The Effect of a Cash Transfer Program and Preventive Nutrition Packages on Household Welfare and Child Nutritional Status in Mali
Trial Snapshot
- Phase
- Phase 4
- Status
- Completed
- Enrollment
- 4,320
- Locations
- 1
- Primary Endpoint
- Child Height-for-age Z-score
Study Overview
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
- 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.
- 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.
- 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.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Other
- Masking
- None
Eligibility Criteria
- Ages
- 6 Months to 5 Years (Child)
- Sex
- All
- Accepts Healthy Volunteers
- No
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
Arms & Interventions
Jigisemejiri cash transfer program
Unconditional cash is distributed every 3 months to beneficiaries of the Jigisemejiri program. During cash handouts, information sessions on health, child nutrition, households economics and education are organized by local NGOs.
Intervention: Cash distribution during first 36 months (Other)
Control and comparison group -cash transfer program
The program is implemented during 48 months. During the first 36 months the control group does not receive any intervention. During the last 12 months eligible beneficiaries receive cash transfer and accompanying information sessions on health, child nutrition, household economics every three months (identical to experimental group).
Intervention: Cash distribution during the last 12 months (Other)
Control and comparison group -cash transfer program
The program is implemented during 48 months. During the first 36 months the control group does not receive any intervention. During the last 12 months eligible beneficiaries receive cash transfer and accompanying information sessions on health, child nutrition, household economics every three months (identical to experimental group).
Intervention: Accompanying information sessions on health, child nutrition, household economics and education during the last 12 months (Behavioral)
Jigisemejiri cash transfer program
Unconditional cash is distributed every 3 months to beneficiaries of the Jigisemejiri program. During cash handouts, information sessions on health, child nutrition, households economics and education are organized by local NGOs.
Intervention: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months (Behavioral)
Jigisemejiri - Preventive Nutrition packages
Households belonging to the experimental group who previously received Cash transfer and information sessions on health, child nutrition, households economics and education for 36 months, with children and/or pregnant/lactating women receiving rations of fortified flour (PNP) during the last 12 months of the project
Intervention: Cash distribution during first 36 months (Other)
Jigisemejiri - Preventive Nutrition packages
Households belonging to the experimental group who previously received Cash transfer and information sessions on health, child nutrition, households economics and education for 36 months, with children and/or pregnant/lactating women receiving rations of fortified flour (PNP) during the last 12 months of the project
Intervention: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months (Behavioral)
Jigisemejiri - Preventive Nutrition packages
Households belonging to the experimental group who previously received Cash transfer and information sessions on health, child nutrition, households economics and education for 36 months, with children and/or pregnant/lactating women receiving rations of fortified flour (PNP) during the last 12 months of the project
Intervention: Preventive Nutrition Packages during last 12 months (Dietary Supplement)
Control and comparison group - Preventive Nutrition packages
Households belonging to the experimental group who previously received Cash transfer and information sessions on health, child nutrition, households economics and education for 36 months, with children and/or pregnant/lactating women
Intervention: Cash distribution during first 36 months (Other)
Control and comparison group - Preventive Nutrition packages
Households belonging to the experimental group who previously received Cash transfer and information sessions on health, child nutrition, households economics and education for 36 months, with children and/or pregnant/lactating women
Intervention: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months (Behavioral)
Outcomes
Primary Outcomes
Child Height-for-age Z-score
Time Frame: After 48 months of program implementation (only in cross-sectional survey)
To calculate HAZ scores the 2006 WHO growth reference will be used (only in cross-sectional survey)
Value of household consumption
Time Frame: After 48 months of program implementation
The household consumption includes food and non-food related economic consumption
Household dietary diversity
Time Frame: After 48 months of program implementation
The household dietary diversity is estimated by a dietary diversity score counting food groups
Child Weight-for-Height Z-score
Time Frame: After 48 months of program implementation (only in cross-sectional survey)
To calculate WHZ scores the 2006 WHO growth reference will be used (only in cross-sectional survey)
Child Height-for-age Z-score
Time Frame: After 24 months of program implementation
To calculate WHZ scores the 2006 WHO growth reference will be used
Value of household consumption
Time Frame: After 24 months of program implementation
The household consumption includes food and non-food related economic consumption
Household dietary diversity
Time Frame: After 24 months of program implementation
The household dietary diversity is estimated by a dietary diversity score counting food groups
Secondary Outcomes
- Child Weight-for-height Z-score(After 24 months of program implementation)
- Prevalence of child wasting(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Prevalence of child stunting(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Body Mass Index of primary caregiver of index child(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Early child development(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Child morbidity (acute respiratory infections, fever, vomiting, diarrhea)(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Caregiver's knowledge and practices related to Infant and Young Child Feeding (IYCF), child health and hygiene(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Child hemoglobin concentration(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Prevalence of child anemia(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Household assets and savings(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Educational level of Household members(After 24 months and 48 months of program implementation)
- Household food security(After 24 months and 48 months of program implementation)
- Household composition(After 24 months and 48 months of program implementation)
- Household agricultural production(After 24 months and 48 months of program implementation)
- Cognitive function of the head of household(After 24 months of program implementation)
- Well-being of household members(After 24 months and 48 months of program implementation)
- Women's empowerment(After 24 months and 48 months of program implementation)
- Child dietary diversity(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Professional occupation of household members(After 24 months and 48 months of program implementation)
- Child Mid-upper Arm Circumference(After 24 months and 48 months (only in cross-sectional survey) of program implementation)
- Maternal hemoglobin concentration(After 48 months (only in cross-sectional survey) of program implementation)
- Maternal anemia(After 48 months (only in cross-sectional survey) of program implementation)