The Effect of a Cash Transfer Program and Preventive Nutrition Packages on Household Welfare and Child Nutritional Status in Mali

Phase 4

Completed

• Conditions: Child Malnutrition; Poverty
• Interventions: Other: Cash distribution during first 36 months; Other: Cash distribution during the last 12 months; Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months; Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during the last 12 months; Dietary Supplement: Preventive Nutrition Packages during last 12 months

• Registration Number: NCT02858011
• Lead Sponsor: International Food Policy Research Institute

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.

Study Timeline

• Study Start: 2014-09
• Study First Submitted: 2016-08-03
• Study First Submitted QC: 2016-08-03
• Study First Posted: 2016-08-08
• Primary Completion: 2019-08-10
• Study Completion: 2019-08-10
• Status Verified: 2019-09
• Last Update Submitted: 2019-09-03
• Last Update Posted: 2019-09-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 4320

Inclusion Criteria

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

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Exclusion Criteria

• Congenital malformations that hamper anthropometric measurements

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Jigisemejiri cash transfer program	Cash distribution during first 36 months	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.
Jigisemejiri - Preventive Nutrition packages	Cash distribution during first 36 months	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
Jigisemejiri - Preventive Nutrition packages	Accompanying information sessions on health, child nutrition, household economics and education during first 36 months	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
Jigisemejiri - Preventive Nutrition packages	Preventive Nutrition Packages during last 12 months	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
Control and comparison group - Preventive Nutrition packages	Cash distribution during first 36 months	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
Control and comparison group -cash transfer program	Cash distribution during the last 12 months	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).
Control and comparison group -cash transfer program	Accompanying information sessions on health, child nutrition, household economics and education during the last 12 months	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).
Jigisemejiri cash transfer program	Accompanying information sessions on health, child nutrition, household economics and education during first 36 months	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.
Control and comparison group - Preventive Nutrition packages	Accompanying information sessions on health, child nutrition, household economics and education during first 36 months	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

Primary Outcome Measures

Name	Time	Method
Child Height-for-age Z-score	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	After 48 months of program implementation	The household consumption includes food and non-food related economic consumption
Household dietary diversity	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	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)

Secondary Outcome Measures

Name	Time	Method
Child Weight-for-height Z-score	After 24 months of program implementation	To calculate WHZ scores the 2006 WHO growth reference will be used
Prevalence of child wasting	After 24 months and 48 months (only in cross-sectional survey) of program implementation	To calculate WHZ scores the 2006 WHO growth reference will be used
Prevalence of child stunting	After 24 months and 48 months (only in cross-sectional survey) of program implementation	To calculate WHZ scores the 2006 WHO growth reference will be used
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
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
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	Measured by the Household Food Insecurity Access Scale (HFIAS)
Household composition	After 24 months and 48 months of program implementation	This entails the household size, the number of one parent households, monogamous and polygamous households, number of infants and children.
Household agricultural production	After 24 months and 48 months of program implementation	The composition and quantity of all crops grown by the houshold over the last year is being recalled
Cognitive function of the head of household	After 24 months of program implementation	Measured by spatial Stroop test and digit span test (forward and backward)
Well-being of household members	After 24 months and 48 months of program implementation	Well-being is assessed by measuring stress, anxiety, psychological well-being, partner violence, marital quality, depression, occurrence of disputes and resource allocation.
Women's empowerment	After 24 months and 48 months of program implementation	Measured by pro-WEAI instrument adapted to local context
Child dietary diversity	After 24 months and 48 months (only in cross-sectional survey) of program implementation	Child dietary diversity is estimated by a dietary diversity score counting food groups consumed
Professional occupation of household members	After 24 months and 48 months of program implementation	We assess if household members have different formal and informal professional occupations or main revenue generating activities between intervention and control group
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