The Effect of a Cash Transfer Program and Preventive Nutrition Packages on Household Welfare and Child Nutritional Status in Mali (Jigisemejiri)

In the last two decades, cash transfer (CT) programs have emerged as a popular approach to long-term poverty alleviation. While the main goal of cash transfer programs is to reduce poverty, they also have the potential to improve many development outcomes, such as health and education.

While many studies, mainly in Latin America and Asia, have investigated the impacts of CTs on poverty and food security and have, for the most part, found positive impacts, less is known about the impacts of CTs in Africa south of the Sahara, and, in particular, West Africa. Moreover, despite the fact that cash transfers have been shown to lead to decreases in poverty, improvements in household food security, and increases in health service utilization, impacts on children's nutritional status (including anthropometric measures) are generally small (Manley, Gitter, and Slavchevska 2013). Consequently, policymakers and governments are left with the question of how to design social safety nets, such as cash transfers, to achieve greater impact on diet quality, health, and nutrition.

The overall goal of this research is to generate evidence and knowledge on an integrated program implemented by the Government of Mali that includes a combination of cash transfers and targeted nutrition interventions. The information generated will inform program implementers and policymakers about best options to improve food security and nutrition among vulnerable groups and individuals in West Africa. Specifically, the main objectives of the research are

1. To provide evidence on the contribution of integrated social transfer programs to enhancing household welfare, food security, dietary diversity, and maternal and child nutrition in West Africa.
2. To test different features and combinations of cash transfers and targeted nutrition interventions, and assess their impact on food security and maternal and child nutrition and health outcomes in Mali.
3. To generate knowledge regarding the pathways of impact of these different program packages, identify the most effective and efficient modalities in the context of Mali, and derive lessons learned for other countries in the region.

Study Overview

• Status: Completed
• Conditions: Child Malnutrition; Poverty
• Intervention / Treatment: Other: Cash distribution during the last 12 months; Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during the last 12 months; Other: Cash distribution during first 36 months; Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months; Dietary supplement: Preventive Nutrition Packages during last 12 months

Detailed Description

The research entails two study designs: i) a repeated cross-sectional survey (baseline, midline and endline) in a sample of 1,440 children between 6 and 24 months of age, mainly to asses the program's impact on child nutrition and health outcomes; ii) a panel study following a cohort of 2,880 children over 3 years mainly focusing on the evaluation of household welfare outcomes. The study will be conducted in the 96 communes where the Jigisemejiri program is being implemented, situated in 5 regions of Mali: Sikasso, Koulikoro, Segou, Mopti and Kayes. Data will be collected at baseline (2014, T=0), midline (2016, T=~24 months) and endline (2018, T=~48 months).

The program is implemented for 48 months. The experimental group receives the cash transfer and group counselling intervention for 36 months. During the last 12 months the experimental group does not receive any intervention. The control group receives no intervention during the first 36 months, but receives the cash transfer and group counselling during the last 12 months. In a subsample of communes from the experimental group, villages were randomized to either receive Preventive Nutrition Packages (PNP) or nothing. The impact of PNP is analyzed by comparing villages that received PNP and villages that did not receive PNP during the last 12 months of the program.

• Study Type: Interventional
• Enrollment (Actual): 4320
• Phase: Phase 4

Contacts and Locations

Study Locations

• Mali
  • Bamako, Mali

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 months to 5 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Being a Household that is beneficiary of the Jigisemejiri program
• Having a child between 6 and 24 months of age

Exclusion Criteria:

• Congenital malformations that hamper anthropometric measurements

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control and comparison group -cash transfer program; The program is implemented during 48 months. During the first 36 months the control group does not receive any intervention. During the last 12 months eligible beneficiaries receive cash transfer and accompanying information sessions on health, child nutrition, household economics every three months (identical to experimental group).	Other: Cash distribution during the last 12 months; Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.; Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during the last 12 months; Large group gatherings of cash beneficiaries are organized in parallel to the cash distributions. During these meetings, local NGOs present and discuss a topic related to health, child nutrition, household economics or education.
Experimental: Jigisemejiri cash transfer program; Unconditional cash is distributed every 3 months to beneficiaries of the Jigisemejiri program. During cash handouts, information sessions on health, child nutrition, households economics and education are organized by local NGOs.	Other: Cash distribution during first 36 months; Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.; Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months; Large group gatherings of cash beneficiaries are organized in parallel to the cash distributions. During these meetings, local NGOs present and discuss a topic related to health, child nutrition, household economics or education.
Experimental: Jigisemejiri - Preventive Nutrition packages; Households belonging to the experimental group who previously received Cash transfer and information sessions on health, child nutrition, households economics and education for 36 months, with children and/or pregnant/lactating women receiving rations of fortified flour (PNP) during the last 12 months of the project	Other: Cash distribution during first 36 months; Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.; Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months; Large group gatherings of cash beneficiaries are organized in parallel to the cash distributions. During these meetings, local NGOs present and discuss a topic related to health, child nutrition, household economics or education.; Dietary supplement: Preventive Nutrition Packages during last 12 months; Fortified flour supplements for children (Supercereal Plus)and pregnant/lactating mothers (super Cereal)
Active Comparator: Control and comparison group - Preventive Nutrition packages; Households belonging to the experimental group who previously received Cash transfer and information sessions on health, child nutrition, households economics and education for 36 months, with children and/or pregnant/lactating women	Other: Cash distribution during first 36 months; Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.; Behavioral: Accompanying information sessions on health, child nutrition, household economics and education during first 36 months; Large group gatherings of cash beneficiaries are organized in parallel to the cash distributions. During these meetings, local NGOs present and discuss a topic related to health, child nutrition, household economics or education.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child Height-for-age Z-score	To calculate WHZ scores the 2006 WHO growth reference will be used	After 24 months of program implementation
Value of household consumption	The household consumption includes food and non-food related economic consumption	After 24 months of program implementation
Household dietary diversity	The household dietary diversity is estimated by a dietary diversity score counting food groups	After 24 months of program implementation
Child Height-for-age Z-score	To calculate HAZ scores the 2006 WHO growth reference will be used (only in cross-sectional survey)	After 48 months of program implementation (only in cross-sectional survey)
Value of household consumption	The household consumption includes food and non-food related economic consumption	After 48 months of program implementation
Household dietary diversity	The household dietary diversity is estimated by a dietary diversity score counting food groups	After 48 months of program implementation
Child Weight-for-Height Z-score	To calculate WHZ scores the 2006 WHO growth reference will be used (only in cross-sectional survey)	After 48 months of program implementation (only in cross-sectional survey)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child Weight-for-height Z-score	To calculate WHZ scores the 2006 WHO growth reference will be used	After 24 months of program implementation
Prevalence of child wasting	To calculate WHZ scores the 2006 WHO growth reference will be used	After 24 months and 48 months (only in cross-sectional survey) of program implementation
Prevalence of child stunting	To calculate WHZ scores the 2006 WHO growth reference will be used	After 24 months and 48 months (only in cross-sectional survey) of program implementation
Child hemoglobin concentration		After 24 months and 48 months (only in cross-sectional survey) of program implementation
Prevalence of child anemia		After 24 months and 48 months (only in cross-sectional survey) of program implementation
Body Mass Index of primary caregiver of index child		After 24 months and 48 months (only in cross-sectional survey) of program implementation
Early child development		After 24 months and 48 months (only in cross-sectional survey) of program implementation
Child morbidity (acute respiratory infections, fever, vomiting, diarrhea)		After 24 months and 48 months (only in cross-sectional survey) of program implementation
Caregiver's knowledge and practices related to Infant and Young Child Feeding (IYCF), child health and hygiene		After 24 months and 48 months (only in cross-sectional survey) of program implementation
Household assets and savings		After 24 months and 48 months (only in cross-sectional survey) of program implementation
Educational level of Household members		After 24 months and 48 months of program implementation
Household food security	Measured by the Household Food Insecurity Access Scale (HFIAS)	After 24 months and 48 months of program implementation
Household composition	This entails the household size, the number of one parent households, monogamous and polygamous households, number of infants and children.	After 24 months and 48 months of program implementation
Household agricultural production	The composition and quantity of all crops grown by the houshold over the last year is being recalled	After 24 months and 48 months of program implementation
Cognitive function of the head of household	Measured by spatial Stroop test and digit span test (forward and backward)	After 24 months of program implementation
Well-being of household members	Well-being is assessed by measuring stress, anxiety, psychological well-being, partner violence, marital quality, depression, occurrence of disputes and resource allocation.	After 24 months and 48 months of program implementation
Women's empowerment	Measured by pro-WEAI instrument adapted to local context	After 24 months and 48 months of program implementation
Child dietary diversity	Child dietary diversity is estimated by a dietary diversity score counting food groups consumed	After 24 months and 48 months (only in cross-sectional survey) of program implementation
Professional occupation of household members	We assess if household members have different formal and informal professional occupations or main revenue generating activities between intervention and control group	After 24 months and 48 months of program implementation
Child Mid-upper Arm Circumference		After 24 months and 48 months (only in cross-sectional survey) of program implementation
Maternal hemoglobin concentration		After 48 months (only in cross-sectional survey) of program implementation
Maternal anemia		After 48 months (only in cross-sectional survey) of program implementation

Collaborators and Investigators

• Sponsor: International Food Policy Research Institute
• Collaborators: Institut de Recherche pour le Developpement; Implementation management committee of the Jigisemejiri program (Ministry of Economics and Finance, Government of Mali)
• Investigators: Study Chair: Dan Gilligan, PhD, IFPRI; Study Chair: Marie Ruel, PhD, IFPRI; Principal Investigator: Melissa Hidrobo, PhD, IFPRI; Principal Investigator: Shalini Roy, PhD, IFPRI

Study record dates

Study Major Dates

• Study Start: September 1, 2014
• Primary Completion (Actual): August 10, 2019
• Study Completion (Actual): August 10, 2019

Study Registration Dates

• First Submitted: August 3, 2016
• First Submitted That Met QC Criteria: August 3, 2016
• First Posted (Estimate): August 8, 2016

Study Record Updates

• Last Update Posted (Actual): September 6, 2019
• Last Update Submitted That Met QC Criteria: September 3, 2019
• Last Verified: September 1, 2019

More Information

Terms related to this study

• Keywords: behavior change communication; cash transfer; household welfare; child nutrition status
• Additional Relevant MeSH Terms: Nutrition Disorders; Malnutrition; Child Nutrition Disorders
• Other Study ID Numbers: 2014-26-PHND-M

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO