Comparing Food and Cash Transfers to the Ultra-Poor in Bangladesh

"Bangladesh has some social safety net programs that transfer food to the poor, some that transfer cash, and some that provide a combination of both. This study evaluates the relative impacts of food and cash transfers on food security and livelihood outcomes among the ultra poor in Bangladesh. The programs impacts are evaluated according to various measures, including how well transfers are delivered; which transfers beneficiaries prefer; how accurately the programs target the extremely poor; effects on food security, livelihoods, and women’s empowerment; and cost effectiveness. The report identifies what has and has not worked in food and cash transfers and recommends ways of improving these programs. This study will be valuable to policymakers and others concerned with poverty reduction in Bangladesh and elsewhere." from textCash transfers, cost effectiveness, food security, Poverty, Poverty reduction, safety net programs, women empowerment,

The Impact of Nutrition during Early Childhood on Education among Guatemalan Adults

Early childhood nutrition is thought to have important effects on education, broadly defined to include various forms of learning. We advance beyond previous literature on the effect of early childhood nutrition on education in developing countries by using unique longitudinal data begun during a nutritional experiment during early childhood with educational outcomes measured in adulthood. Estimating an intent-to-treat model capturing the effect of exposure to the intervention from birth to 36 months, our results indicate significantly positive, and fairly substantial, effects of the randomized nutrition intervention a quarter century after it ended: increased grade attainment by women (1.2 grades) via increased likelihood of completing primary school and some secondary school; speedier grade progression by women; a one-quarter SD increase in a test of reading comprehension with positive effects found for both women and men; and a one-quarter SD increase on nonverbal cognitive tests scores. There is little evidence of heterogeneous impacts with the exception being that exposure to the intervention had a larger effect on grade attainment and reading comprehension scores for females in wealthier households. The findings are robust to an array of alternative estimators of the standard errors and controls for sample attrition

What Determines Adult Cognitive Skills? Influences of Pre-Schooling, Schooling, and Post-Schooling Experiences in Guatemala

Most empirical investigations of the effects of cognitive skills assume that they are produced by schooling, and that schooling is exogenous. Drawing on a rich longitudinal data set to estimate production functions for adult reading-comprehension cognitive skills and adult nonverbal cognitive skills, we find that (1) Schooling attainment has a significant and substantial effect on adult reading-comprehension cognitive skills but not on adult nonverbal cognitive skills; and (2) Pre-schooling and post-schooling experiences have substantial positive significant effects on adult cognitive skills. Pre-schooling experiences that increase height for age at age six years substantially and significantly increase adult reading-comprehension and nonverbal cognitive skills, even after controlling for schooling attainment and post-school skilled job tenure. Post-schooling tenure in skilled jobs also has a significant positive effect on adult reading-comprehension and nonverbal cognitive skills, although the latter estimate is sensitive to how we treat gender. Age also has significant positive effect but with diminishing returns on adult reading-comprehension cognitive skills. The findings (1) reinforce the importance of early life investments; (2) support the importance of childhood nutrition (“Flynn effect”) and work complexity in explaining increases in cognitive skills; (3) question interpretations of studies reporting productivity impacts of cognitive skills without controlling for endogeneity; and (4) point to limitations in using adult schooling alone to represent human capital

Comparing delivery channels to promote nutrition-sensitive agriculture: A cluster-randomized controlled trial in Bangladesh

We use a randomized controlled trial in rural Bangladesh to compare two models of delivering nutrition content jointly to husbands and wives: deploying female nutrition workers versus mostly male agriculture extension workers. Both approaches increased nutrition knowledge of men and women, household and individual diet quality, and women’s empowerment. Intervention effects on agriculture and nutrition knowledge, agricultural production diversity, dietary diversity, women’s empowerment, and gender parity do not significantly differ between models where nutrition workers versus agriculture extension workers provide the training. The exception is in an attitudes score, where results indicate same-sex agents may affect scores differently than opposite-sex agents. Our results suggest opposite-sex agents may not necessarily be less effective in providing training. In South Asia, where agricultural extension systems and the pipeline to those systems are male-dominated, training men to deliver nutrition messages may offer a temporary solution to the shortage of female extension workers and offer opportunities to scale promote nutrition-sensitive agriculture

Increasing production diversity and diet quality through agriculture, gender, and nutrition linkages: A cluster-randomized controlled trial in Bangladesh

