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

Not Applicable

Completed

• Conditions: Food Security; Intimate Partner Violence; Poverty; Child Nutrition; Child Development; Gender Dynamics
• Interventions: Other: Food transfer; Other: Cash transfer; Other: Control; Other: Food and cash transfer; Behavioral: Nutrition behavior Communication Change (BCC)

• Registration Number: NCT03810300
• Lead Sponsor: International Food Policy Research Institute

Brief Summary

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

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 \[north and south\].

Study Timeline

• Study Start: 2012-04-15
• Study First Submitted: 2018-05-14
• Primary Completion: 2018-05-15
• Study Completion: 2018-05-15
• Status Verified: 2019-01
• Study First Submitted QC: 2019-01-17
• Last Update Submitted: 2019-01-17
• Study First Posted: 2019-01-18
• Last Update Posted: 2019-01-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 5000

Inclusion Criteria

• Former participant of Transfer Modality Research Initiative study (in cash, food, cash+BCC, food+BCC, or control arms)

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Exclusion Criteria

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Food transfer + nutrition BCC	Food transfer	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).
Cash transfer	Cash transfer	1500 taka ($18.75) per household distributed monthly
Control	Control	No transfer, no behavior change communication
Food and cash transfer	Food and cash transfer	15 kg of rice; 1 kg of lentils and 1 kg of micronutrient fortified cooking oil and 750 taka cash per household, distributed monthly
Cash transfer + nutrition BCC	Cash transfer	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).
Food transfer + nutrition BCC	Nutrition behavior Communication Change (BCC)	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).
Food transfer	Food transfer	30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly
Cash transfer + nutrition BCC	Nutrition behavior Communication Change (BCC)	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).

Primary Outcome Measures

Name	Time	Method
Prevalence of physical intimate partner violence	After 4 years post-intervention	Prevalence of any physical intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument
Food Consumption Score	After 4 years post-intervention	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.
Child height-for-age z-score	After 4 years post-intervention	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.

Secondary Outcome Measures

Name	Time	Method
Household dietary diversity	After 4 years post-intervention	Measured by counting the number of food groups consumed by the household
Value of household asset ownership	After 4 years post-intervention	Total value of all assets owned
Child score on Strengths and Difficulties Questionnaire	After 4 years post-intervention	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.
Parental interaction with child	After 4 years post-intervention	Time spent on child stimulation activities in previous 7 days, measured using modules developed for the survey
Parental discipline of the child	After 4 years post-intervention	Disciplinary measures used in the past month, measured using modules developed for the survey
Community norms on gender	After 4 years post-intervention	Community leaders' attitudes toward gender, measured using modules developed for the survey
Value of household food consumption	After 4 years post-intervention	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.
Value of household non-food consumption	After 4 years post-intervention	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.
Household food insecurity	After 4 years post-intervention	Measured using the Household Food Insecurity Access Scale. Scale range is 0 to 27, with higher values reflecting higher food insecurity.
Value of household labor income	After 4 years post-intervention	Value of annual labor income over all household members
Value of household non-labor income	After 4 years post-intervention	Value of annual non-labor income over all household members
Household land ownership	After 4 years post-intervention	Area of land owned
Child score on Raven's Progressive Matrices	After 4 years post-intervention	Measured using Raven's Progressive Matrices set A and set B. This is constructed following the test's protocol for scoring.
Child score on Early Grade Reading Assessment	After 4 years post-intervention	Measured using Early Grade Reading Assessment adapted to local context. This is constructed following the test's protocol for scoring.
Child score on Early Grade Mathematics Assessment	After 4 years post-intervention	Measured using Early Grade Mathematics Assessment adapted to local context. This is constructed following the test's protocol for scoring.
Value of total household consumption	After 4 years post-intervention	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.
Prevalence of child stunting	After 4 years post-intervention	Calculated using the 2006 WHO growth reference
Housing quality: interviews	After 4 years post-intervention	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.
Maternal nutrition knowledge score	After 4 years post-intervention	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.
Maternal infant and young child feeding practices	After 4 years post-intervention	Maternal adherence to WHO-recommended infant and young child feeding practices
Child weight-for-height z-score	After 4 years post-intervention	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.
Individual attitudes toward gender and intimate partner violence	After 4 years post-intervention	Measured using men's and women's attitudes toward gender and intimate partner violence modules developed for the survey
Prevalence of child wasting	After 4 years post-intervention	Calculated using the 2006 WHO growth reference
Child illness	After 4 years post-intervention	Mother's report of child illness in previous 2 weeks
Prevalence of emotional violence	After 4 years post-intervention	Prevalence of any emotional intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument
Individual decisionmaking	After 4 years post-intervention	Measured using men's and women's decisionmaking modules adapted from pro-WEAI
Individual asset ownership	After 4 years post-intervention	Measured using men's and women's asset ownership modules developed for the survey
Individual mobility	After 4 years post-intervention	Measured using men's and women's mobility modules adapted from pro-WEAI
Individual labor force participation	After 4 years post-intervention	Measured using men's and women's labor modules developed for the survey
Prevalence of controlling behaviors	After 4 years post-intervention	Prevalence of any controlling behaviors in the past 12 months measured using the WHO Violence Against Women instrument
Prevalence of individual acts of intimate partner violence	After 4 years post-intervention	Prevalence of individual acts of intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument
Individual social capital	After 4 years post-intervention	Measured using men's and women's social capital modules developed for the survey
Individual stress	After 4 years post-intervention	Measured using men's and women's Perceived Stress Scale scores
Individual depression	After 4 years post-intervention	Measured using men's and women's Patient Health Questionnaire-9 Depression Test scores
Individual aspirations	After 4 years post-intervention	Measured using men's and women's aspirations modules developed for the survey
Spousal relationship	After 4 years post-intervention	Measured using men's and women's relationship modules developed for the survey