Clinical trial NCT02858011: The Effect of a Cash Transfer Program and Preventive Nutrition Packages on Household Welfare and Child Nutritional Status in Mali
Official title: The Effect of a Cash Transfer Program and Preventive Nutrition Packages on Household Welfare and Child Nutritional Status in Mali
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Poverty
Child Malnutrition
Keywords: behavior change communication
cash transfer
household welfare
child nutrition status
Lead sponsor: International Food Policy Research Institute
Sponsor class: OTHER
Collaborators: name: Institut de Recherche pour le Developpement
name: Implementation management committee of the Jigisemejiri program (Ministry of Economics and Finance, Government of Mali)
First posted: 2016-08-08
Enrollment: 4320
Sex: ALL
Minimum age (years): 6
Maximum age (years): 5
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: In the last two decades, cash transfer (CT) programs have emerged as a popular approach to long-term poverty alleviation. While the main goal of cash transfer programs is to reduce poverty, they also have the potential to improve many development outcomes, such as health and education.

While many studies, mainly in Latin America and Asia, have investigated the impacts of CTs on poverty and food security and have, for the most part, found positive impacts, less is known about the impacts of CTs in Africa south of the Sahara, and, in particular, West Africa. Moreover, despite the fact that cash transfers have been shown to lead to decreases in poverty, improvements in household food security, and increases in health service utilization, impacts on children's nutritional status (including anthropometric measures) are generally small (Manley, Gitter, and Slavchevska 2013). Consequently, policymakers and governments are left with the question of how to design social safety nets, such as cash transfers, to achieve greater impact on diet quality, health, and nutrition.

The overall goal of this research is to generate evidence and knowledge on an integrated program implemented by the Government of Mali that includes a combination of cash transfers and targeted nutrition interventions. The information generated will inform program implementers and policymakers about best options to improve food security and nutrition among vulnerable groups and individuals in West Africa. Specifically, the main objectives of the research are

1. To provide evidence on the contribution of integrated social transfer programs to enhancing household welfare, food security, dietary diversity, and maternal and child nutrition in West Africa.
2. To test different features and combinations of cash transfers and targeted nutrition interventions, and assess their impact on food security and maternal and child nutrition and health outcomes in Mali.
3. To generate knowledge regarding the pathways of impact of these different program packages, identify the most effective and efficient modalities in the context of Mali, and derive lessons learned for other countries in the region.

Detailed description: The research entails two study designs: i) a repeated cross-sectional survey (baseline, midline and endline) in a sample of 1,440 children between 6 and 24 months of age, mainly to asses the program's impact on child nutrition and health outcomes; ii) a panel study following a cohort of 2,880 children over 3 years mainly focusing on the evaluation of household welfare outcomes. The study will be conducted in the 96 communes where the Jigisemejiri program is being implemented, situated in 5 regions of Mali: Sikasso, Koulikoro, Segou, Mopti and Kayes. Data will be collected at baseline (2014, T=0), midline (2016, T=\~24 months) and endline (2018, T=\~48 months).

The program is implemented for 48 months. The experimental group receives the cash transfer and group counselling intervention for 36 months. During the last 12 months the experimental group does not receive any intervention. The control group receives no intervention during the first 36 months, but receives the cash transfer and group counselling during the last 12 months. In a subsample of communes from the experimental group, villages were randomized to either receive Preventive Nutrition Packages (PNP) or nothing. The impact of PNP is analyzed by comparing villages that received PNP and villages that did not receive PNP during the last 12 months of the program.

Eligibility criteria: Inclusion Criteria:

* Being a Household that is beneficiary of the Jigisemejiri program
* Having a child between 6 and 24 months of age

Exclusion Criteria:

* Congenital malformations that hamper anthropometric measurements

Primary outcomes:
measure: Child Height-for-age Z-score
timeFrame: After 24 months of program implementation
measure: Value of household consumption
timeFrame: After 24 months of program implementation
measure: Household dietary diversity
timeFrame: After 24 months of program implementation
measure: Child Height-for-age Z-score
timeFrame: After 48 months of program implementation (only in cross-sectional survey)
measure: Value of household consumption
timeFrame: After 48 months of program implementation
measure: Household dietary diversity
timeFrame: After 48 months of program implementation
measure: Child Weight-for-Height Z-score
timeFrame: After 48 months of program implementation (only in cross-sectional survey)
Secondary outcomes:
measure: Child Weight-for-height Z-score
timeFrame: After 24 months of program implementation
measure: Prevalence of child wasting
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Prevalence of child stunting
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Child hemoglobin concentration
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Prevalence of child anemia
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Body Mass Index of primary caregiver of index child
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Early child development
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Child morbidity (acute respiratory infections, fever, vomiting, diarrhea)
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Caregiver's knowledge and practices related to Infant and Young Child Feeding (IYCF), child health and hygiene
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Household assets and savings
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Educational level of Household members
timeFrame: After 24 months and 48 months of program implementation
measure: Household food security
timeFrame: After 24 months and 48 months of program implementation
measure: Household composition
timeFrame: After 24 months and 48 months of program implementation
measure: Household agricultural production
timeFrame: After 24 months and 48 months of program implementation
measure: Cognitive function of the head of household
timeFrame: After 24 months of program implementation
measure: Well-being of household members
timeFrame: After 24 months and 48 months of program implementation
measure: Women's empowerment
timeFrame: After 24 months and 48 months of program implementation
measure: Child dietary diversity
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Professional occupation of household members
timeFrame: After 24 months and 48 months of program implementation
measure: Child Mid-upper Arm Circumference
timeFrame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
measure: Maternal hemoglobin concentration
timeFrame: After 48 months (only in cross-sectional survey) of program implementation
measure: Maternal anemia
timeFrame: After 48 months (only in cross-sectional survey) of program implementation
Other outcomes:
Locations:
city: Bamako
country: Mali
Study officials:
affiliation: IFPRI
name: Dan Gilligan, PhD
role: STUDY_CHAIR
affiliation: IFPRI
name: Marie Ruel, PhD
role: STUDY_CHAIR
affiliation: IFPRI
name: Melissa Hidrobo, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: IFPRI
name: Shalini Roy, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: IFPRI
name: Lieven Huybregts, PhD
role: PRINCIPAL_INVESTIGATOR
References: