Transfer Modality Research Initiative - Bangladesh

Study Overview
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Brief Summary
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This is a randomized control trial in two zones of Bangladesh (north and south). Treatment is assigned at the village level where treatments are: cash transfers (north and south); cash transfers + nutrition behavior communication change (north only); food transfers (north and south); food transfers + nutrition behavior communication change (south only); food-cash split (north and south); and controls (north and south). Within treatment localities, women living in very poor households are targeted to receive benefits for two years.

Official Title
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Transfer Modality Research Initiative - Bangladesh

Conditions
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Improving Pre-school Anthropometric Status, Improving Household Food Security, Improving Maternal Nutrition Knowledge

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


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Child age < 60 months Exclusion Criteria: None

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 + BCC<br>1500 taka ($18.75) per household distributed monthly Weekly, one hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice Occasional home visits | Other: Cash transfer<br>* 1500 taka ($18.75) per household distributed monthly<br>Behavioral: Behavior Communication Change (BCC)<br>* Weekly, one hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice Occasional home visits<br>|
| Experimental: Food transfer + BCC<br>30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly Weekly, one hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice Occasional home visits | Other: Food transfer<br>* 30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly<br>Behavioral: Behavior Communication Change (BCC)<br>* Weekly, one hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice Occasional home visits<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Child anthropometry | Height for age z scores Weight for height z scores Weight for age z scores Stunting Wasting Outcomes specified in terms of levels one year after intervention started (2013), two years after intervention started and as changes: 2012-2013, 2013-2014 and 2012-2014 | Baseline. Up to 12 months. Up to 24 months. | 
| Child food intake | Number of unique foods consumed in previous 24 hours Number of food groups consumed in previous 24 hours Consumption of specified food groups - animal source foods, dairy, Vitamin A rich foods etc Caloric consumption in previous 24 hours Outcomes specified in terms of levels one year after intervention started (2013), two years after intervention started and as changes: 2012-2013, 2013-2014 and 2012-2014 | Baseline. Up to 12 months. Up to 24 months. | 
| Child health | Did mother report child was ill in previous 2 weeks Outcomes specified in terms of levels one year after intervention started (2013), two years after intervention started and as changes: 2012-2013, 2013-2014 and 2012-2014 | Baseline. Up to 12 months. Up to 24 months. | 
| Distribution of food intake within the household | Consumption of foods by all household members in previous 24 hours as recalled by mothers as measured by yes/no questions on foods, food groups and calories Outcomes specified in terms of levels one year after intervention started (2013), two years after intervention started and as changes: 2012-2013, 2013-2014 and 2012-2014 | Baseline. Up to 12 months. Up to 24 months. | 
| Household food security | Food groups consumed by household in previous seven days Number of unique foods consumed in previous seven days Number of food groups consumed in previous seven days Number of food groups consumed in previous seven days weighted by nutritional value and frequency of consumption Value of food consumption in previous seven days Household caloric availability in previous seven days Outcomes specified in terms of levels one year after intervention started (2013), two years after intervention started and as changes: 2012-2013, 2013-2014 and 2012-2014 | Baseline. Up to 12 months. Up to 24 months. | 
| Maternal nutrition knowledge | Maternal knowledge of infant and young child feeding practices (IYCF) Knowledge, attitudes, practice of IYCF Scored as yes/no and as a total score on all questions Levels assessed in 2013 and 2014 and as changes between 2012-2013, 2013-2014 and 2012-2014 | Baseline. Up to 12 months. Up to 24 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Household consumption | Value of food consumption in previous seven days Value of monthly non-food consumption Value of monthly non-food consumption by specified sub-groups (clothing, medical expenses, education expenses, transport, consumables, semi-durables) Value of monthly household consumption (food and non-food) Outcomes specified in terms of levels one year after intervention started (2013), two years after intervention started and as changes: 2012-2013, 2013-2014 and 2012-2014 | Baseline. Up to 12 months. Up to 24 months. | 
| Household income | Value of annual income derived from agriculture at endline (2014) Value of annual income derived from non-agricultural sources at endline (2014) Value of annual total income derived from all sources at endline (2014) Change in annual income (agriculture, non-agricultural, total) between 2012-2013, 2013-2014 and 2012-2014 Outcomes specified in terms of levels one year after intervention started (2013), two years after intervention started and as changes: 2012-2013, 2013-2014 and 2012-2014 | Baseline. Up to 12 months. Up to 24 months. | 
| Asset accumulation | Index (z score) of consumer durables Index (z score) of productive assets Index of quality of housing stock Productive land ownership (ha) Outcomes specified in terms of levels one year after intervention started (2013), two years after intervention started and as changes: 2012-2013, 2013-2014 and 2012-2014 | Baseline. Up to 12 months. Up to 24 months. | 
| Women's empowerment | Index of women's decision making autonomy within the household Index of women's mobility outside the household Outcome measured as level in 2013, level in 2014 and change between 2013-2014 | Up to 12 months. Up to 24 months. | 
| Information spillovers to non-beneficiaries | Knowledge of infant and young child feeding practices (IYCF) of mothers Knowledge, attitudes, practice of IYCF Scored as yes/no and as a total score on all questions Non-beneficiaries are mothers living near intervention households (within approximately a 10 minute walk) in the following treatment arms: North: cash, cash + BCC, control. South: food, food + BCC, control. Levels assessed in 2014 | Up to 24 months. |