Sustainability of Impacts of Cash Transfers, Food Transfers, and Behavior Change Communication in Bangladesh

Study Overview
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Brief Summary
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This study assesses the sustainability of impacts, 4 years post-program, from a pilot safety net program that was implemented from May 2012-April 2014. The intervention, called the Transfer Modality Research Initiative (TMRI), was assigned following a cluster-randomized controlled trial design in two zones of Bangladesh (north and south). Intervention arms were assigned at the village level, where arms were as follows: (1) cash transfers [north and south]; (2) cash transfers + nutrition behavior communication change (BCC) [north only]; (3) food transfers [north and south]; (4) food transfers + nutrition BCC [south only]; (4) food-cash split [north and south]; and (5) control [north and south]. Within treatment villages, women living in very poor households were targeted to receive benefits for two years.

Detailed Description
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The objective of the study is to assess, 4 years after a pilot safety net intervention ended in April 2014, the sustainability of the intervention's impacts on households, children, and women. The intervention, called the Transfer Modality Research Initiative (TMRI), was assigned following a cluster-randomized controlled trial design in two zones of Bangladesh (north and south). WFP-Bangladesh implemented the intervention, and the International Food Policy Research Institute (IFPRI) conducted the impact evaluation research. Intervention arms were assigned at the village level, where arms were as follows: (1) cash transfers [north and south]; (2) cash transfers + nutrition behavior communication change (BCC) [north only]; (3) food transfers [north and south]; (4) food transfers + nutrition BCC [south only]; (5) food-cash split [north and south]; and (5) control [north and south]. Within treatment villages, women living in very poor households were targeted to receive benefits for two years, from May 2012-April 2014. For the original impact evaluation, longitudinal data on 5000 households were collected from 2012-2015 (ClinicalTrials.gov Identifier: NCT02237144). For the sustainability study in 2018, given available funding, the sampling frame will include 4000 households. This will include all households that were originally in the following arms: (1) cash transfers [north and south]; (2) cash transfers + nutrition BCC [north only]; (3) food transfers [north and south]; (4) food transfers + nutrition BCC [south only]; (5) control [north and south].

Official Title
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Sustainability of Impacts of Cash Transfers, Food Transfers, and Behavior Change Communication in Bangladesh: Transfer Modality Research Initiative

Conditions
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Food Security, Poverty, Child Nutrition, Child Development, Intimate Partner Violence, Gender Dynamics

