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Effects of Cash Transfers on Severe Acute Malnutrition

This study has been completed.
Sponsor:
Collaborator:
Save the Children
Information provided by (Responsible Party):
Emmanuel Grellety, UNICEF
ClinicalTrials.gov Identifier:
NCT02460848
First received: May 27, 2015
Last updated: January 4, 2016
Last verified: January 2016
  Purpose

Cash transfer, aims to strengthen food security for vulnerable households by giving families enough purchasing power to consume an adequate and balanced diet, maintain a good standard of hygiene, access health services, and invest in their own means of food production in addition to their children's growth and development.

While cash transfer to vulnerable households has shown a long-term positive impact on growth and on malnutrition-related mortality in children aged 0-5 years, there is little conclusive evidence their effectiveness in Sub-Saharan Africa that cash transfer has a direct effect on the Community-based Management of Acute Malnutrition (CMAM). Here, the investigators will perform a cluster-randomized trial to investigate during 6 months the effects of unconditional cash transfers on the management of severe acute malnutrition (SAM) in children from 6 to 59 months according to the national protocol in the Democratic Republic of Congo.


Condition Intervention
Severe Malnutrition Other: Outpatient therapeutic program, counseling and cash transfer Other: Outpatient therapeutic program and counseling

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Effects of Unconditional Cash Transfers on the Management of Severe Acute Malnutrition (SAM) in the Democratic Republic of Congo: a Cluster Randomized Trial

Resource links provided by NLM:


Further study details as provided by Emmanuel Grellety, UNICEF:

Primary Outcome Measures:
  • Recovery rate in the outpatient therapeutic program [ Time Frame: At 6 week ]
    Recovery is defined for patient of 6 to 59 months old as Weight-for-Height Z-score ≥−1.5 SD (WHO Growth Standards 2006) or Mid-Upper Arm Circumference ≥125mm at two consecutive visits and absence of bilateral edema for 14 days.


Secondary Outcome Measures:
  • Recovery rate in the outpatient therapeutic program [ Time Frame: At 8 week ]
  • Length of stay in the outpatient therapeutic program [ Time Frame: One month (average) ]
  • Default rate in the outpatient therapeutic program [ Time Frame: Two weeks ]
    Patient who failed to appear for two consecutive weeks during the follow-up visits.

  • Relapse rate [ Time Frame: At 2, 3 and 4 months following discharge ]
    Patient who reach inclusion criteria within 2 months following discharge.

  • Transfer rate from outpatient therapeutic program to inpatient therapeutic program [ Time Frame: One month average ]
    Patient who develop signs of a serious medical complication according to the national protocol are transfer to the inpatient therapeutic program.

  • Failure rate in the outpatient therapeutic program [ Time Frame: Up to three months ]
    Patients who failed to reach after 3 months the recovery criteria.

  • Morbidity rate [ Time Frame: At 6 week, 8 week and 6 month ]
    ARI, diarrhoea, anaemia and malaria incidence. Morbidity will be assessed every week in the outpatient therapeutic program and every month after discharge by a locally pre-tested standardized questionnaire.

  • Death rate [ Time Frame: At 6 week, 8 week and 6 month ]
    Death from any cause during follow-up.

  • Weight gain [ Time Frame: At 6 week, 8 week and 6 month ]
    Weight gain will be assessed every week in the outpatient therapeutic program and every month after discharge.

  • Mid-Upper Arm Circumference gain [ Time Frame: At 6 week, 8 week and 6 month ]
    Mid-upper arm circumference gain will be assessed every week in the outpatient therapeutic program and every month after discharge.

  • Change in Growth rates [ Time Frame: At 6 month ]
    Growth will be measured every week in the outpatient therapeutic program and every month after discharge.

  • Diet replacement & Intra-household dispatching of the therapeutic food [ Time Frame: One month average ]
    Diet replacement & Intra-household dispatching of the therapeutic food will be assessed with the household every week during the recovery period by a locally pre-tested standardized questionnaire.

