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

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ClinicalTrials.gov Identifier: NCT02858011
Recruitment Status : Recruiting
First Posted : August 8, 2016
Last Update Posted : August 21, 2018
Sponsor:
Collaborators:
Institut de Recherche pour le Developpement
Implementation management committee of the Jigisemejiri program (Ministry of Economics and Finance, Government of Mali)
Information provided by (Responsible Party):
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.

Condition or disease Intervention/treatment Phase
Poverty Child Malnutrition Other: Cash distribution during first 36 months Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months Dietary Supplement: Preventive Nutrition Packages during last 12 months Other: Cash distribution during the last 12 months Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during the last 12 months Phase 4

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 Type : Interventional  (Clinical Trial)
Estimated Enrollment : 4320 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: The Effect of a Cash Transfer Program and Preventive Nutrition Packages on Household Welfare and Child Nutritional Status in Mali
Study Start Date : September 2014
Estimated Primary Completion Date : June 2019
Estimated Study Completion Date : June 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Child Nutrition

Arm Intervention/treatment
Active Comparator: 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).
Other: Cash distribution during the last 12 months
Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.

Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during the last 12 months
Large group gatherings of cash beneficiaries are organized in parallel to the cash distributions. During these meetings, local NGOs present and discuss a topic related to health, child nutrition, household economics or education.

Experimental: 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.
Other: Cash distribution during first 36 months
Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.

Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months
Large group gatherings of cash beneficiaries are organized in parallel to the cash distributions. During these meetings, local NGOs present and discuss a topic related to health, child nutrition, household economics or education.

Experimental: 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
Other: Cash distribution during first 36 months
Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.

Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months
Large group gatherings of cash beneficiaries are organized in parallel to the cash distributions. During these meetings, local NGOs present and discuss a topic related to health, child nutrition, household economics or education.

Dietary Supplement: Preventive Nutrition Packages during last 12 months
Fortified flour supplements for children (Supercereal Plus)and pregnant/lactating mothers (super Cereal)

Active Comparator: 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
Other: Cash distribution during first 36 months
Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.

Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months
Large group gatherings of cash beneficiaries are organized in parallel to the cash distributions. During these meetings, local NGOs present and discuss a topic related to health, child nutrition, household economics or education.




Primary Outcome Measures :
  1. 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

  2. Value of household consumption [ Time Frame: After 24 months of program implementation ]
    The household consumption includes food and non-food related economic consumption

  3. 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

  4. 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)

  5. Value of household consumption [ Time Frame: After 48 months of program implementation ]
    The household consumption includes food and non-food related economic consumption

  6. 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

  7. 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)


Secondary Outcome Measures :
  1. Child Weight-for-height Z-score [ Time Frame: After 24 months of program implementation ]
    To calculate WHZ scores the 2006 WHO growth reference will be used

  2. Prevalence of child wasting [ Time Frame: 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

  3. Prevalence of child stunting [ Time Frame: 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

  4. Child hemoglobin concentration [ Time Frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation ]
  5. Prevalence of child anemia [ Time Frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation ]
  6. Body Mass Index of primary caregiver of index child [ Time Frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation ]
  7. Early child development [ Time Frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation ]
  8. Child morbidity (acute respiratory infections, fever, vomiting, diarrhea) [ Time Frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation ]
  9. Caregiver's knowledge and practices related to Infant and Young Child Feeding (IYCF), child health and hygiene [ Time Frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation ]
  10. Household assets and savings [ Time Frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation ]
  11. Educational level of Household members [ Time Frame: After 24 months and 48 months of program implementation ]
  12. Household food security [ Time Frame: After 24 months and 48 months of program implementation ]
    Measured by the Household Food Insecurity Access Scale (HFIAS)

  13. Household composition [ Time Frame: 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.

  14. Household agricultural production [ Time Frame: 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

  15. Cognitive function of the head of household [ Time Frame: After 24 months of program implementation ]
    Measured by spatial Stroop test and digit span test (forward and backward)

  16. Well-being of household members [ Time Frame: 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.

  17. Women's empowerment [ Time Frame: After 24 months and 48 months of program implementation ]
    Measured by pro-WEAI instrument adapted to local context

  18. Child dietary diversity [ Time Frame: 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

  19. Professional occupation of household members [ Time Frame: 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

  20. Child Mid-upper Arm Circumference [ Time Frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation ]
  21. Maternal hemoglobin concentration [ Time Frame: After 48 months (only in cross-sectional survey) of program implementation ]
  22. Maternal anemia [ Time Frame: After 48 months (only in cross-sectional survey) of program implementation ]


Information from the National Library of Medicine

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Ages Eligible for Study:   6 Months to 5 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02858011


Contacts
Contact: Melissa Hidrobo, PhD m.hidrobo@cgiar.org
Contact: Shalini Roy, PhD s.roy@cgiar.org

Locations
Mali
Recruiting
Bamako, Mali
Contact: Yves Kameli, MSc       yves.kameli@ird.fr   
Contact: Eric Sessou, MSc       e.sessou@cgiar.org   
Sponsors and Collaborators
International Food Policy Research Institute
Institut de Recherche pour le Developpement
Implementation management committee of the Jigisemejiri program (Ministry of Economics and Finance, Government of Mali)
Investigators
Study Chair: Dan Gilligan, PhD IFPRI
Study Chair: Marie Ruel, PhD IFPRI
Principal Investigator: Melissa Hidrobo, PhD IFPRI
Principal Investigator: Shalini Roy, PhD IFPRI
Principal Investigator: Lieven Huybregts, PhD IFPRI

Responsible Party: International Food Policy Research Institute
ClinicalTrials.gov Identifier: NCT02858011     History of Changes
Other Study ID Numbers: 2014-26-PHND-M
First Posted: August 8, 2016    Key Record Dates
Last Update Posted: August 21, 2018
Last Verified: August 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by International Food Policy Research Institute:
behavior change communication
cash transfer
household welfare
child nutrition status

Additional relevant MeSH terms:
Malnutrition
Child Nutrition Disorders
Nutrition Disorders