scholarly journals Evaluation of an unconditional cash transfer program targeting children’s first-1,000–days linear growth in rural Togo: A cluster-randomized controlled trial

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003388
Author(s):  
Justine Briaux ◽  
Yves Martin-Prevel ◽  
Sophie Carles ◽  
Sonia Fortin ◽  
Yves Kameli ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Protective Effect ◽  
Linear Growth ◽  
Controlled Trial ◽  
Cash Transfer ◽  
Community Activities ◽  
Positive Effects ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
Unconditional Cash Transfer

Background In 2014, the government of Togo implemented a pilot unconditional cash transfer (UCT) program in rural villages that aimed at improving children’s nutrition, health, and protection. It combined monthly UCTs (approximately US$8.40 /month) with a package of community activities (including behavior change communication [BCC] sessions, home visits, and integrated community case management of childhood illnesses and acute malnutrition [ICCM-Nut]) delivered to mother–child pairs during the first “1,000 days” of life. We primarily investigated program impact at population level on children’s height-for-age z-scores (HAZs) and secondarily on stunting (HAZ < −2) and intermediary outcomes including household’s food insecurity, mother–child pairs’ diet and health, delivery in a health facility and low birth weight (LBW), women’s knowledge, and physical intimate partner violence (IPV). Methods and findings We implemented a parallel-cluster–randomized controlled trial, in which 162 villages were randomized into either an intervention arm (UCTs + package of community activities, n = 82) or a control arm (package of community activities only, n = 80). Two different representative samples of children aged 6–29 months and their mothers were surveyed in each arm, one before the intervention in 2014 (control: n = 1,301, intervention: n = 1,357), the other 2 years afterwards in 2016 (control: n = 996, intervention: n = 1,035). Difference-in-differences (DD) estimates of impact were calculated, adjusting for clustering. Children’s average age was 17.4 (± 0.24 SE) months in the control arm and 17.6 (± 0.19 SE) months in the intervention arm at baseline. UCTs had a protective effect on HAZ (DD = +0.25 z-scores, 95% confidence interval [CI]: 0.01–0.50, p = 0.039), which deteriorated in the control arm while remaining stable in the intervention arm, but had no impact on stunting (DD = −6.2 percentage points [pp], relative odds ratio [ROR]: 0.74, 95% CI: 0.51–1.06, p = 0.097). UCTs positively impacted both mothers’ and children’s (18–23 months) consumption of animal source foods (ASFs) (respectively, DD = +4.5 pp, ROR: 2.24, 95% CI: 1.09–4.61, p = 0.029 and DD = +9.1 pp, ROR: 2.65, 95% CI: 1.01–6.98, p = 0.048) and household food insecurity (DD = −10.7 pp, ROR: 0.63, 95% CI: 0.43–0.91, p = 0.016). UCTs did not impact on reported child morbidity 2 week’s prior to report (DD = −3.5 pp, ROR: 0.80, 95% CI: 0.56–1.14, p = 0.214) but reduced the financial barrier to seeking healthcare for sick children (DD = −26.4 pp, ROR: 0.23, 95% CI: 0.08–0.66, p = 0.006). Women who received cash had higher odds of delivering in a health facility (DD = +10.6 pp, ROR: 1.53, 95% CI: 1.10–2.13, p = 0.012) and lower odds of giving birth to babies with birth weights (BWs) <2,500 g (DD = −11.8, ROR: 0.29, 95% CI: 0.10–0.82, p = 0.020). Positive effects were also found on women’s knowledge (DD = +14.8, ROR: 1.86, 95% CI: 1.32–2.62, p < 0.001) and physical IPV (DD = −7.9 pp, ROR: 0.60, 95% CI: 0.36–0.99, p = 0.048). Study limitations included the short evaluation period (24 months) and the low coverage of UCTs, which might have reduced the program’s impact. Conclusions UCTs targeting the first “1,000 days” had a protective effect on child’s linear growth in rural areas of Togo. Their simultaneous positive effects on various immediate, underlying, and basic causes of malnutrition certainly contributed to this ultimate impact. The positive impacts observed on pregnancy- and birth-related outcomes call for further attention to the conception period in nutrition-sensitive programs. Trial registration ISRCTN Registry ISRCTN83330970.

