Cash Transfers to Increase Dietary Diversity in Grand Gedeh County, Liberia

Study Overview
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Brief Summary
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The investigators aim to evaluate the efficacy of a cash transfer and nutrition education program delivered by community health assistants to increase dietary diversity among children 6 to 23 months of age in Grand Gedeh County, Liberia.

Detailed Description
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Worldwide, more than one in five children suffer from chronic malnutrition. In Liberia, there are more than 230,000 children suffering from chronic malnutrition and 32% of children under five are stunted. Previous studies have shown that inadequate dietary diversity is strongly associated with stunting in children under two years of age. An interventional package including cash transfers and education has the potential to improve dietary diversity and long-term outcomes such as improved growth and reduced rates of stunting among children. The investigators' objective is to evaluate the efficacy of a cash transfer and nutrition education program delivered by community health assistants to increase dietary diversity among children 6 to 23 months of age in Grand Gedeh County, Liberia. The investigators will conduct a pilot, cluster randomized trial in 45 communities. The investigators hypothesize that a multi-pronged interventional package aimed at strengthening the household environment will result in improved dietary diversity for children 6 to 23 months of age. Moreover, the investigators also hypothesize that unconditional cash transfers will result in improved dietary diversity for children 6 to 23 months of age in Grand Gedeh County, Liberia.

Official Title
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A Cluster Randomized Trial to Study the Effect of Cash Transfers and Nutrition Education on Dietary Diversity Among Children 6-23 Months of Age in Grand Gedeh County, Liberia: A Pilot Study

Conditions
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Malnutrition, Child

Intervention / Treatment
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* Other: Cash Transfer
* Other: Cash Transfers and Nutrition Education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants 6 to 23 months of age Participants with consenting caregivers to have monthly visits and to participate in the program Caregivers of all ages will be included Exclusion Criteria: Participants who are younger than 6 months of age (children < 6 months of age are encouraged to exclusively breastfeed, making dietary diversity irrelevant in this age group) Participants older than 23 months of age Participants with non-consenting caregivers

Ages Eligible for Study
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Minimum Age: 6 Months
Maximum Age: 23 Months

Sexes Eligible for Study
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All

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>Participants in this arm will receive routine monthly visits along with survey administration and the regular package of health services provided at the facility level and at home by community health assistants | |
| Experimental: Cash Transfers<br>Participants in this arm will receive routine monthly visits along with the regular package of health services provided at the facility level and at home by community health assistants and unconditional cash transfers every month | Other: Cash Transfer<br>* Monthly cash transfers<br>|
| Experimental: Cash Transfers and Nutrition Education<br>Participants in this arm will receive routine monthly visits along with the regular package of health services provided at the facility level and at home by community health assistants, unconditional cash transfers every month, and structured nutrition education provided at household level by community health assistants based on a structured nutrition education handbook. | Other: Cash Transfers and Nutrition Education<br>* Cash transfers every month and structured nutrition education provided at household level by community health assistants based on a nutrition education handbook<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in proportion of children 6 to 23 months of age who meet minimum dietary diversity scores (DDS) over the study period as reported by caregivers | The DDS has been widely used to measure the sum of diverse food groups consumed in a 24-hour period | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Meal frequency | Mean self-reported meal frequency over the 24-hour period prior to monthly CHA visits | 6 months | 
| Increase in child weight in kilograms | changes in child weight in kilograms during the study period measured with digital scale (UNISCALE) | 6 months | 
| Increase in mid upper arm circumference in centimeters | changes in mid upper arm circumference in centimeters measured with MUAC tape measure | 6 months | 
| Increase in child length/height in centimeters | changes in child length/height in centimeters during the study period measured with Height Board | 6 months | 
| Health care utilization (clinic) | number of clinic visits for illnesses (including type of illness) | 6 months | 
| Health care utilization (hospital) | hospitalizations (if any) during the study period | 6 months | 
| Health care utilization (antimicrobials) | use of antibiotics/antimalarials during the study period | 6 months | 
| Health care utilization (nutritional support) | if the child received supplementary nutritional support (e.g. ready to use therapeutic food RUTF) | 6 months | 
| Knowledge, attitudes, and practices | caregiver's knowledge, attitudes, and practices (KAP) of infant and young child feeding | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cash Transfers, Liberia, Stunting, Dietary diversity