Wealth differentials in the impact of conditional and unconditional cash transfers on education: findings from a community-randomised controlled trial in Zimbabwe Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial Effects of cash transfers on Children’s health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya. Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia. The impact of cash transfers on social determinants of health and health inequalities in Sub-Saharan Africa: a systematic review protocol Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades The impact of Mexico's conditional cash transfer programme, Oportunidades, on birthweight. Unconditional government social cash transfer in Africa does not increase fertility Mexico's conditional cash transfer programme increases cesarean section rates among the rural poor. Paying for Happiness: Experimental Results from a Large Cash Transfer Program in Malawi Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries The impact of Zambia’s unconditional child grant on schooling and work: results from a large-scale social experiment Cash for Women’s Empowerment? A Mixed-Methods Evaluation of the Government of Zambia’s Child Grant Program A systematic review of online interventions for mental health in low and middle income countries: a neglected field Does money buy happiness? Evidence from an unconditional cash transfer in Zambia Conditional Cash Transfers And Health Of Low-Income Families In The US: Evaluating The Family Rewards Experiment. Empowering women to obtain high quality care: evidence from an evaluation of Mexico's conditional cash transfer programme. mHealth Interventions in Low and Middle-Income Countries: A Systematic Review Impact of the Kenya Cash Transfer for Orphans and Vulnerable Children on early pregnancy and marriage of adolescent girls. Cash component of conditional cash transfer program is associated with higher body mass index and blood pressure in adults. Effect of Ecuador's cash transfer program (Bono de Desarrollo Humano) on child development in infants and toddlers: a randomized effectiveness trial. Interventions for domestic violence among pregnant women in low- and middle-income countries: a systematic review protocol
Abstract We investigated ( 1 ) how household wealth affected the relationship between conditional cash transfers ( CCT ) and unconditional cash transfers ( UCT ) and school attendance , ( 2 ) whether CCT and UCT affected educational outcomes ( repeating a year of school ) , ( 3 ) if baseline school attendance and transfer conditions affected how much of the transfers participants spent on education and ( 4 ) if CCT or UCT reduced child labour in recipient households . Data were analysed from a cluster-r and omized controlled trial of  CCT and UCT in 4043 households from 2009 to 2010 . Recipient households received $ 18 dollars per month plus $ 4 per child . CCT were conditioned on above 80 % school attendance , a full vaccination record and a birth certificate . In the poorest quintile , the odds ratio of above 80 % school attendance at follow-up for those with below 80 % school attendance at baseline was 1.06 ( p = .67 ) for UCT vs. CCT . UCT recipients reported spending slightly more ( 46.1 % ( 45.4–46.7 ) ) of the transfer on school expenses than did CCT recipients ( 44.8 % ( 44.1–45.5 ) ) . Amongst those with baseline school attendance of below 80 % , there was no statistically significant difference between CCT and UCT participants in the proportion of the transfer spent on school expenses ( p = .63 ) . Amongst those with above 80 % baseline school attendance , CCT participants spent 3.5 % less ( p = .001 ) on school expenses than UCT participants . UCT participants were no less likely than those in the control group to repeat a grade of school .  CCT participants had .69 ( .60–.79 ) lower odds vs. control of repeating the previous school grade . Children in CCT recipient households spent an average of .31 fewer hours in paid work than those in the control group ( p < .001 ) and children in the UCT arm spent an average of .15 fewer hours in paid work each week than those in the control arm ( p = .06 ) Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children , but few studies have rigorously assessed their effectiveness in sub-Saharan Africa . We investigated the effects of unconditional cash transfers ( UCTs ) and conditional cash transfers ( CCTs ) on birth registration , vaccination uptake , and school attendance in children in Zimbabwe . Methods We did a matched , cluster-r and omised controlled trial in ten sites in Manical and , Zimbabwe . We divided each study site into three clusters . After a baseline survey between July , and September , 2009 , clusters in each site were r and omly assigned to UCT , CCT , or control , by drawing of lots from a hat . Eligible households contained children younger than 18 years and satisfied at least one other criteria : head of household was younger than 18 years ; household cared for at least one orphan younger than 18 years , a disabled person , or an individual who was chronically ill ; or household was in poorest wealth quintile . Between January , 2010 , and January , 2011 , households in UCT clusters collected payments every 2 months . Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing . Eligible households in all clusters , including control clusters , had access to parenting skills classes and received maize seed and fertiliser in December , 2009 , and August , 2010 . Households and individuals delivering the intervention were not masked , but data analysts were . The primary endpoints were proportion of children younger than 5 years with a birth certificate , proportion younger than 5 years with up-to- date vaccinations , and proportion aged 6–12 years attending school at least 80 % of the time . This trial is registered with Clinical Trials.gov , number NCT00966849 . Findings 1199 eligible households were allocated to the control group , 1525 to the UCT group , and 1319 to the CCT group . Compared with control clusters , the proportion of children aged 0–4 years with birth certificates had increased by 1·5 % ( 95 % CI −7·1 to 10·1 ) in the UCT group and by 16·4 % ( 7·8–25·0 ) in the CCT group by the end of the intervention period . The proportions of children aged 0–4 years with complete vaccination records was 3·1 % ( −3·8 to 9·9 ) greater in the UCT group and 1·8 % ( −5·0 to 8·7 ) greater in the CCT group than in the control group . The proportions of children aged 6–12 years who attended school at least 80 % of the time was 7·2 % ( 0·8–13·7 ) higher in the UCT group and 7·6 % ( 1·2–14·1 ) in the CCT group than in the control group . Interpretation Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa , but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region . Funding Wellcome Trust , the World Bank through the Partnership for Child Development , and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children Background Unconditional and conditional cash transfer programmes ( UCT and CCT ) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS ( OVC ) . We address the gap in current underst and ing about the extent to which household-based cash transfers differentially impact individual children ’s outcomes , according to risk or protective factors such as orphan status and household assets . Methods Data were obtained from a cluster-r and omised controlled trial in eastern Zimbabwe , with r and om assignment to three study arms – UCT , CCT or control . The sample included 5,331 children ages 6 - 17 from 1,697 households . Generalized linear mixed models were specified to predict OVC health vulnerability ( child chronic illness and disability ) and social protection ( birth registration and 90 % school attendance ) . Models included child-level risk factors ( age , orphan status ) ; household risk factors ( adults with chronic illnesses and disabilities , greater household size ) ; and household protective factors ( including asset-holding ) . Interactions were systematic ally tested . Results Orphan status was associated with decreased likelihood for birth registration , and paternal orphans and children for whom both parents ’ survival status was unknown were less likely to attend school . In the UCT arm , paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans . Effects of study arms on outcomes were not moderated by any other risk or protective factors . High household asset-holding was associated with decreased likelihood of child ’s chronic illness and increased birth registration and school attendance , but household assets did not moderate the effects of cash transfers on risk or protective factors . Conclusion Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based setting s. UCT and CCT each produced direct effects on children ’s social protection which are not moderated by other child- and household-level risk factors , but orphans are less likely to attend school or obtain birth registration . The effects of UCT and CCT are not moderated by asset-holding , but greater household assets predict greater social protection outcomes . Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children . These efforts might include caregiver education , and additional incentives based on efforts made specifically for orphaned children PURPOSE This study investigates the causal effect of Kenya 's  unconditional cash transfer program on  mental health outcomes of young people . METHODS Selected locations in Kenya were r and omly assigned to receive unconditional cash transfers  in the first phase of Kenya 's Cash Transfer Program for orphans and Vulnerable Children . In intervention locations , low-income households and those with orphans and vulnerable childrens began receiving monthly cash transfers of $ 20 in 2007 . In 2011 , 4 years after program onset , data were collected on the psychosocial status for youth aged 15 - 24 years from households in intervention and control locations ( N = 1960 ) . The primary outcome variable was an indicator of depressive symptoms using the 10- question Center for Epidemiologic Studies Depression Scale . Secondary outcomes include an indicator for hopefulness and physical health measures . Logistic regression models that adjusted for individual and household characteristics were used to determine the effect of the cash transfer program . RESULTS The cash transfer reduced the odds of depressive symptoms by 24 percent among young persons living in households that received cash transfers . Further analysis by gender and age revealed that the effects were only significant for young men and were larger among men aged 20 - 24 years and orphans . CONCLUSIONS This study provides evidence that poverty-targeted unconditional cash transfer programs , can improve the mental health of young people in low-income countries There is promising recent evidence that poverty-targeted social cash transfers have potential to improve maternal health outcomes ; however , questions remain surrounding design features responsible for impacts . In addition , virtually no evidence exists from the African region . This study explores the impact of Zambia 's Child Grant Program  on a range of maternal health utilization outcomes using a r and omized design