دورية أكاديمية
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Evaluation of an unconditional cash transfer program targeting children's first-1,000-days linear growth in rural Togo: A cluster-randomized controlled trial.

التفاصيل البيبلوغرافية
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.
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.
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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
الوصف
تدمد:1549-1676
DOI:10.1371/journal.pmed.1003388