Impact evaluation of a conditional cash transfer program

"This paper presents the main findings of a quantitative evaluation of the Red de Protección Social (RPS), a conditional cash transfer program in Nicaragua, against its primary objectives. These included supplementing income to increase household expenditures on food, reducing primary school desertion, and improving the health care and nutritional status of children under age 5. The evaluation design is based on a randomized, community-based intervention with measurements before and after the intervention in both treatment and control communities. Where possible, we erred on the side of assessing effects in conservative manners, for example, in the calculation of standard errors and the treatment of possible control group contamination. Overall, we find that RPS had positive (or favorable) and significant double-difference estimated average effects on a broad range of indicators and outcomes. Where it did not, it was often due to similar, smaller improvements in the control group that appear to have been stimulated indirectly by the program. Most of the estimated effects were larger for the extreme poor. The findings presented here played an important role in the decision to continue this effective program." Authors' AbstractImpact evaluation ,Transfer payments ,Human capital ,Impact assessment ,

Effectiveness of specialized nutritious foods and social and behavior change communication interventions to prevent stunting among children in Badakhshan, Afghanistan: Protocol for a quasi-experimental study

Stunting predominantly occurs during the first 1000 days of life and continues to the age of five years. We will aim to assess the effectiveness of specialized nutritious foods (SNF)and social and behavior change communication (SBCC) strategies during the first 1000 days of life to prevent stunting among children in two rural districts of Badakhshan, Afghanistan. This will be a quasi-experimental pre-post study with the control group utilizing qualitative and quantitative methods. Before launching the program, formative research will be conducted on the acceptability, appropriate use and SBCC strategies needed to support the introduction of intervention package. Repeated cross-sectional baseline and endline surveys will be conducted in both the intervention and the control districts. After the formative research and baseline household survey, an intervention focusing on the provision of SNF, targeting pregnant and lactating women and children 6-23 months, and SBCC strategies will be implemented for at least 12 months. The primary outcome will be a reduction in the prevalence of stunting among children under two years in the intervention group compared to the control group. We will aim to compare the intervention and control group between the pre- and post-intervention assessments to isolate the effect of the intervention by difference-in-differences estimates. The program monitoring and evaluation component will examine the quality of implementation, acceptability of intervention, identification of potential barriers and to learn how to enhance the program\u27s effectiveness through ongoing operational improvements. The results will be beneficial to design interventions to prevent stunting within Afghanistan and other low-middle-income countries

Burden of severe maternal morbidity and association with adverse birth outcomes in sub–Saharan Africa and south Asia: protocol for a prospective cohort study

Background Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia in children and young adults worldwide. The disease burden associated with N. meningitidis infections has not been systematically assessed in China. Therefore, we undertook this study to determine the burden of meningococcal disease in China. Method We performed a systematic review and meta–analysis of articles on N. meningitidis incidence, carriage, seroprevalence and mortality rates in China by searching the Chinese BioMedical Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang database and PubMed for publications from January 2005 to Aug 2015. Results In total, 50 articles were included in our analysis. The overall incidence of meningococcal disease and associated mortality were estimated to be 1.84 (95% confidence interval (CI) 0.91–3.37) per 100 000 persons per year and 0.33 (95% CI 0.12–0.86) per 100 000 persons per year, respectively. N. meningitidis carriage rate among the healthy population was estimated to be 2.7% (95% CI 2.0–3.5%). Prevalence of antibodies against N. meningitidis serogroup A and C were estimated to be 77.3% (95% CI 72.4%–81.6%) and 33.5% (95% CI 27.0%–40.8%), respectively. No studies were found for serogroup specific disease burden. Conclusions The overall incidence of meningococcal disease in China is low. The lower seroprevalence of serogroup C within the population suggests that it may pose a greater risk for meningococcal disease outbreak than serogroup A. The lack of data on serogroup disease burden by age groups suggests the implementation of laboratory based meningococcal surveillance systems are urgently needed in China

Health effect of household fuel pollution on young children in semi-urban and urban areas of Bangladesh

Household fuel pollution from the use of low quality biomass fuels is considered as a risk factor for respiratory tract infections (RTl) in women and children. Inhalation of fuel-derived pulmonary toxins (e.g. particulate matter (PM2.5µm) , and carbon monoxide (CO) can harm the lungs of young children, due to their under-developed immune defences. In Bangladesh acute respiratory infections (ARI) are the leading cause of child mortality « 5years of age). This thesis aimed to examine the relationship between RTl and household fuel pollution exposure using measured pollution data and medical diagnoses. During an 18-month longitudinal health intervention in northern Bangladesh households (n=408) were interviewed (3 times) on cooking/fuel-use practices and child health. Anthropometric data (height/weight) and finger-prick blood samples for analysis of immune status (c-reactive protein, alpha-I-acidglycoprotein (AGP) and albumin) were collected (n=32 I < 5years of age). All unwell children (62.4%) were medically examined. Household pollution levels (particulate matter (PM2.5µm) and carbon monoxide (CO) were monitored for a 24-hour period (n=61). Moderate/ severe RTI was common (24.8%) (youngest child only n=213). Poor child growth (stunted: 43.8%, underweight=66.7%, wasted: 38.4%) and immunity were detected. 98% of the households used inefficient chimneyless mud stoves and low quality biomass fuels (wood, golden, dung). The measured indoor pollution levels exceeded the WHO safety thresholds (PM2.5 µm range: 85 to 3020 µm/m3 CO range: 0-16 ppm) (PM2.5 µm>25 µm/m3 , CO>9ppm). Longitudinal multivariate GLM showed that cooking practices were associated with child immune status: haemoglobin levels (F= 1.555, p=NS) were significantly associated with Bihari ethnicity and a fixed stove use (F=3.718 and F=3.716, p<0.05 respectively). Elevated 10glO-AGP levels were found (F=4.371, p<0.05) in Saidpur in households using a fixed stove (F=4.123, F=3.780, p<0.05). The patterns in child growth z-scores were due to age only (stunting: F=7.413,