A growing body of evidence indicates that agricultural development programs can potentially improve production diversity and diet quality of poor rural households; however, less is known about which aspects of program design are effective in diverse contexts and feasible to implement at scale. We address this issue through an evaluation of the Agriculture, Gender, and Nutrition Linkages (ANGeL) project. ANGeL is a randomized controlled trial testing what combination of trainings focused on agricultural production, nutrition behavior change communication, and gender sensitization were most effective in improving production diversity and diet quality among rural farm households in Bangladesh. We find that trainings focused on agriculture improved production diversity in terms of greater production of fruits and vegetables grown on the homestead, eggs, dairy, and fish; adding trainings on nutrition and gender did not significantly change these impacts. Trainings focused on both agriculture and nutrition showed the largest impacts on diet quality, with evidence indicating that households in this arm also significantly increased consumption out of homestead production for fruits and vegetables, eggs, dairy, and fish. Findings indicate that agricultural training that promotes production of diverse, high-value, nutrient-rich foods can increase production diversity, and this can improve diet quality, but diet quality impacts are larger when agricultural training is combined with nutrition training. Relative to treatments combining agriculture and nutrition training, we find no significant impact of adding the gender sensitization on our measures of production diversity or diet quality

Shonjibon cash and counselling : a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh

Background: Undernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months. Method: The study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child’s age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Household food security (10) Number of events for child suffering from diarrhoea, acute respiratory illness and fever (11) Average costs of mobile phone BCC and cash transfer, and benefit-cost ratio for primary and secondary outcomes. Discussion: The proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh. Trial registration: The study has been registered in the Australian New Zealand Clinical Trials Registry (ACTRN12618001975280)

Stakeholder involvement in systematic reviews:a scoping review

Abstract Background There is increasing recognition that it is good practice to involve stakeholders (meaning patients, the public, health professionals and others) in systematic reviews, but limited evidence about how best to do this. We aimed to document the evidence-base relating to stakeholder involvement in systematic reviews and to use this evidence to describe how stakeholders have been involved in systematic reviews. Methods We carried out a scoping review, following a published protocol. We searched multiple electronic databases (2010–2016), using a stepwise searching approach, supplemented with hand searching. Two authors independently screened and discussed the first 500 abstracts and, after clarifying selection criteria, screened a further 500. Agreement on screening decisions was 97%, so screening was done by one reviewer only. Pre-planned data extraction was completed, and the comprehensiveness of the description of methods of involvement judged. Additional data extraction was completed for papers judged to have most comprehensive descriptions. Three stakeholder representatives were co-authors for this systematic review. Results We included 291 papers in which stakeholders were involved in a systematic review. Thirty percent involved patients and/or carers. Thirty-two percent were from the USA, 26% from the UK and 10% from Canada. Ten percent (32 reviews) were judged to provide a comprehensive description of methods of involving stakeholders. Sixty-nine percent (22/32) personally invited people to be involved; 22% (7/32) advertised opportunities to the general population. Eighty-one percent (26/32) had between 1 and 20 face-to-face meetings, with 83% of these holding ≤ 4 meetings. Meetings lasted 1 h to ½ day. Nineteen percent (6/32) used a Delphi method, most often involving three electronic rounds. Details of ethical approval were reported by 10/32. Expenses were reported to be paid to people involved in 8/32 systematic reviews. Discussion/conclusion We identified a relatively large number (291) of papers reporting stakeholder involvement in systematic reviews, but the quality of reporting was generally very poor. Information from a subset of papers judged to provide the best descriptions of stakeholder involvement in systematic reviews provide examples of different ways in which stakeholders have been involved in systematic reviews. These examples arguably currently provide the best available information to inform and guide decisions around the planning of stakeholder involvement within future systematic reviews. This evidence has been used to develop online learning resources. Systematic review registration The protocol for this systematic review was published on 21 April 2017. Publication reference: Pollock A, Campbell P, Struthers C, Synnot A, Nunn J, Hill S, Goodare H, Watts C, Morley R: Stakeholder involvement in systematic reviews: a protocol for a systematic review of methods, outcomes and effects. Research Involvement and Engagement 2017, 3:9. https://doi.org/10.1186/s40900-017-0060-4

Why MSM in rural South African communities should be an HIV prevention research priority.

Research into HIV and men who have sex with men's (MSM) health in South Africa has been largely confined to the metropolitan centres. Only two studies were located making reference to MSM in rural contexts or same-sex behaviors among men in the same. There is growing recognition in South Africa that MSM are not only disproportionately affected by HIV and have been underserved by the country's national response, but that they contribute significantly to sustaining the high number of new infections recorded each year. We argue that to meet the objectives of the country's national strategic plan for HIV, STI and TB it is important we know how these behaviours may be contributing to the sustained rural HIV epidemic in the youngest age groups and determine what constitutes appropriate and feasible programmatic response that can be implemented in the country's public sector health services