دورية أكاديمية
Evaluation of an unconditional cash transfer program targeting children's first-1,000-days linear growth in rural Togo: A cluster-randomized controlled trial.
العنوان: | Evaluation of an unconditional cash transfer program targeting children's first-1,000-days linear growth in rural Togo: A cluster-randomized controlled trial. |
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المؤلفون: | Briaux J; NUTRIPASS, French National Research Institute for Sustainable Development-University of Montpellier-Montpellier SupAgro, Montpellier, France.; University of Bordeaux, Inserm, Institut de Recherche pour le Développement, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, Bordeaux, France., Martin-Prevel Y; NUTRIPASS, French National Research Institute for Sustainable Development-University of Montpellier-Montpellier SupAgro, Montpellier, France., Carles S; NUTRIPASS, French National Research Institute for Sustainable Development-University of Montpellier-Montpellier SupAgro, Montpellier, France., Fortin S; NUTRIPASS, French National Research Institute for Sustainable Development-University of Montpellier-Montpellier SupAgro, Montpellier, France., Kameli Y; NUTRIPASS, French National Research Institute for Sustainable Development-University of Montpellier-Montpellier SupAgro, Montpellier, France., Adubra L; NUTRIPASS, French National Research Institute for Sustainable Development-University of Montpellier-Montpellier SupAgro, Montpellier, France., Renk A; Paris School of Economics, UMR 8545, Paris, France., Agboka Y; Projet de Développement Communautaire et Filets Sociaux, Ministère du Développement à la Base, Lomé, Togo., Romedenne M; UNICEF, Child Survival and Development, Lomé, Togo., Mukantambara F; UNICEF, Social protection, Lomé, Togo., Van Dyck J; The World Bank, Social Protection and Labor Global Practice, Washington, District of Columbia, United States of America., Boko J; The World Bank, Social Protection and Labor Global Practice, Country Office of Cotonou, Benin., Becquet R; University of Bordeaux, Inserm, Institut de Recherche pour le Développement, UMR 1219, Bordeaux Population Health Research Center, Team IDLIC, Bordeaux, France., Savy M; NUTRIPASS, French National Research Institute for Sustainable Development-University of Montpellier-Montpellier SupAgro, Montpellier, France. |
المصدر: | PLoS medicine [PLoS Med] 2020 Nov 17; Vol. 17 (11), pp. e1003388. Date of Electronic Publication: 2020 Nov 17 (Print Publication: 2020). |
نوع المنشور: | Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
اللغة: | English |
بيانات الدورية: | Publisher: Public Library of Science Country of Publication: United States NLM ID: 101231360 Publication Model: eCollection Cited Medium: Internet ISSN: 1549-1676 (Electronic) Linking ISSN: 15491277 NLM ISO Abbreviation: PLoS Med Subsets: MEDLINE |
أسماء مطبوعة: | Original Publication: San Francisco, CA : Public Library of Science, [2004]- |
مواضيع طبية MeSH: | Food Supply/*economics , Intimate Partner Violence/*prevention & control , Malnutrition/*epidemiology , Nutritional Status/*physiology, Adult ; Child ; Child, Preschool ; Community Participation/statistics & numerical data ; Developing Countries/economics ; Diet/statistics & numerical data ; Female ; Food Supply/methods ; Humans ; Infant ; Intimate Partner Violence/economics ; Male ; Mothers/psychology ; Pregnancy ; Rural Population/statistics & numerical data ; Togo |
مستخلص: | Background: In 2014, the government of Togo implemented a pilot unconditional cash transfer (UCT) program in rural villages that aimed at improving children's nutrition, health, and protection. It combined monthly UCTs (approximately US$8.40 /month) with a package of community activities (including behavior change communication [BCC] sessions, home visits, and integrated community case management of childhood illnesses and acute malnutrition [ICCM-Nut]) delivered to mother-child pairs during the first "1,000 days" of life. We primarily investigated program impact at population level on children's height-for-age z-scores (HAZs) and secondarily on stunting (HAZ < -2) and intermediary outcomes including household's food insecurity, mother-child pairs' diet and health, delivery in a health facility and low birth weight (LBW), women's knowledge, and physical intimate partner violence (IPV). Methods and Findings: We implemented a parallel-cluster-randomized controlled trial, in which 162 villages were randomized into either an intervention arm (UCTs + package of community activities, n = 82) or a control