and difference-in-differences multivariate regression from data collected over 24 months from 2010 to 2012 . Results indicate that while there are no measurable program impacts among the main sample , there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services . The latter result is particularly interesting because of the overall low level of health care availability in program areas suggesting that dedicated program design or matching supply-side interventions may be necessary to leverage unconditional cash transfers in similar setting s to impact maternal health Background There is increasing pressure to address the social determinants of health ( SDoH ) and health inequities through the implementation of culturally acceptable interventions particularly in Sub-Saharan Africa ( SSA ) where health outcomes are generally poor . Available evaluation research on cash transfers ( CTs ) suggests that the programs may influence the wider determinants of health in SSA ; yet , there has been no attempt to synthesize the evidence regarding their contribution to tackling the SDoH and health inequalities . To date , nearly all the review s on CTs ' impact on health have predominantly featured evidence from Latin America with limited transferability to the social , cultural , and political environments in SSA . Therefore , the aim of this study is to undertake a systematic review to assess the role of CTs in tackling the wider determinants of health and health inequalities in SSA . Methods / design A systematic review of published and unpublished literature on CTs ’ impact on health and health determinants covering the period 2000–2016 will be undertaken . Studies will be considered for inclusion if they present quantitative or qualitative data , including all relevant study design s. The SDoH conceptual framework will be used to guide the data extraction process . EPPI Review er software will be used for data management and analysis . Studies included in the review will be analyzed by narrative synthesis and /or meta- analysis as appropriate for the nature of the data retrieved . Discussion This review will provide empirical evidence on the impact of CTs on SDoH to inform CT policy , implementation , and research in SSA . The protocol follows the Preferred Reporting Items for Systematic Review and Meta- Analysis Protocol s ( PRISMA -P ) . Systematic review registration This protocol has been registered with the PROSPERO international prospect i ve register of systematic review s , reference CRD42015025015 BACKGROUND Many governments have implemented conditional cash transfer ( CCT ) programmes with the goal of improving options for poor families through interventions in health , nutrition , and education . Families enrolled in CCT programmes  receive cash in exchange for complying with certain conditions : preventive health requirements and nutrition supplementation , education , and monitoring design ed to improve health outcomes and promote positive behaviour change . Our aim was to disaggregate the effects of cash transfer from those of other programme components . METHODS In an intervention that began in 1998 in Mexico , low-income communities ( n=506 ) were r and omly assigned to be enrolled in a CCT programme  ( Oportunidades , formerly Progresa ) immediately or 18 months later . In 2003 , children ( n=2449 ) aged 24 - 68 months who had been enrolled in the programme their entire lives were assessed for a wide variety of outcomes . We used linear and logistic regression to determine the effect size for each outcome that is associated with a doubling of cash transfers while controlling for a wide range of covariates , including measures of household socioeconomic status . FINDINGS A doubling of cash transfers was associated with higher height-for-age Z score ( beta 0.20 , 95 % CI 0.09 - 0.30 ; p<0.0001 ) , lower prevalence of stunting ( -0.10 , -0.16 to -0.05 ; p<0.0001 ) , lower body-mass index for age percentile ( -2.85 , -5.54 to -0.15 ; p=0.04 ) , and lower prevalence of being overweight ( -0.08 , -0.13 to -0.03 ; p=0.001 ) . A doubling of cash transfers was also associated with children doing better on a scale of motor development , three scales of cognitive development , and with receptive language . INTERPRETATION Our results suggest that the cash transfer component of Oportunidades is associated with better outcomes in child health , growth , and development OBJECTIVES To evaluate the impact of Oportunidades , a large-scale , conditional cash transfer programme in Mexico , on  birthweight .  The programme provides cash transfers to low-income , rural households in Mexico , conditional on accepting nutritional supplements health education , and health care . METHODS The primary analyses used retrospective reports from 840 women in poor rural communities participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states . Pregnant women in participating households received nutrition supplements and health care , and accepted cash transfers . Using multivariate and instrumental variable analyses , we estimated the impact of the programme on birthweight in grams and low birthweight ( < 2500 g ) , receipt of any pre-natal care , and number of pre-natal visits . RESULTS Oportunidades beneficiary status was associated with 127.3 g higher birthweight among participating women and a 4.6 percentage point reduction in low birthweight . CONCLUSION The Oportunidades conditional cash transfer programme improved birthweight outcomes . This finding is relevant to countries implementing conditional cash transfer programmes Among policymakers , a common perception surrounding the