scholarly journals Optimizing the efficiency and implementation of cash transfers to improve adherence to antiretroviral therapy: study protocol for a cluster randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Laura Packel ◽  
Prosper Njau ◽  
Carolyn Fahey ◽  
Angela Ramadhani ◽  
William H. Dow ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Viral Suppression ◽  
Controlled Trial ◽  
Cash Transfers ◽  
Cash Transfer ◽  
Hiv Care ◽  
Effective Strategy ◽  
Implementation Challenges ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Background Antiretroviral therapy (ART) for HIV, taken daily, is an effective strategy to clinically suppress the virus, providing the dual benefit of improved survival and vastly decreasing the risk of transmission. However, this highly effective intervention has not yet reached all who could benefit. Cash transfers are increasingly recognized as an effective strategy to motivate behavior change and improve HIV care and treatment outcomes, including engagement in HIV care and adherence to ART. Despite a growing evidence base and strong theoretical foundation for the cash transfer approach, key questions remain. To address these questions and begin to bridge the “know-do gap” with respect to cash transfers, our team is employing an implementation science approach to iterative development of an incentive-based intervention to promote ART uptake and adherence among people living with HIV (PLHIV) in the Lake Zone region, Tanzania. Methods We will conduct a type I hybrid implementation–effectiveness trial to test the effectiveness of a cash transfer intervention on the outcome of HIV viral suppression, and concurrently examine the potential for real-world implementation with a mobile health technology (mHealth) system. Specifically, our team will expand the intervention to 32 clinics and enroll 1984 PLHIV to (a) evaluate its effectiveness by conducting a cluster randomized controlled trial with clinics as the unit of randomization and 12-month viral suppression as the primary outcome and (b) evaluate the implementation challenges and successes at multiple levels (patient, provider, clinic). Discussion This trial will provide evidence not only about the real-world effectiveness of cash transfers for retention in HIV care and viral suppression, but also on the implementation challenges and successes that will facilitate or hinder wider scale-up within Tanzania and beyond. Trial registration ClinicalTrials.gov NCT04201353. Registered on December 17, 2019

scholarly journals Conditional cash transfer and/or lipid-based nutrient supplement targeting the first 1000 d of life increased attendance at preventive care services but did not improve linear growth in young children in rural Mali: results of a cluster-randomized controlled trial

2019 ◽  
Vol 110 (6) ◽  
pp. 1476-1490 ◽  
Author(s):  
Laura Adubra ◽  
Agnes Le Port ◽  
Yves Kameli ◽  
Sonia Fortin ◽  
Tanimoune Mahamadou ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Linear Growth ◽  
Controlled Trial ◽  
Conditional Cash Transfer ◽  
Cluster Randomized Controlled Trial ◽  
Growth Monitoring ◽  
Randomized Controlled ◽  
Nutrient Supplement ◽  
Intermediate Outcomes ◽  
Cluster Randomized

ABSTRACT Background In 2014, the World Food Programme added to an ongoing health and nutrition program named “Santé Nutritionnelle à Assise Communautaire dans la région de Kayes” (SNACK), the distribution of cash to mothers and/or lipid-based nutrient supplement (LNS) to children aged 6–23 mo, conditional upon attendance at community health centers (CHCs) during the first 1000 d of life. Objective We evaluated the additional impact of the distribution of cash and/or LNS on mean height-for-age z scores (HAZ; primary outcome), stunting (HAZ < −2), and on intermediate outcomes along the program impact pathways. Methods In a cluster-randomized controlled trial using a 2 × 2 factorial design, 76 CHCs were randomly assigned to deliver either SNACK, SNACK + Cash, SNACK + LNS, or SNACK + Cash + LNS. Cross-sectional surveys among 12- to 42-mo-old children and their mothers were conducted at baseline (2013, n = 5046) and at endline (2016, n = 5098). Results Factorial analysis showed no interaction between cash and LNS treatments for HAZ, but found an antagonistic interaction for stunting (OR: 1.55; 95% CI: 1.05, 2.31; P = 0.03). There were no impacts of the cash, LNS, or cash + LNS treatments, compared with the SNACK alone, on either HAZ or stunting (treatment × time interaction). There were significant impacts of the LNS and cash + LNS treatments on attendance at ≥1 growth monitoring (GM) session (OR: 3.95; 95% CI: 1.69, 9.24; OR: 3.90; 95% CI: 1.73, 8.81, respectively) and half the expected sessions (OR: 4.72; 95% CI: 1.47, 15.17; OR: 5.25; 95% CI: 1.82, 15.11, respectively), mothers’ knowledge on importance of GM (OR: 1.98; 95% CI: 1.16, 3.39; OR: 3.12; 95% CI: 1.60, 6.09, respectively), and, only for the LNS group, appropriate timing for complementary feeding (OR: 1.62; 95% CI: 1.09, 2.41). Conclusions Implementation constraints and suboptimal participation in program activities may explain the lack of impact on child linear growth in this rural region of Mali. This trial was registered at www.isrctn.com as ISRCTN08435964.

scholarly journals Supplementation with Fortified Lipid-Based and Blended Complementary Foods has Variable Impact on Body Composition Among Rural Bangladeshi Children: A Cluster-Randomized Controlled Trial

2020 ◽  
Vol 150 (7) ◽  
pp. 1924-1932 ◽  
Author(s):  
Saijuddin Shaikh ◽  
Rebecca K Campbell ◽  
Sucheta Mehra ◽  
Alamgir Kabir ◽  
Kerry J Schulze ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Body Composition ◽  
Linear Growth ◽  
Controlled Trial ◽  
Food Supplements ◽  
Cluster Randomized Controlled Trial ◽  
Complementary Food ◽  
Food Supplementation ◽  
Randomized Controlled ◽  
Cluster Randomized

