Sustainability of Impacts of Cash Transfers, Food Transfers, and Behavior Change Communication in Bangladesh (TMRI)

Sustainability of Impacts of Cash Transfers, Food Transfers, and Behavior Change Communication in Bangladesh: Transfer Modality Research Initiative

This study assesses the sustainability of impacts, 4 years post-program, from a pilot safety net program that was implemented from May 2012-April 2014. The intervention, called the Transfer Modality Research Initiative (TMRI), was assigned following a cluster-randomized controlled trial design in two zones of Bangladesh (north and south). Intervention arms were assigned at the village level, where arms were as follows: (1) cash transfers [north and south]; (2) cash transfers + nutrition behavior communication change (BCC) [north only]; (3) food transfers [north and south]; (4) food transfers + nutrition BCC [south only]; (4) food-cash split [north and south]; and (5) control [north and south]. Within treatment villages, women living in very poor households were targeted to receive benefits for two years.

Study Overview

• Status: Completed
• Conditions: Child Development; Intimate Partner Violence; Food Security; Poverty; Child Nutrition; Gender Dynamics
• Intervention / Treatment: Other: Cash transfer; Other: Food transfer; Other: Food and cash transfer; Behavioral: Nutrition behavior Communication Change (BCC); Other: Control

Detailed Description

The objective of the study is to assess, 4 years after a pilot safety net intervention ended in April 2014, the sustainability of the intervention's impacts on households, children, and women. The intervention, called the Transfer Modality Research Initiative (TMRI), was assigned following a cluster-randomized controlled trial design in two zones of Bangladesh (north and south). WFP-Bangladesh implemented the intervention, and the International Food Policy Research Institute (IFPRI) conducted the impact evaluation research. Intervention arms were assigned at the village level, where arms were as follows: (1) cash transfers [north and south]; (2) cash transfers + nutrition behavior communication change (BCC) [north only]; (3) food transfers [north and south]; (4) food transfers + nutrition BCC [south only]; (5) food-cash split [north and south]; and (5) control [north and south]. Within treatment villages, women living in very poor households were targeted to receive benefits for two years, from May 2012-April 2014. For the original impact evaluation, longitudinal data on 5000 households were collected from 2012-2015 (ClinicalTrials.gov Identifier: NCT02237144).

For the sustainability study in 2018, given available funding, the sampling frame will include 4000 households. This will include all households that were originally in the following arms: (1) cash transfers [north and south]; (2) cash transfers + nutrition BCC [north only]; (3) food transfers [north and south]; (4) food transfers + nutrition BCC [south only]; (5) control [north and south].

• Study Type: Interventional
• Enrollment (Actual): 5000
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 65 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Former participant of Transfer Modality Research Initiative study (in cash, food, cash+BCC, food+BCC, or control arms)

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cash transfer; 1500 taka ($18.75) per household distributed monthly	Other: Cash transfer; 1500 taka ($18.75) per household distributed monthly
Experimental: Food transfer; 30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly	Other: Food transfer; 30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly
Experimental: Food and cash transfer; 15 kg of rice; 1 kg of lentils and 1 kg of micronutrient fortified cooking oil and 750 taka cash per household, distributed monthly	Other: Food and cash transfer; 15 kg of rice, 1 kg of lentils, and 1 kg of micronutrient-fortified cooking oil, and 750 taka cash per household, distributed monthly
Experimental: Cash transfer + nutrition BCC; 1500 taka ($18.75) per household distributed monthly. Nutrition behavior change communication (weekly, one-hour group-based meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings).	Other: Cash transfer; 1500 taka ($18.75) per household distributed monthly; Behavioral: Nutrition behavior Communication Change (BCC); Weekly, group-based, one-hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings
Experimental: Food transfer + nutrition BCC; 30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly. Nutrition behavior change communication (weekly, one-hour group-based meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings).	Other: Food transfer; 30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly; Behavioral: Nutrition behavior Communication Change (BCC); Weekly, group-based, one-hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings
Experimental: Control; No transfer, no behavior change communication	Other: Control; No transfer, no behavior change communication