effects of cash transfer programmes , particularly unconditional programmes targeted to families with children , is that they induce increased fertility . We evaluate the Zambian Child Grant Programme  , a government unconditional cash transfer targeted to families with a child under the age of 5 and examine impacts on fertility and household composition . The evaluation was a cluster r and omized control trial , with data collected over 4 years from 2010 to 2014 . Our results indicate that there are no programme impacts on overall fertility . Our results contribute to a small evidence base demonstrating that there are no unintended incentives related to fertility due to cash transfers BACKGROUND Caesarean section rates are increasing in Mexico and Latin America . This study evaluates the impact of a large-scale , conditional cash transfer programme in Mexico on caesarean section rates . The programme provides cash transfers to participating low income , rural households in Mexico conditional on accepting health care and nutrition supplements . METHODS The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states . Using multivariate and instrumental variable analyses , we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting . Programme participation is measured by beneficiary status , programme months and cash transfers . RESULTS More than two-thirds of poor rural women delivered in a health facility . Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates ; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for > or=6 months before delivery . Beneficiaries had significantly higher caesarean delivery rates in social security facilities ( 24.0 compared with 5.6 % among non-beneficiaries ) and in other government facilities ( 19.3 compared with 9.5 % ) . CONCLUSION The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities . This effect appears to be driven by the increases in disposable income from the cash transfer . These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements Abstract This study analyzes the short‐term impact of an exogenous , positive income shock on  caregivers ’ subjective well‐being ( SWB ) in Malawi using panel data from 3,365 households targeted to receive Malawi 's Social Cash Transfer Program that provides unconditional cash to ultra‐poor , labor‐constrained households . The study consists of a cluster‐r and omized , longitudinal design . After the baseline survey , half of these village clusters were r and omly selected to receive the transfer and a follow‐up was conducted 17 months later . We find that the short‐term impact of household income increases from the cash transfer leads to substantial SWB gains among caregivers . After a year 's worth of transfers , caregivers in beneficiary households have higher life satisfaction and are more likely to believe in a better future . We examine whether program impacts on consumption , food security , resilience , and hopefulness could explain the increase in SWB but do not find that any of these mechanisms individually mediate our results People living with HIV ( PLWH ) experience greater psychological distress than the general population . Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms , quality of life , and HIV care engagement . However , little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries ( LMICs ) , where the large majority of PLWH reside . This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these setting s. A systematic search strategy was undertaken to identify peer- review ed published papers of intervention trials addressing negative psychological states or disorders ( e.g. depression , anxiety ) among PLWH in LMIC setting s. Search results were assessed against pre-established inclusion and exclusion criteria . Data from papers meeting criteria were extracted for synthesis . Twenty-six papers , published between 2000 and 2014 , describing 22 unique interventions were identified . Trials were implemented in sub-Saharan Africa ( n = 13 ) , Asia ( n = 7 ) , and the Middle East ( n = 2 ) , and addressed mental health using a variety of approaches , including cognitive-behavioral ( n = 18 ) , family-level ( n = 2 ) , and pharmacological ( n = 2 ) treatments . Four r and omized controlled trials reported significant intervention effects in mental health outcomes , and 11 preliminary studies demonstrated promising findings . Among the limited mental health intervention trials with PLWH in LMICs , few demonstrated efficacy .  Mental health interventions for PLWH in LMICs must be further developed and adapted for re source -limited setting s to improve effectiveness ABSTRACT This article reports on the impact on child schooling and work of the Government of Zambia ’s Child Grant Program ( CGP ) , an unconditional cash transfer programme targeted to households with children under age 3 years in three districts of the country . Although the CGP ’s focus is on very young children , we look to see if the programme has impacts on older children who are not the explicit target group . We use data from a large-scale social experiment involving 2519 households , half of whom were r and omised out to a delayed-entry control group , that was implemented to assess the impact of the programme . We find that the CGP has no discernible impact on school enrolment of children age 7–14 . However , when we break the sample by older ( 11–14 ) and younger ( 7–10 ) children – based on the grade structure of the Zambian schooling system – we find a significant impact among children age 11–14 , which coincides with the exact age range where a sharp drop-out begins to occur in Zambia