ABSTRACT Background Complementary food supplementation enhances linear growth and may affect body composition in children. Objective We aimed to determine the effect of complementary food supplements provided from the age of 6 to 18 mo on fat-free mass (FFM) and fat mass (FM) gain among children in rural Bangladesh. Methods In an unblinded, cluster-randomized, controlled trial we tested the effects of 4 complementary food supplements for 1 y [chickpea, rice lentil, Plumpy'doz, and wheat-soy-blend++ (WSB++)] compared with no supplements on linear growth. Body composition was estimated using weight-length-based, age- and sex-specific equations at 6, 9, 12, 15, and 18 mo and postintervention aged 24 mo. Generalized estimating equations (GEEs) were applied to estimate the effect of each complementary food on mean FFM and FM from 9 to 18 and 24 mo compared with the control, adjusting for baseline measures. Sex interactions were also explored. Results In total, 3592 (65.9% of enrolled) children completed all anthropometric assessments. Estimated FFM and FM (mean ± SD) were 5.3 ± 0.6 kg and 1.4 ± 0.4 kg, respectively, at the age of 6 mo. Mean ± SE FFM and FM from 9 to 18 mo were 75.4 ± 14.0 g and 32.9 ± 7.1 g, and 61.0 ± 16.6 g and 30.0 ± 8.4 g, higher with Plumpy'doz and chickpea foods, respectively, than the control (P &lt; 0.001). Estimated FFM was 41.5 ± 16.6 g higher in rice-lentil-fed versus control (P &lt; 0.05) children. WSB++ had no impact on FFM or FM. A group-sex interaction (P &lt; 0.1) was apparent with Plumpy'doz and rice-lentil foods, with girls involved in the intervention having higher estimated FFM and FM than control girls compared with no significant effect in boys. At 24 mo, FFM and FM remained higher only in girls eating Plumpy'doz compared with the controls (P &lt; 0.01). Conclusions In this randomized trial, supplementation effected small shifts in apparent body composition in rural Bangladeshi children. Where seen, FFM increments were twice that of FM, in proportion to these compartments, and more pronounced in girls. FFM increased in line with reported improvements in length. This trial was registered at clinicaltrials.gov as NCT01562379.

scholarly journals The Effect of Eggs on Growth Among Infants 6–12 months of Age in Rural Bangladesh: A Cluster Randomized Controlled Trial

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 885-885
Author(s):  
Monica Pasqualino ◽  
Saijuddin Shaikh ◽  
Md Iqbal Hossain ◽  
Md Tanvir Islam ◽  
Hasmot Ali ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Nutrition Education ◽  
Regression Models ◽  
Linear Growth ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Rural Bangladesh ◽  
Randomized Controlled ◽  
Z Scores ◽  
Cluster Randomized

Abstract Objectives To assess the impact of daily egg supplementation on infant growth from 6–12 months of age in Bangladesh. Methods A cluster randomized controlled trial was conducted in rural Bangladesh to test the effect of daily egg supplementation and nutrition education versus nutrition education alone on linear growth and stunting prevalence among infants. Infants were enrolled at 3 months of age and assigned to a trial arm based on their geographic sector of residence. Households were visited weekly to distribute eggs and monitor compliance starting at 6 months of age. Length, weight, head circumference, and mid upper arm circumference were measured at 6, 9, and 12 months, as well as dietary intake from home foods in the last 24 hours. Analyses were conducted on an intention-to-treat basis. Linear regression models were developed for continuous outcomes. For dichotomous outcomes, prevalence ratios were estimated using log-binomial regression models. Generalized estimating equations were used with all models to account for clustering. Each model was adjusted for the baseline measure of the outcome variable. Results Overall, 909 infants were enrolled in the treatment arm from 142 clusters and 842 infants in the control arm from 140 clusters. Prevalence of stunting at baseline was 19.4%, wasting was 6.7%, and underweight was 18.1%. After 6 months of supplementation, the intervention had no effect on mean length-for-age z-scores (β = 0.05, 95% CI: −0.12, 0.23) or prevalence of stunting (PR = 1.00, 95% CI: 0.90, 1.10). Infants in the egg arm had significantly higher mean weight-for-length z-scores (β = 0.11, 95% CI: 0.04, 0.18) and weight-for-age z-scores (β = 0.08, 95% CI: 0.03, 0.12), adjusting for baseline measures of the outcomes. Our presented results will include findings from mixed-effects regression analyses assessing the effect of the intervention on growth rate. Conclusions The provision of a daily egg for 6 months to infants in rural Bangladesh had an effect on ponderal but not linear growth. Funding Sources Bill and Melinda Gates Foundation.

Sign in / Sign up

Export Citation Format

Share Document