Intervention / Treatment
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* Other: Cash transfer
* Other: Food transfer
* Other: Food and cash transfer
* Behavioral: Nutrition behavior Communication Change (BCC)
* Other: Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Former participant of Transfer Modality Research Initiative study (in cash, food, cash+BCC, food+BCC, or control arms) Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cash transfer<br>1500 taka ($18.75) per household distributed monthly | Other: Cash transfer<br>* 1500 taka ($18.75) per household distributed monthly<br>|
| Experimental: Food transfer<br>30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly | Other: Food transfer<br>* 30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly<br>|
| Experimental: Food and cash transfer<br>15 kg of rice; 1 kg of lentils and 1 kg of micronutrient fortified cooking oil and 750 taka cash per household, distributed monthly | Other: Food and cash transfer<br>* 15 kg of rice, 1 kg of lentils, and 1 kg of micronutrient-fortified cooking oil, and 750 taka cash per household, distributed monthly<br>|
| Experimental: Cash transfer + nutrition BCC<br>1500 taka ($18.75) per household distributed monthly. Nutrition behavior change communication (weekly, one-hour group-based meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings). | Other: Cash transfer<br>* 1500 taka ($18.75) per household distributed monthly<br>Behavioral: Nutrition behavior Communication Change (BCC)<br>* Weekly, group-based, one-hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings<br>|
| Experimental: Food transfer + nutrition BCC<br>30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly. Nutrition behavior change communication (weekly, one-hour group-based meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings). | Other: Food transfer<br>* 30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly<br>Behavioral: Nutrition behavior Communication Change (BCC)<br>* Weekly, group-based, one-hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings<br>|
| Experimental: Control<br>No transfer, no behavior change communication | Other: Control<br>* No transfer, no behavior change communication<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Food Consumption Score | The Food Consumption Score, as defined by the World Food Programme, is calculated as the number of food groups consumed by the household in the previous 7 days, weighted by each food group's nutritional value and frequency of consumption. Scale range is 0 to 112, with higher values reflecting higher food consumption. | After 4 years post-intervention | 
| Child height-for-age z-score | Calculated using the 2006 WHO growth reference. This is a continuous measure that represents the number of standard deviations from the mean among comparable children in the WHO growth reference. | After 4 years post-intervention | 
| Prevalence of physical intimate partner violence | Prevalence of any physical intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument | After 4 years post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Household dietary diversity | Measured by counting the number of food groups consumed by the household | After 4 years post-intervention | 
| Value of total household consumption | Aggregate value of household food and non-food consumption expenditures. This is a continuous measure calculated from household survey responses on consumption behavior, using the methodology and questionnaire modules described in Deaton and Zaidi (2002). Citation: A.Deaton,, and S. Zaidi. 2002. Guidelines for Constructing Consumption Aggregates for Welfare Analysis. Washington, DC : World Bank. | After 4 years post-intervention | 
| Value of household food consumption | Value of household food consumption expenditures. This is a continuous measure calculated from household survey responses on consumption behavior, using the methodology and questionnaire modules described in Deaton and Zaidi (2002). Citation: A.Deaton,, and S. Zaidi. 2002. Guidelines for Constructing Consumption Aggregates for Welfare Analysis. Washington, DC : World Bank. | After 4 years post-intervention | 
| Value of household non-food consumption | Value of household non-food consumption expenditures. This is a continuous measure calculated from household survey responses on consumption behavior, using the methodology and questionnaire modules described in Deaton and Zaidi (2002). Citation: A.Deaton,, and S. Zaidi. 2002. Guidelines for Constructing Consumption Aggregates for Welfare Analysis. Washington, DC : World Bank. | After 4 years post-intervention | 
| Household food insecurity | Measured using the Household Food Insecurity Access Scale. Scale range is 0 to 27, with higher values reflecting higher food insecurity. | After 4 years post-intervention | 
| Value of household labor income | Value of annual labor income over all household members | After 4 years post-intervention | 
| Value of household non-labor income | Value of annual non-labor income over all household members | After 4 years post-intervention | 
| Value of household asset ownership | Total value of all assets owned | After 4 years post-intervention | 
| Household land ownership | Area of land owned | After 4 years post-intervention | 
| Housing quality: interviews | Quality of housing stock. This is measured using a module developed for the study context, and information is collected through household enumerator observation during interviews. | After 4 years post-intervention | 
| Maternal nutrition knowledge score | Number answered correctly on a test of maternal knowledge regarding infant and young child feeding practices developed for the survey, based on the curriculum of training sessions in the intervention. | After 4 years post-intervention | 
| Maternal infant and young child feeding practices | Maternal adherence to WHO-recommended infant and young child feeding practices | After 4 years post-intervention | 
| Child score on Raven's Progressive Matrices | Measured using Raven's Progressive Matrices set A and set B. This is constructed following the test's protocol for scoring. | After 4 years post-intervention | 
| Child score on Early Grade Reading Assessment | Measured using Early Grade Reading Assessment adapted to local context. This is constructed following the test's protocol for scoring. | After 4 years post-intervention | 
| Child score on Early Grade Mathematics Assessment | Measured using Early Grade Mathematics Assessment adapted to local context. This is constructed following the test's protocol for scoring. | After 4 years post-intervention | 
| Child score on Strengths and Difficulties Questionnaire | Measured using Strengths and Difficulties Questionnaire, part of the Development and Well-Being Assessment family of mental heath measures. This is constructed following the test's protocol for scoring. | After 4 years post-intervention | 
| Child weight-for-height z-score | Calculated using the 2006 WHO growth reference. This is a continuous measure that represents the number of standard deviations from the mean among comparable children in the WHO growth reference. | After 4 years post-intervention | 
| Prevalence of child stunting | Calculated using the 2006 WHO growth reference | After 4 years post-intervention | 
| Prevalence of child wasting | Calculated using the 2006 WHO growth reference | After 4 years post-intervention | 
| Child illness | Mother's report of child illness in previous 2 weeks | After 4 years post-intervention | 
| Parental interaction with child | Time spent on child stimulation activities in previous 7 days, measured using modules developed for the survey | After 4 years post-intervention | 
| Parental discipline of the child | Disciplinary measures used in the past month, measured using modules developed for the survey | After 4 years post-intervention | 
| Community norms on gender | Community leaders' attitudes toward gender, measured using modules developed for the survey | After 4 years post-intervention | 
| Prevalence of emotional violence | Prevalence of any emotional intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument | After 4 years post-intervention | 
| Prevalence of controlling behaviors | Prevalence of any controlling behaviors in the past 12 months measured using the WHO Violence Against Women instrument | After 4 years post-intervention | 
| Prevalence of individual acts of intimate partner violence | Prevalence of individual acts of intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument | After 4 years post-intervention | 
| Individual decisionmaking | Measured using men's and women's decisionmaking modules adapted from pro-WEAI | After 4 years post-intervention | 
| Individual asset ownership | Measured using men's and women's asset ownership modules developed for the survey | After 4 years post-intervention | 
| Individual mobility | Measured using men's and women's mobility modules adapted from pro-WEAI | After 4 years post-intervention | 
| Individual labor force participation | Measured using men's and women's labor modules developed for the survey | After 4 years post-intervention | 
| Individual attitudes toward gender and intimate partner violence | Measured using men's and women's attitudes toward gender and intimate partner violence modules developed for the survey | After 4 years post-intervention | 
| Individual social capital | Measured using men's and women's social capital modules developed for the survey | After 4 years post-intervention | 
| Individual stress | Measured using men's and women's Perceived Stress Scale scores | After 4 years post-intervention | 
| Individual depression | Measured using men's and women's Patient Health Questionnaire-9 Depression Test scores | After 4 years post-intervention | 
| Individual aspirations | Measured using men's and women's aspirations modules developed for the survey | After 4 years post-intervention | 
| Spousal relationship | Measured using men's and women's relationship modules developed for the survey | After 4 years post-intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cash transfers, Food transfers, Behavior change communication, Sustainability, Social protection, Nutrition, Gender