Impact evaluation of a maternal and child cash transfer intervention, integrated with nutrition, early childhood development, and agriculture messaging (MAZIKO-IE): a study protocol for a cluster-randomised controlled trial.

Cash transfers Community-based child centres Early child development Impact evaluation Nutrition

Journal

Trials

ISSN: 1745-6215

Titre abrégé: Trials

Pays: England

ID NLM: 101263253

Informations de publication

Date de publication:
13 Jan 2024

Historique:

received: 22 04 2023

accepted: 06 11 2023

medline: 14 1 2024

pubmed: 14 1 2024

entrez: 13 1 2024

Statut: epublish

Résumé

Children in Malawi face high rates of malnutrition and are at risk of not reaching their developmental potential. Community-based childcare centres (CBCCs) can be cost-effective platforms for scaling-up early childhood development (ECD) and nutrition social behaviour change (SBC) interventions. However, evidence also suggests potential synergies from coupling nutrition SBC with cash transfers (CT), given that rural households in Malawi face high levels of poverty and recurring extreme lean season food-security shocks. The Maziko trial is aimed at evaluating the effectiveness and cost-effectiveness of using CBCCs and parenting care groups as platforms to improve maternal diets and child nutrition and development by providing nutrition-sensitive SBC and CT intervention packages in communities already receiving a standard of care Government SBC program. We designed a 3-year cluster-randomised controlled trial in two districts of Malawi, including 156 communities randomised to one of four treatment arms: (1) standard of care (SoC) arm: receiving the standard Government SBC program; (2) SBC arm: receiving the SoC intervention with additional nutrition-sensitive SBC activities to improve nutritious food production, diets, and care practices for young children; (3) low CT arm: SoC plus SBC plus a maternal and child cash transfer ~ 17 USD per month; and (4) high CT arm: SoC plus SBC plus a maternal and child CT ~ 43 USD per month. The trial will enrol pregnant women and children < 2 years of age. The primary outcomes are maternal diet assessed using the mean probability of adequacy and child development assessed using the Malawi Developmental Assessment Tool. Intermediate outcomes along the programme impact pathways will also be measured, including maternal mental health, maternal empowerment, child feeding practices, and child nutritional status. This is the first study to examine the impact and synergies of combining ECD SBC with nutrition-sensitive SBC and CTs on maternal and child outcomes during the first 1000 days. The findings from this evaluation will inform national ECD and nutrition programmes. ISRCTN ISRCTN53055824. Registered on 7 March 2022.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

We designed a 3-year cluster-randomised controlled trial in two districts of Malawi, including 156 communities randomised to one of four treatment arms: (1) standard of care (SoC) arm: receiving the standard Government SBC program; (2) SBC arm: receiving the SoC intervention with additional nutrition-sensitive SBC activities to improve nutritious food production, diets, and care practices for young children; (3) low CT arm: SoC plus SBC plus a maternal and child cash transfer ~ 17 USD per month; and (4) high CT arm: SoC plus SBC plus a maternal and child CT ~ 43 USD per month. The trial will enrol pregnant women and children < 2 years of age. The primary outcomes are maternal diet assessed using the mean probability of adequacy and child development assessed using the Malawi Developmental Assessment Tool. Intermediate outcomes along the programme impact pathways will also be measured, including maternal mental health, maternal empowerment, child feeding practices, and child nutritional status.

DISCUSSION CONCLUSIONS

This is the first study to examine the impact and synergies of combining ECD SBC with nutrition-sensitive SBC and CTs on maternal and child outcomes during the first 1000 days. The findings from this evaluation will inform national ECD and nutrition programmes.

TRIAL REGISTRATION BACKGROUND

ISRCTN ISRCTN53055824. Registered on 7 March 2022.

Identifiants

DOI: 10.1186/s13063-023-07782-3 PMID: 38218938

pubmed: 38218938

doi: 10.1186/s13063-023-07782-3

pii: 10.1186/s13063-023-07782-3

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

Investigateurs

Aulo Gelli (A)

Jan Duchoslav (J)

Melissa Gladstone (M)

Daniel Gilligan (D)

Mangani Katundu (M)

Ken Maleta (K)

Agnes Quisumbing (A)

Lilia Bliznashka (L)

Marilyn Ahun (M)

Informations de copyright

Références

Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, et al. Early childhood development coming of age: science through the life course. Lancet. 2017;389:77–90. https://doi.org/10.1016/S0140-6736(16)31389-7 .

doi: 10.1016/S0140-6736(16)31389-7 pubmed: 27717614

Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–51. https://doi.org/10.1016/S0140-6736(13)60937-X .

doi: 10.1016/S0140-6736(13)60937-X pubmed: 23746772

Initiatives Development. Global Nutrition Report 2017: Nourishing the SDGs. Bristol, UK: Development Initiatives; 2017.

Bailey RL, West KP Jr, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66(suppl 2):22–33.

doi: 10.1159/000371618 pubmed: 26045325

National Statistical Office. Malawi Demographic and Health Survey. Natl Stat Off DHS Progr. 2017; 1–658. http://www.measuredhs.com/ .

Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, et al. Nurturing care: promoting early childhood development. Lancet. 2017;389:91–102. https://doi.org/10.1016/S0140-6736(16)31390-3 .

doi: 10.1016/S0140-6736(16)31390-3 pubmed: 27717615

Black MM, Trude ACB, Lutter CK. All children thrive: integration of nutrition and early childhood development. Annu Rev Nutr. 2020;40:375–406. https://doi.org/10.1146/annurev-nutr-120219-023757 .

doi: 10.1146/annurev-nutr-120219-023757 pubmed: 32966185

Alderman H, Fernald L. The nexus between nutrition and early childhood development. Annu Rev Nutr. 2017;37:447–76. https://doi.org/10.1146/annurev-nutr-071816-064627 .

doi: 10.1146/annurev-nutr-071816-064627 pubmed: 28564554

Heckman JJ. Skill formation and the economics of investing in disadvantaged children. Science (80-). 2006;312:1900–2. https://doi.org/10.1126/science.1130121 .

doi: 10.1126/science.1130121

Daelmans B, Black MM, Lombardi J, Lucas J, Richter L, Silver K, et al. Effective interventions and strategies for improving early child development. BMJ. 2015;351:h4029. https://doi.org/10.1136/bmj.h4029 .

doi: 10.1136/bmj.h4029 pubmed: 26371213

Engle PL, Black MM, Behrman JR, de Cabral Mello M, Gertler PJ, Kapiriri L, et al. Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. Lancet. 2007;369:229–42. https://doi.org/10.1016/S0140-6736(07)60112-3 .

doi: 10.1016/S0140-6736(07)60112-3 pubmed: 17240290

Manley J, Balarajan Y, Malm S, Harman L, Owens J, Murthy S, et al. Cash transfers and child nutritional outcomes: a systematic review and meta-analysis. BMJ Glob Heal. 2020;5:1–9. https://doi.org/10.1136/bmjgh-2020-003621 .

doi: 10.1136/bmjgh-2020-003621

de Groot R, Palermo T, Handa S, Ragno LP, Peterman A. Cash transfers and child nutrition: pathways and impacts. Dev Policy Rev. 2017;35:621–43. https://doi.org/10.1111/dpr.12255 .

doi: 10.1111/dpr.12255 pubmed: 31363343 pmcid: 6667168

Brugh K, Angeles G, Mvula P, Tsoka M, Handa S. Impacts of the Malawi social cash transfer program on household food and nutrition security. Food Policy. 2018;76:19–32. https://doi.org/10.1016/j.foodpol.2017.11.002 .

doi: 10.1016/j.foodpol.2017.11.002

Ruel MT, Quisumbing AR, Balagamwala M. Nutrition-sensitive agriculture: What have we learned so far? Glob Food Sec. 2018;17:1–26. https://doi.org/10.1016/j.gfs.2018.01.002 .

doi: 10.1016/j.gfs.2018.01.002

Ruel MT, Alderman H. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382:536–51. https://doi.org/10.1016/S0140-6736(13)60843-0 .

doi: 10.1016/S0140-6736(13)60843-0 pubmed: 23746780

Özler B, Fernald LCH, Kariger P, McConnell C, Neuman M, Fraga E. Combining pre-school teacher training with parenting education: a cluster-randomized controlled trial. J Dev Econ. 2018;133:448–67. https://doi.org/10.1016/j.jdeveco.2018.04.004 .

doi: 10.1016/j.jdeveco.2018.04.004

Gelli A, Margolies A, Santacroce M, Roschnik N, Twalibu A, Katundu M, et al. Using a community-based early childhood development center as a platform to promote production and consumption diversity increases children’s dietary intake and reduces stunting in Malawi: a cluster-randomized trial. J Nutr. 2018;148:1587–97. https://doi.org/10.1093/jn/nxy148 .

doi: 10.1093/jn/nxy148 pubmed: 30204916 pmcid: 6168702

Gelli A, Kemp C, Margolies A, Twalibu A, Katundu M, Levin C. Economic evaluation of an early childhood development center–based agriculture and nutrition intervention in Malawi. Food Secur. 2021. https://doi.org/10.1007/s12571-021-01203-6 .

doi: 10.1007/s12571-021-01203-6

World Bank. Investing in early years for growth and productivity in Malawi project. Washington, DC: 2018.

Gelli A, Donovan J, Margolies A, Aberman N, Santacroce M, Chirwa E, et al. Value chains to improve diets: diagnostics to support intervention design in Malawi. Glob Food Sec. 2019. https://doi.org/10.1016/J.GFS.2019.09.006 .

doi: 10.1016/J.GFS.2019.09.006

WHO, UNICEF, World Bank. Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. Geneva: 2018.

