN intervention coverage. This scoping review examined existing analytic approaches and applications for assessing the cocoverage of health and nutrition interventions. We searched Web of Science Core Collection, PubMed, and EBSCOhost for studies that used, described, or developed cocoverage methods to measure nutrition- and health-related intervention coverage. Titles and abstracts were screened by 2 independent reviewers using Covidence, followed by full-text screening based on predefined criteria. Screening 4478 abstracts yielded 73 eligible studies applying 8 distinct methods to quantify cocoverage across health and nutrition interventions. Most studies were observational (90%) and conducted in LMICs, particularly sub-Saharan Africa and South Asia, with publications increasing over the past decade. Data were primarily drawn from surveys (93%), particularly Demographic and Health Surveys (41 studies). Commonly included individual-level interventions in cocoverage indices were antenatal care (ANC, 66 studies) or ANC components, child immunizations (48 studies), and skilled birth attendance (42 studies). Evidence on measuring a range of multisectoral interventions at the household level was limited. Intervention selection was often guided by established frameworks or guidelines. Coverage indices were calculated using simple counts, weighted averages, and scoring systems. Although 18 studies validated their indices through methods such as Cohen's κ and sensitivity analyses, most relied on previously used approaches without specific validation. These findings underscore the considerable variability in cocoverage methodologies and the need for greater harmonization and validation to enable consistent monitoring of multisectoral nutrition progress.