Cash Transfers to Increase Dietary Diversity in Grand Gedeh County, Liberia

A Cluster Randomized Trial to Study the Effect of Cash Transfers and Nutrition Education on Dietary Diversity Among Children 6-23 Months of Age in Grand Gedeh County, Liberia: a Pilot Study

The investigators aim to evaluate the efficacy of a cash transfer and nutrition education program delivered by community health assistants to increase dietary diversity among children 6 to 23 months of age in Grand Gedeh County, Liberia.

Study Overview

• Status: Completed
• Conditions: Malnutrition, Child
• Intervention / Treatment: Other: Cash Transfer; Other: Cash Transfers and Nutrition Education

Detailed Description

Worldwide, more than one in five children suffer from chronic malnutrition. In Liberia, there are more than 230,000 children suffering from chronic malnutrition and 32% of children under five are stunted. Previous studies have shown that inadequate dietary diversity is strongly associated with stunting in children under two years of age. An interventional package including cash transfers and education has the potential to improve dietary diversity and long-term outcomes such as improved growth and reduced rates of stunting among children.

The investigators' objective is to evaluate the efficacy of a cash transfer and nutrition education program delivered by community health assistants to increase dietary diversity among children 6 to 23 months of age in Grand Gedeh County, Liberia. The investigators will conduct a pilot, cluster randomized trial in 45 communities. The investigators hypothesize that a multi-pronged interventional package aimed at strengthening the household environment will result in improved dietary diversity for children 6 to 23 months of age. Moreover, the investigators also hypothesize that unconditional cash transfers will result in improved dietary diversity for children 6 to 23 months of age in Grand Gedeh County, Liberia.

• Study Type: Interventional
• Enrollment (Actual): 599
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Liberia
  • Zwedru, Liberia
    • Grand Geddeh County Health Office

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 months to 1 year (Child)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Participants 6 to 23 months of age
• Participants with consenting caregivers to have monthly visits and to participate in the program
• Caregivers of all ages will be included

Exclusion Criteria:

• Participants who are younger than 6 months of age (children < 6 months of age are encouraged to exclusively breastfeed, making dietary diversity irrelevant in this age group)
• Participants older than 23 months of age
• Participants with non-consenting caregivers

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; Participants in this arm will receive routine monthly visits along with survey administration and the regular package of health services provided at the facility level and at home by community health assistants
Experimental: Cash Transfers; Participants in this arm will receive routine monthly visits along with the regular package of health services provided at the facility level and at home by community health assistants and unconditional cash transfers every month	Other: Cash Transfer; Monthly cash transfers
Experimental: Cash Transfers and Nutrition Education; Participants in this arm will receive routine monthly visits along with the regular package of health services provided at the facility level and at home by community health assistants, unconditional cash transfers every month, and structured nutrition education provided at household level by community health assistants based on a structured nutrition education handbook.	Other: Cash Transfers and Nutrition Education; Cash transfers every month and structured nutrition education provided at household level by community health assistants based on a nutrition education handbook

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in proportion of children 6 to 23 months of age who meet minimum dietary diversity scores (DDS) over the study period as reported by caregivers	The DDS has been widely used to measure the sum of diverse food groups consumed in a 24-hour period	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Meal frequency	Mean self-reported meal frequency over the 24-hour period prior to monthly CHA visits	6 months
Increase in child weight in kilograms	changes in child weight in kilograms during the study period measured with digital scale (UNISCALE)	6 months
Increase in mid upper arm circumference in centimeters	changes in mid upper arm circumference in centimeters measured with MUAC tape measure	6 months
Increase in child length/height in centimeters	changes in child length/height in centimeters during the study period measured with Height Board	6 months
Health care utilization (clinic)	number of clinic visits for illnesses (including type of illness)	6 months
Health care utilization (hospital)	hospitalizations (if any) during the study period	6 months
Health care utilization (antimicrobials)	use of antibiotics/antimalarials during the study period	6 months
Health care utilization (nutritional support)	if the child received supplementary nutritional support (e.g. ready to use therapeutic food RUTF)	6 months
Knowledge, attitudes, and practices	caregiver's knowledge, attitudes, and practices (KAP) of infant and young child feeding	6 months

Collaborators and Investigators

• Sponsor: Boston Children's Hospital
• Collaborators: UNICEF

Publications and helpful links

General Publications

• Rees CA, Cleon D, Davis AB, Sammy AM, Britto CD, Massaquoi W, Forkpa OW, Johnson AJ, Hook VF, MaCauley JA, Pewu GF, Gorpue M, Gborie A, Brown TT, Fannieh A, Dweh T, Marley RB, Baysah MK, Nowine NN, Niescierenko M, Zaizay L. Cash transfers and nutrition education to improve dietary diversity among children aged 6-23 months in Grand Gedeh County, Liberia: a cluster-randomized trial. J Trop Pediatr. 2022 Oct 6;68(6):fmac096. doi: 10.1093/tropej/fmac096.

Study record dates

Study Major Dates

• Study Start (Actual): October 15, 2019
• Primary Completion (Actual): July 31, 2021
• Study Completion (Actual): November 1, 2022

Study Registration Dates

• First Submitted: June 27, 2019
• First Submitted That Met QC Criteria: September 23, 2019
• First Posted (Actual): September 24, 2019

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 8, 2025
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: Dietary diversity; Stunting; Liberia; Cash Transfers
• Additional Relevant MeSH Terms: Nutrition Disorders; Malnutrition; Child Nutrition Disorders
• Other Study ID Numbers: P00031767

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No