Operationalizing a proposed national protocol for the prevention and management of severe pre-eclampsia and eclampsia using a loading dose of magnesium sulphate at community health facilities in Bangladesh

About 20 percent of maternal deaths in Bangladesh are caused by pre-eclampsia and eclampsia. Most of these deaths, which occur during care within local communities due to lack of maternal health information, poor antenatal care attendance, and delays in seeking care, can be easily prevented with low-cost maternal health commodities. A quasi-experimental pre- and post-test study, with no control group, was implemented to assess the abilities of community facility service providers to screen and detect eclampsia patients, administer a loading dose of magnesium sulphate to diagnosed patients, and refer them to an appropriate facility for condition management. These interventions were instituted for nine months in 19 Union Health and Family Welfare Centers and 53 community clinics in two upazilas in Brahmanbaria district. The general objective of this study was to assess the abilities of community facility-based service providers in screening and detecting PE/E patients, then administering a loading dose of MgSO4 to appropriate patients and referring them to higher-level-care facilities. This report presents findings from this study

Workforce interventions to deliver postnatal care to improve neonatal outcomes in low and lower-middle income countries: a narrative synthesis

CAUL read and publish agreement 2023fals

Promoting Handwashing and Sanitation: Evidence From a Large-Scale Randomized Trial in Rural Tanzania

This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. Their results highlight the importance of focusing on intermediate outcomes of take-up and behavior change as a critical first step in large-scale programs before realizing the changes in health that sanitation and hygiene interventions aim to deliver

Assessment of Micronutrient Status in Pregnant Malawian Women Before and After Treatment for Moderate Malnutrition

Background: Multiple micronutrient deficiencies are prevalent in pregnant women in developing countries and can result in adverse effects to both the mother and infant. Multiple micronutrient supplements or supplementary foods may be a way to combat micronutrient deficiencies. Objective: To assess change in micronutrient and protein levels in moderately malnourished pregnant Malawian women after receiving one of three nutritional interventions. Methods: Serum retinol, 25-hydroxyvitamin D, ferritin, vitamin B12, folate, zinc, albumin and C-reactive protein concentrations were measured in pregnant women with MUAC \u3e20.6 cm and Results: Baseline micronutrient concentrations indicated high rates of deficiency in zinc (29-39%) and albumin (37-46%), and marginal status of retinol (26-37%) and vitamin D (31-32%). Adjusted mean changes in vitamin B12 concentrations from week 0 to week 10 were -17.1, -36.1, and -52.9 pg/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in vitamin D concentrations from week 0 to week 10 were 6.1, 3.1, and 1.7 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in folate concentrations from week 0 to week 10 were 2.2, 1.7, and 4.0 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.37 for effect of treatment; p=0.06 for the interaction effect of time*treatment). Changes in ferritin, zinc, albumin, retinol, and CRP were not significantly different between treatment groups. Conclusions: Deficiencies in zinc and albumin, and marginal status of vitamin D and retinol, are common among this population of moderately malnourished pregnant Malawian women. Significant changes in vitamin D and vitamin B12were observed from week 0 to week 10, with the RUSF group having the greatest improvements compared to the CSB-UNIMMAP and CSB-IFA treatments

Prevalence of Undiagnosed Diabetes in 2004 and 2012: Evidence From the English Longitudinal Study of Aging

BACKGROUND: In light of recent publicity campaigns to raise awareness of diabetes, we investigated changes in the prevalence of diabetes and undiagnosed diabetes in adults age 50 and older in England between 2004 and 2012, and explored risk factors for undiagnosed diabetes. METHOD: 7666 and 7729 individuals were from Wave 2 (2004-2005, mean age 66.6) and Wave 6 (2012-2013, mean age 67.6) of the English Longitudinal Study of Ageing. Diagnosed diabetes was defined as either self-reported diabetes or taking diabetic medications. Undiagnosed diabetes was defined as not self-reporting diabetes and not taking diabetic medications, but having a glycated haemoglobin measurement ≥ 48 mmol/mol (6.5%). RESULTS: There were increases in both diagnosed diabetes (7.7% to 11.5%) and undiagnosed diabetes (2.4% to 3.4%) between 2004 and 2012. However, a small decrease in the proportion of people with diabetes who were unaware of this condition (24.5% to 23.1%, p<0.05) was observed. Only men aged 50-74 showed a stable prevalence of undiagnosed diabetes, with better recognition of diabetes. Age, non-white ethnicity, manual social class, higher diastolic blood pressure and cholesterol level were factors associated with higher risks of undiagnosed diabetes, whereas greater depressive symptoms were related to lower risks. CONCLUSION: This study suggests that the greater awareness of diabetes in the population of England has not resulted in a decline in undiagnosed cases between 2004 and 2012. A greater focus on people from lower socioeconomic groups and those with cardiometabolic risk factors may help early diagnosis of diabetes for older adults