with point estimates in the range of 7–8 percentage points . Finally , we provide evidence on the potential pathways through which the unconditional cash transfer impacts on enrolment . Households in the CGP spend more on education , and in particular on uniforms and shoes , two items cited as key barriers to school enrolment in study areas Summary . — The empowerment of women , broadly defined , is an often-cited objective and benefit of social cash transfer programs in developing countries . Despite the promise and potential of cash transfers to empower women , the evidence supporting this outcome is mixed . In addition , there is little evidence from programs at scale in sub-Saharan Africa . We conducted a mixed- methods evaluation of the Government of Zambia ’s Child Grant Program , a poverty-targeted , unconditional transfer given to mothers or primary caregivers of young children aged zero to five . The quantitative component was a four-year longitudinal clustered-r and omized control trial in three rural districts , and the qualitative component was a one-time data collection involving in-depth interviews with women and their partners stratified on marital status and program participation . Our study found that women in beneficiary households were making more sole or joint decisions ( across five out of nine domains ) ; however , impacts translated into relatively modest increases in the number of decision domains a woman is involved in , on average by 0.34 ( or a 6 % increase over a baseline mean of 5.3 ) . Qualitatively , we found that changes in intrahousehold relationships were limited by entrenched gender norms , which indicate men as heads of household and primary decision makers . However , women ’s narratives showed the transfer increased financial empowerment as they were able to retain control over transfers for household investment and savings for emergencies . We highlight method ological challenges in using intrahousehold decision making as the primary indicator to measure empowerment . Results show potential for unconditional cash transfer programs to improve the financial and intrahousehold status of female beneficiaries , however it is likely additional design components are need for transformational change Background . Low and middle income countries ( LMICs ) are facing an increase of the impact of mental health problems while confronted with limited re sources and limited access to mental health care , known as the ‘ mental health gap ’ . One strategy to reduce the mental health gap would be to utilize the internet to provide more widely-distributed and low cost mental health care . We undertook this systematic review to investigate the effectiveness and efficacy of online interventions in LMICs . Methods . We systematic ally search ed the data -bases PubMed , PsycINFO , JMIR , and additional sources . MeSH terms , Thesaurus , and free text keywords were used . We included all r and omized controlled trials ( RCTs ) of online interventions in LMICs . Results . We found only three articles reported results of RCTs on  online interventions for mental health conditions in LMICs , but none of these interventions was compared with an active control condition . Also , the mental health conditions were diverse across the three studies . Conclusions . There is a dearth of studies examining the effect of online interventions  in LMICs , so we can not draw a firm conclusion on its effectiveness . However , given the effectiveness of  online interventions in high income countries and sharp increase of internet access in LMICs , online interventions may offer a potential to help reduce the ‘ mental health gap ’ . More studies are urgently needed in LMICs The relationship between happiness and income has been at the center of a vibrant debate , with both intrinsic and instrumental importance , as emotional states are an important determinant of health and social behavior . We investigate whether a government-run unconditional cash transfer paid directly to women in poor households had an impact on self-reported happiness . The evaluation was design ed as a cluster-r and omized controlled trial in rural Zambia across 90 communities . The program led to a 7.5 to 10 percentage point impact on women ’s happiness after 36- and 48-months , respectively ( or 0.19–0.25 st and ard deviations over the control group mean ) . In addition , women have higher overall satisfaction regarding their young children ’s well-being , including indicators of satisfaction with their children ’s health and positive outlook on their children ’s future . Complementary analysis suggests that self-assessed relative poverty ( as measured by comparison to other households in the community ) is a more important mediator of program effects on happiness than absolute poverty ( as measured by household consumption expenditures ) . Although typically not the focus of such evaluations , impacts on psychosocial indicators , including happiness , should not be discounted as important outcomes , as they capture different , non- material , holistic aspects of an individual ’s overall level of well-being Opportunity  NYC-Family Rewards was the first conditional cash transfer , r and omized controlled trial for low-income families in the United States . From 2007 to 2010 , Family Rewards offered 2,377 New York City families cash transfers  that were conditional upon their investments in education , preventive health care , and parental employment . Their health and other outcomes were compared to those of a  control group of 2,372 families . The experiment led to a modest improvement in health insurance