arm (package of community activities only, n = 80). Two different representative samples of children aged 6-29 months and their mothers were surveyed in each arm, one before the intervention in 2014 (control: n = 1,301, intervention: n = 1,357), the other 2 years afterwards in 2016 (control: n = 996, intervention: n = 1,035). Difference-in-differences (DD) estimates of impact were calculated, adjusting for clustering. Children's average age was 17.4 (± 0.24 SE) months in the control arm and 17.6 (± 0.19 SE) months in the intervention arm at baseline. UCTs had a protective effect on HAZ (DD = +0.25 z-scores, 95% confidence interval [CI]: 0.01-0.50, p = 0.039), which deteriorated in the control arm while remaining stable in the intervention arm, but had no impact on stunting (DD = -6.2 percentage points [pp], relative odds ratio [ROR]: 0.74, 95% CI: 0.51-1.06, p = 0.097). UCTs positively impacted both mothers' and children's (18-23 months) consumption of animal source foods (ASFs) (respectively, DD = +4.5 pp, ROR: 2.24, 95% CI: 1.09-4.61, p = 0.029 and DD = +9.1 pp, ROR: 2.65, 95% CI: 1.01-6.98, p = 0.048) and household food insecurity (DD = -10.7 pp, ROR: 0.63, 95% CI: 0.43-0.91, p = 0.016). UCTs did not impact on reported child morbidity 2 week's prior to report (DD = -3.5 pp, ROR: 0.80, 95% CI: 0.56-1.14, p = 0.214) but reduced the financial barrier to seeking healthcare for sick children (DD = -26.4 pp, ROR: 0.23, 95% CI: 0.08-0.66, p = 0.006). Women who received cash had higher odds of delivering in a health facility (DD = +10.6 pp, ROR: 1.53, 95% CI: 1.10-2.13, p = 0.012) and lower odds of giving birth to babies with birth weights (BWs) <2,500 g (DD = -11.8, ROR: 0.29, 95% CI: 0.10-0.82, p = 0.020). Positive effects were also found on women's knowledge (DD = +14.8, ROR: 1.86, 95% CI: 1.32-2.62, p < 0.001) and physical IPV (DD = -7.9 pp, ROR: 0.60, 95% CI: 0.36-0.99, p = 0.048). Study limitations included the short evaluation period (24 months) and the low coverage of UCTs, which might have reduced the program's impact. Conclusions: UCTs targeting the first "1,000 days" had a protective effect on child's linear growth in rural areas of Togo. Their simultaneous positive effects on various immediate, underlying, and basic causes of malnutrition certainly contributed to this ultimate impact. The positive impacts observed on pregnancy- and birth-related outcomes call for further attention to the conception period in nutrition-sensitive programs. Trial Registration: ISRCTN Registry ISRCTN83330970. Competing Interests: The authors have declared that no competing interests exist. |
References: | Lancet. 2013 Aug 10;382(9891):536-51. (PMID: 23746780) BMC Public Health. 2016 Jun 08;16:488. (PMID: 27278935) Int J Public Health. 2014 Aug;59(4):609-18. (PMID: 24898173) J Health Popul Nutr. 2002 Mar;20(1):65-76. (PMID: 12022162) J Dev Orig Health Dis. 2016 Apr;7(2):144-62. (PMID: 26279311) Nestle Nutr Inst Workshop Ser. 2017;87:73-87. (PMID: 28315900) BMJ. 2010 Mar 23;340:c869. (PMID: 20332511) Lancet. 2006 Oct 7;368(9543):1260-9. (PMID: 17027732) Eval Program Plann. 2018 Jun;68:47-56. (PMID: 29475057) Lancet. 2008 Jan 26;371(9609):340-57. (PMID: 18206223) Cochrane Database Syst Rev. 2009 Oct 07;(4):CD008137. (PMID: 19821444) Am J Clin Nutr. 2019 Dec 1;110(6):1476-1490. (PMID: 31562508) J Nutr. 2017 Jul;147(7):1410-1417. (PMID: 28539413) Lancet. 2008 Feb 2;371(9610):417-40. (PMID: 18206226) World Dev. 2017 Jul;95:55-72. (PMID: 31363300) Curr Dev Nutr. 2020 May 28;4(7):nzaa099. (PMID: 32666032) Perspect Clin Res. 2016 Jul-Sep;7(3):144-6. (PMID: 27453832) World Health Organ Tech Rep Ser. 1995;854:1-452. (PMID: 8594834) AIDS Care. 2009;21 Suppl 1:60-75. (PMID: 22380980) Int J Environ Health Res. 2016 Oct-Dec;26(5-6):554-71. (PMID: 27666296) Curr Dev Nutr. 2017 Nov 02;1(12):. (PMID: 29955691) J Health Popul Nutr. 2013 Dec;31(4 Suppl 2):48-66. (PMID: 24992803) Dev Policy Rev. 2017 Summer;35(5):621-643. (PMID: 31363343) Matern Child Nutr. 2011 Oct;7 Suppl 3:5-18. (PMID: 21929633) PLoS One. 2017 Mar 22;12(3):e0173068. (PMID: 28328940) Matern Child Nutr. 2019 Oct;15(4):e12843. (PMID: 31102494) |
سلسلة جزيئية: | ISRCTN ISRCTN83330970 |
تواريخ الأحداث: | Date Created: 20201117 Date Completed: 20210125 Latest Revision: 20210125 |
رمز التحديث: | 20221213 |
مُعرف محوري في PubMed: | PMC7671539 |
DOI: | 10.1371/journal.pmed.1003388 |
PMID: | 33201927 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1549-1676 |
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DOI: | 10.1371/journal.pmed.1003388 |