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Food Consumption Score	The Food Consumption Score, as defined by the World Food Programme, is calculated as the number of food groups consumed by the household in the previous 7 days, weighted by each food group's nutritional value and frequency of consumption. Scale range is 0 to 112, with higher values reflecting higher food consumption.	After 4 years post-intervention
Child height-for-age z-score	Calculated using the 2006 WHO growth reference. This is a continuous measure that represents the number of standard deviations from the mean among comparable children in the WHO growth reference.	After 4 years post-intervention
Prevalence of physical intimate partner violence	Prevalence of any physical intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument	After 4 years post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Household dietary diversity	Measured by counting the number of food groups consumed by the household	After 4 years post-intervention
Value of total household consumption	Aggregate value of household food and non-food consumption expenditures. This is a continuous measure calculated from household survey responses on consumption behavior, using the methodology and questionnaire modules described in Deaton and Zaidi (2002). Citation: A.Deaton,, and S. Zaidi. 2002. "Guidelines for Constructing Consumption Aggregates for Welfare Analysis." Washington, DC : World Bank.	After 4 years post-intervention
Value of household food consumption	Value of household food consumption expenditures. This is a continuous measure calculated from household survey responses on consumption behavior, using the methodology and questionnaire modules described in Deaton and Zaidi (2002). Citation: A.Deaton,, and S. Zaidi. 2002. "Guidelines for Constructing Consumption Aggregates for Welfare Analysis." Washington, DC : World Bank.	After 4 years post-intervention
Value of household non-food consumption	Value of household non-food consumption expenditures. This is a continuous measure calculated from household survey responses on consumption behavior, using the methodology and questionnaire modules described in Deaton and Zaidi (2002). Citation: A.Deaton,, and S. Zaidi. 2002. "Guidelines for Constructing Consumption Aggregates for Welfare Analysis." Washington, DC : World Bank.	After 4 years post-intervention
Household food insecurity	Measured using the Household Food Insecurity Access Scale. Scale range is 0 to 27, with higher values reflecting higher food insecurity.	After 4 years post-intervention
Value of household labor income	Value of annual labor income over all household members	After 4 years post-intervention
Value of household non-labor income	Value of annual non-labor income over all household members	After 4 years post-intervention
Value of household asset ownership	Total value of all assets owned	After 4 years post-intervention
Household land ownership	Area of land owned	After 4 years post-intervention
Housing quality: interviews	Quality of housing stock. This is measured using a module developed for the study context, and information is collected through household enumerator observation during interviews.	After 4 years post-intervention
Maternal nutrition knowledge score	Number answered correctly on a test of maternal knowledge regarding infant and young child feeding practices developed for the survey, based on the curriculum of training sessions in the intervention.	After 4 years post-intervention
Maternal infant and young child feeding practices	Maternal adherence to WHO-recommended infant and young child feeding practices	After 4 years post-intervention
Child score on Raven's Progressive Matrices	Measured using Raven's Progressive Matrices set A and set B. This is constructed following the test's protocol for scoring.	After 4 years post-intervention
Child score on Early Grade Reading Assessment	Measured using Early Grade Reading Assessment adapted to local context. This is constructed following the test's protocol for scoring.	After 4 years post-intervention
Child score on Early Grade Mathematics Assessment	Measured using Early Grade Mathematics Assessment adapted to local context. This is constructed following the test's protocol for scoring.	After 4 years post-intervention
Child score on Strengths and Difficulties Questionnaire	Measured using Strengths and Difficulties Questionnaire, part of the Development and Well-Being Assessment family of mental heath measures. This is constructed following the test's protocol for scoring.	After 4 years post-intervention
Child weight-for-height z-score	Calculated using the 2006 WHO growth reference. This is a continuous measure that represents the number of standard deviations from the mean among comparable children in the WHO growth reference.	After 4 years post-intervention
Prevalence of child stunting	Calculated using the 2006 WHO growth reference	After 4 years post-intervention
Prevalence of child wasting	Calculated using the 2006 WHO growth reference	After 4 years post-intervention
Child illness	Mother's report of child illness in previous 2 weeks	After 4 years post-intervention
Parental interaction with child	Time spent on child stimulation activities in previous 7 days, measured using modules developed for the survey	After 4 years post-intervention
Parental discipline of the child	Disciplinary measures used in the past month, measured using modules developed for the survey	After 4 years post-intervention
Community norms on gender	Community leaders' attitudes toward gender, measured using modules developed for the survey	After 4 years post-intervention
Prevalence of emotional violence	Prevalence of any emotional intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument	After 4 years post-intervention
Prevalence of controlling behaviors	Prevalence of any controlling behaviors in the past 12 months measured using the WHO Violence Against Women instrument	After 4 years post-intervention
Prevalence of individual acts of intimate partner violence	Prevalence of individual acts of intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument	After 4 years post-intervention
Individual decisionmaking	Measured using men's and women's decisionmaking modules adapted from pro-WEAI	After 4 years post-intervention
Individual asset ownership	Measured using men's and women's asset ownership modules developed for the survey	After 4 years post-intervention
Individual mobility	Measured using men's and women's mobility modules adapted from pro-WEAI	After 4 years post-intervention
Individual labor force participation	Measured using men's and women's labor modules developed for the survey	After 4 years post-intervention
Individual attitudes toward gender and intimate partner violence	Measured using men's and women's attitudes toward gender and intimate partner violence modules developed for the survey	After 4 years post-intervention
Individual social capital	Measured using men's and women's social capital modules developed for the survey	After 4 years post-intervention
Individual stress	Measured using men's and women's Perceived Stress Scale scores	After 4 years post-intervention
Individual depression	Measured using men's and women's Patient Health Questionnaire-9 Depression Test scores	After 4 years post-intervention
Individual aspirations	Measured using men's and women's aspirations modules developed for the survey	After 4 years post-intervention
Spousal relationship	Measured using men's and women's relationship modules developed for the survey	After 4 years post-intervention

Collaborators and Investigators

• Sponsor: International Food Policy Research Institute
• Collaborators: Cornell University; Data Analysis and Technical Assistance Ltd; World Food Programme, Bangladesh
• Investigators: Principal Investigator: John Hoddinott, DPhil, Cornell University; Principal Investigator: Melissa Hidrobo, PhD, International Food Policy Research Institute

Study record dates

Study Major Dates

• Study Start (Actual): April 15, 2012
• Primary Completion (Actual): May 15, 2018
• Study Completion (Actual): May 15, 2018

Study Registration Dates

• First Submitted: May 14, 2018
• First Submitted That Met QC Criteria: January 17, 2019
• First Posted (Actual): January 18, 2019

Study Record Updates

• Last Update Posted (Actual): January 18, 2019
• Last Update Submitted That Met QC Criteria: January 17, 2019
• Last Verified: January 1, 2019

More Information

Terms related to this study

• Keywords: Nutrition; Sustainability; Gender; Cash transfers; Food transfers; Behavior change communication; Social protection
• Other Study ID Numbers: 12835

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No