coverage and a large increase in the use of preventive dental care . It improved parents ' perception of their own health and levels of hope , mainly through improvements in reported financial well-being . While the program 's impacts on physical health were weaker , our study might not have captured effects on chronic disease risk that take longer to accrue . In the context of New York City 's operating social-safety-net programs , conditional cash transfers may have led to positive , albeit modest , improvements in the health of poor families OBJECTIVES To evaluate the impact of Mexico 's conditional cash transfer programme on the quality of health care received by poor women . Quality is measured by maternal reports of prenatal care procedures received that correspond with clinical guidelines . METHODS The data describe retrospective reports of care received from 892 women in poor rural communities in seven Mexican states . The women were participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 . Eligible women accepted cash transfers conditional on obtaining health care and nutritional supplements , and participated in health education sessions . RESULTS Oportunidades beneficiaries received 12.2 % more prenatal procedures compared with non-beneficiaries ( adjusted mean 78.9 , 95 % Confidence Interval ( CI ) : 77.5 - 80.3 ; P < 0.001 ) . CONCLUSION The Oportunidades conditional cash transfer programme is associated with better quality of prenatal care for low-income , rural women in Mexico . This result is probably a manifestation of the programme 's empowerment goal , by encouraging beneficiaries to be informed and active health consumers The purpose of this review was to determine whether mHealth interventions were effective in low- and middle-income countries in order to create a baseline for the evidence to support mHealth in developing countries . Studies were identified by search ing Medline on 02 October 2014 for articles published in the English language between January 2000 and September 2014 . Inclusion criteria were : 1 ) written in English , 2 ) completion of an mHealth intervention in a low or middle-income country , 3 ) measurement of patient outcomes , and 4 ) participants 18 years of age or older . 7,920 titles were review ed and 7 were determined eligible based on inclusion criteria . Interventions included a cluster r and omized trial , mixed methods study , retrospective comparison of an opt-in text message program , a two-arm proof of concept , single arm trial , a r and omized trial , and a single subject design . Five out of seven of the studies showed significant difference between the control and intervention . Currently there is little evidence on mHealth interventions in developing countries , and existing studies are very diverse ; however initial studies show changes in clinical outcomes , adherence , and health communication , including improved communication with providers , decrease in travel time , ability to receive expert advice , changes in clinical outcomes , and new forms of cost-effective education . While this initial review is promising , more evidence is needed to support and direct system-level re source investment There is promising evidence that poverty-targeted cash transfer programs can have positive impacts on  adolescent transitions to adulthood in re source poor setting s , however existing research is typically from small scale programs in diverse geographic and cultural setting s. We provide estimates of the impact of a national unconditional cash transfer program , the Kenya Cash Transfer for Orphans and Vulnerable Children  , on pregnancy and early marriage among females aged 12 to 24 , four years after program initiation . The evaluation was design ed as a clustered r and omized controlled trial and ran from 2007 to 2011 , capitalizing on the existence of a control group , which was delayed entry to the program due to budget constraints . Findings indicate that , among 1549 females included in the study , while the program reduced the likelihood of pregnancy by five percentage points , there was no significant impact on likelihood of early marriage . Program impacts on pregnancy appear to work through increasing the enrollment of young women in school , financial stability of the household and delayed age at first sex . The Kenyan program is similar in design to most other major national cash transfer programs in Eastern and Southern Africa , suggesting a degree of generalizability of the results reported here . Although the objective of the program is primarily poverty alleviation , it appears to have an important impact on facilitating the successful transition of adolescent girls into adulthood The cash component of Oportunidades , a large conditional cash transfer ( CCT ) program in Mexico , has previously been shown to be associated with better outcomes for child growth and development . The objective of this analysis was to determine whether the cash transfers were also associated with positive outcomes for adult health .  