Save the Children. Real Fathers: Mentor Visit Guide. Lilongwe. 2017.

USAID Advancing Nutrition. Responsive care ad early learning Addendum: Counseling Cards. Arlington, VA: USAID Advancing Nutrition; 2021.

Davis B, Handa S, Hypher N, Rossi NW, Winters P, Yablonski J. From evidence to action: the story of cash transfers and impact evaluation in sub Saharan Africa. OUP Oxford; 2016.

Schneider KR. Nationally representative estimates of the cost of adequate diets, nutrient level drivers, and policy options for households in rural Malawi. Food Policy. 2022;113:102275. https://doi.org/10.1016/j.foodpol.2022.102275 .

doi: 10.1016/j.foodpol.2022.102275 pubmed: 36570775 pmcid: 9763653

Gelli A, Nguyen PH, Santacroce M, Twalibu A, Margolies A, Katundu M. A community-based early childhood development center platform promoting diversified diets and food production increases the mean probability of adequacy of intake of preschoolers in Malawi: a cluster randomized trial. J Nutr. 2019;150:350. https://doi.org/10.1093/jn/nxz245 .

doi: 10.1093/jn/nxz245

Hayes RJ, Moulton LH. Cluster Randomised Trials, Second Edition. 2nd Editio. Chapman and Hall/CRC; 2017. https://doi.org/10.4324/9781315370286 .

StataCorp. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC; 2021.

Gibson RS, Ferguson EL. An interactive 24-hour recall for assessing the adequacy of iron and zinc intakes in developing countries. Washington DC, Cali, Colombia: International Food Policy Research Institute, International Center for Tropical Agriculture; 2008.

Tooze JA, Kipnis V, Buckman DW, Carroll RJ, Freedman LS, Guenther PM, et al. A mixed-effects model approach for estimating the distribution of usual intake of nutrients: the NCI method. Stat Med. 2010;29:2857–68. https://doi.org/10.1002/sim.4063 .

doi: 10.1002/sim.4063 pubmed: 20862656

Gladstone M, Lancaster GA, Umar E, Nyirenda M, Kayira E, van den Broek NR, et al. The Malawi developmental assessment tool (MDAT): the creation, validation, and reliability of a tool to assess child development in rural African settings. PLoS Med. 2010;7:e1000273. https://doi.org/10.1371/journal.pmed.1000273 .

doi: 10.1371/journal.pmed.1000273 pubmed: 20520849 pmcid: 2876049

Loeb M, Cappa C, Crialesi R, de Palma E. Measuring child functioning:the Unicef/ Washington Group Module. Salud Publica Mex. 2017;59:485. https://doi.org/10.21149/8962 .

doi: 10.21149/8962 pubmed: 29211271 pmcid: 7373168

Robinson LA, Hammitt JK, Cecchini M, Chalkidou K, Claxton K, Cropper ML, Eozenou P, de Ferranti D, Deolalikar AB, Campos Guanais de Aguiar F, Jamison DT, Kwon S, Lauer JA, O'Keeffe L, Walker D, Whittington D, Wilkinson T, Wilson D, Wong B. Reference Case Guidelines for Benefit-Cost Analysis in Global Health and Development (May 1, 2019). Available at SSRN: https://ssrn.com/abstract=4015886 or https://doi.org/10.2139/ssrn.4015886 .

Vassall A, Sweeney S, Kahn J, Gomez G, Bollinger L, Marseille E, GHCC Reference case on global health costing. Reference case for estimating the costs of Global health services and interventions. Seattle, WA: Global Health Cost Consortium; 2017.

Bruhn M, McKenzie D. In pursuit of balance: randomization in practice in development field experiments. Am Econ J Appl Econ. 2009;1:200–32. https://doi.org/10.1257/app.1.4.200 .

doi: 10.1257/app.1.4.200

Goldstein H. Multilevel statistical models. London, UK: Edward Arnold; 2003.

Moher D, Schulz KF, Altman D. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA. 2001;285:1987–91. https://doi.org/10.1001/jama.285.15.1987 .

doi: 10.1001/jama.285.15.1987 pubmed: 11308435

Grantham-McGregor SM, Fernald LCHH, Kagawa RMCC, Walker S. Effects of integrated child development and nutrition interventions on child development and nutritional status. Ann N Y Acad Sci. 2014;1308:11–32. https://doi.org/10.1111/nyas.12284 .

doi: 10.1111/nyas.12284 pubmed: 24673166

Sudfeld CR, Bliznashka L, Ashery G, Yousafzai AK, Masanja H. Effect of a home-based health, nutrition and responsive stimulation intervention and conditional cash transfers on child development and growth: a cluster-randomised controlled trial in Tanzania. BMJ Glob Heal. 2021;6: e005086. https://doi.org/10.1136/bmjgh-2021-005086 .

doi: 10.1136/bmjgh-2021-005086