1 research outputs found
PLoS Med
Background In 2014, the government of Togo implemented a pilot unconditional cash transfer (UCT) program in rural villages that aimed at improving childrenâs 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 motherâchild pairs during the first â1,000 daysâ of life. We primarily investigated program impact at population level on childrenâs height-for-age z-scores (HAZs) and secondarily on stunting (HAZ < â2) and intermediary outcomes including householdâs food insecurity, motherâchild pairsâ diet and health, delivery in a health facility and low birth weight (LBW), womenâs knowledge, and physical intimate partner violence (IPV). Methods and findings We implemented a parallel-clusterârandomized 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 6â29 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. Childrenâs 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]: 0.01â0.50, p = 0.039), which deteriorated in the control arm while remaining stable in the intervention arm, but had no impact on stunting (DD = â6.2 percentage points [pp], relative odds ratio [ROR]: 0.74, 95% CI: 0.51â1.06, p = 0.097). UCTs positively impacted both mothersâ and childrenâs (18â23 months) consumption of animal source foods (ASFs) (respectively, DD = +4.5 pp, ROR: 2.24, 95% CI: 1.09â4.61, p = 0.029 and DD = +9.1 pp, ROR: 2.65, 95% CI: 1.01â6.98, p = 0.048) and household food insecurity (DD = â10.7 pp, ROR: 0.63, 95% CI: 0.43â0.91, p = 0.016). UCTs did not impact on reported child morbidity 2 weekâs prior to report (DD = â3.5 pp, ROR: 0.80, 95% CI: 0.56â1.14, p = 0.214) but reduced the financial barrier to seeking healthcare for sick children (DD = â26.4 pp, ROR: 0.23, 95% CI: 0.08â0.66, 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: 1.10â2.13, p = 0.012) and lower odds of giving birth to babies with birth weights (BWs) <2,500 g (DD = â11.8, ROR: 0.29, 95% CI: 0.10â0.82, p = 0.020). Positive effects were also found on womenâs knowledge (DD = +14.8, ROR: 1.86, 95% CI: 1.32â2.62, p < 0.001) and physical IPV (DD = â7.9 pp, ROR: 0.60, 95% CI: 0.36â0.99, p = 0.048). Study limitations included the short evaluation period (24 months) and the low coverage of UCTs, which might have reduced the programâs impact. Conclusions UCTs targeting the first â1,000 daysâ had a protective effect on childâs 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