Oportunidades  was originally r and omized across 506 rural ( < 2500 inhabitants ) communities assigned to immediate incorporation into the program in 1997 or incorporation 18 mo later . Adults ( n = 1649 early , n = 2039 late intervention ) aged 18 - 65 y were then assessed in 2003 . All of the households included in the analysis reported here complied with Oportunidades 's requirements for the entire period , but some received higher cumulative cash transfers because they were living in communities r and omized to begin receiving transfers earlier and /or they accumulated cash at a faster rate because they had more school-aged children at baseline . Our primary findings were that a doubling of cumulative cash transfers to the household was associated with higher BMI ( beta = + 0.83 , 95 % CI 0.46 , 1.20 ; P < 0.0001 ) , higher diastolic blood pressure ( beta = + 1.19 , 95 % CI 0.09 , 2.29 ; P = 0.03 ) , and higher prevalence of overweight [ odds ratio ( OR ) = 1.41 , 95 % CI 1.18 , 1.67 ; P < 0.0001 ) , grade I obesity ( OR = 1.41 , 95 % CI 1.14 , 1.75 ; P = 0.002 ) , and grade II obesity ( OR = 1.57 , 95 % CI 1.05 , 2.36 ; P = 0.03 ) , while controlling for a wide range of covariates , including household composition at baseline . Oportunidades has been portrayed as a model for CCT programs worldwide , but the results reported here support the notion that the cash component of Oportunidades may be negatively associated with some adult health outcomes We examined the effects of Ecuador 's  Bono de Desarrollo Humano (BDH)--an unconditional cash transfer program that was rolled-out using a r and omized design --on health and development outcomes in very young children . Communities that were r and omly assigned to the treatment group began receiving the BDH  in 2004 and those r and omly assigned to the comparison group began receiving benefits two years later . Families enrolled in the BDH  received a monthly cash stipend ( $ 15USD ) representing an approximate 6 - 10 % increase in household income . Participants analyzed in this study are children aged 12 - 35 months from treatment ( n = 797 ) and comparison ( n = 399 ) communities in rural and urban Ecuador . Main outcomes measured were language skills ( the Fundación MacArthur Inventorio del Desarollo de Habilidades Comunicativas-Breve ) , height-for-age z-score , and hemoglobin concentration . Results indicate that in rural areas , being r and omized to receive the BDH in very early childhood led to significantly better performance on the number of words a child was saying , and on the probability that the child was combining two or more words . There were no significant effects on language development for children in urban areas and there were no effects on height-for-age z-score or hemoglobin concentration in rural or urban areas . A limited number of potential pathways with respect to cognitive/ language stimulation , health behaviors , and parenting quality were also explored . Findings indicate that compared to children in comparison areas , rural children in treatment areas were more likely to have received vitamin A or iron supplementation and have been bought a toy in the past six months . This study provides evidence for significant benefits of an unconditional cash transfer program for language development in very young children in rural areas Background Violence during pregnancy is a global problem , associated with serious health risks for both the mother and baby . Evaluation of interventions targeted for reducing or controlling domestic violence ( DV ) is still in its infancy , and the majority of findings are primarily from high-income countries ( HICs ) . Therefore , there is an urgent need for generating evidence of DV interventions among pregnant women in low- and middle-income countries ( LMICs ) . Methods Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRISMA ) guidelines will be employed to structure the review . A comprehensive search will be carried out via electronic data bases including MEDLINE , CINAHL , Scopus , Embase , Web of Science , PsycINFO , and The Cochrane library . Gray literature will also be scrutinized for potential articles . An optimal search strategy has been developed following consultations with subject-matter experts and librarians . This search strategy will be adapted to the different data bases . Experimental studies evaluating DV interventions among pregnant women from LMICs will be included in the review . The review will only include literature written in English . Two review ers will independently screen and assess studies for inclusion in the review . A third author will resolve any discrepancies between the review ers . Risk of bias will be assessed based on the Cochrane risk of bias assessment tool , and overall quality of the evidence will be judged using Grading of Recommendations , Assessment , Development , and Evaluation ( GRADE ) criteria . Findings will be presented with the narrative synthesis , and if applicable , they will be further quantified using r and om-effects meta- analysis . Effect size , risk ratio for dichotomous variables , and st and ardized mean differences for continuous variables will be calculated for each outcome using Review Manager 5.3 . Discussion Systematic review s to evaluate the efficacy of interventions to address DV within the perinatal context have been limited . Hence , no one intervention has emerged as substantially effective towards addressing perinatal DV and associated health consequences . The evidence generated from this systematic review will inform research ers and policy makers about the effectiveness of existing DV interventions among pregnant women in LMICs and provide recommendations for future research in this area . This in turn will contribute towards violence prevention in LMICs . Systematic review registration PROSPERO
The available evidence on impact of CCT and UCT on contraception is inconclusive due to the limited number of studies , varying outcome measures , and lack of intervention specifically for contraception
This systematic review synthesizes evidence on the impact of conditional and unconditional cash transfers ( CCT and UCT ) on contraception in low- and middle-income countries .