  • Change in the Individual Dietary Diversity Score (IDDS) [ Time Frame: At 6 week, 8 week and 6 month ]
    IDDS for measurement of food access of the children will be assessed with the household every week during the recovery period and every month after discharge by a locally pre-tested standardized questionnaire.

  • Change in the Household Dietary Diversity Score (HDDS) [ Time Frame: At 6 month ]
    HDDS for measurement of food access will be assessed with the household at the beginning and the end of the study by a locally pre-tested standardized questionnaire.

  • Satisfaction of parents and acceptability [ Time Frame: At 6 month ]
    Survey will be conducted in the households at the end of the study.


Enrollment: 1600
Study Start Date: July 2015
Study Completion Date: January 2016
Primary Completion Date: November 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Outpatient therapeutic program, counseling and cash transfer
Ten outpatient therapeutic program sites (OTP) will be randomly allocated to unconditional cash transfer for children admitted for treatment of SAM according to the integrated management of acute malnutrition national protocol which will be associated with counseling on infant and young child feeding (IYCF).
Other: Outpatient therapeutic program, counseling and cash transfer

Each household will receive an unconditional cash transfer of $40 value every month during a 6 months' period.

The amount of cash per household per month was defined according to the results of the Household Economy Approach survey. This amount represents 70% of supplement to the monthly average household income characterized as very poor to meet their basic needs. This threshold corresponds to the total of food and income necessary to cover 100% of energy needs food (2100 kcal per day per person), the costs associated with the preparation and consumption of food (e.g. salt, soap, kerosene and / or firewood for cooking and basic lighting) and finally all expenses for access to water for human consumption.

Active Comparator: Outpatient therapeutic program and counseling
Ten outpatient therapeutic program sites (OTP) will be randomly allocated for children admitted for treatment of SAM according to the integrated management of acute malnutrition national protocol which will be associated with counseling on infant and young child feeding (IYCF).
Other: Outpatient therapeutic program and counseling

  Eligibility

Ages Eligible for Study:   6 Months to 59 Months   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Living in the catchment area of one of the 20 outpatient therapeutic program site participating in this cluster randomized trial;
  • 6-59 months of age;
  • Weight for Height Zscore <-3 SD (WHO Growth Standards 2006) and/or Mid-Upper Arm Circumference <115mm and/or with bilateral edema;
  • No major clinical complications;
  • Positive appetite test;
  • Accept to participate at the study.

Exclusion Criteria:

  • Not living in the catchment area of the outpatient therapeutic program site of the cluster randomized trial;
  • Weight-for-Height Z-score ≥-3 (WHO Growth Standards 2006) and Mid-Upper Arm Circumference ≥115mm without bilateral edema;
  • Major clinical complications;
  • Failure to appetite test;
  • Refuse to participate at the study.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT02460848

Locations
Congo, The Democratic Republic of the
Save the Children
Mbuji-Mayi, Kasaï Oriental, Congo, The Democratic Republic of the, B.P. 440
Sponsors and Collaborators
UNICEF
Save the Children
Investigators
Study Chair: Eric Alain Ategbo, PhD United Nations Children's Fund (UNICEF)
  More Information

Responsible Party: Emmanuel Grellety, Principal Investigator, UNICEF
ClinicalTrials.gov Identifier: NCT02460848     History of Changes
Other Study ID Numbers: ARCCII-Nutrition
Study First Received: May 27, 2015
Last Updated: January 4, 2016

Keywords provided by Emmanuel Grellety, UNICEF:
Malnutrition
Severe Acute Malnutrition
Cash Transfer
Democratic Republic of Congo
Cluster randomize trial

Additional relevant MeSH terms:
Malnutrition
Severe Acute Malnutrition
Nutrition Disorders

ClinicalTrials.gov processed this record on September 21, 2017