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.
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
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
4,320
Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.
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.
Fortified flour supplements for children (Supercereal Plus)and pregnant/lactating mothers (super Cereal)
Three-monthly distribution of Cash (30,000 FCFA/trimester) to households that are beneficiary of the Jigisemejiri program.
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.
Unnamed facility
Bamako, Mali
Child Height-for-age Z-score
To calculate WHZ scores the 2006 WHO growth reference will be used
Time frame: After 24 months of program implementation
Value of household consumption
The household consumption includes food and non-food related economic consumption
Time frame: After 24 months of program implementation
Household dietary diversity
The household dietary diversity is estimated by a dietary diversity score counting food groups
Time frame: 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)
Time frame: 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
Time frame: After 48 months of program implementation
Household dietary diversity
The household dietary diversity is estimated by a dietary diversity score counting food groups
Time frame: 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)
Time frame: After 48 months of program implementation (only in cross-sectional survey)
Child Weight-for-height Z-score
To calculate WHZ scores the 2006 WHO growth reference will be used
Time frame: After 24 months of program implementation
Prevalence of child wasting
To calculate WHZ scores the 2006 WHO growth reference will be used
Time frame: 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
Time frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
Child hemoglobin concentration
Time frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
Prevalence of child anemia
Time frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
Body Mass Index of primary caregiver of index child
Time frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
Early child development
Time frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
Child morbidity (acute respiratory infections, fever, vomiting, diarrhea)
Time frame: 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
Time frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
Household assets and savings
Time frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
Educational level of Household members
Time frame: After 24 months and 48 months of program implementation
Household food security
Measured by the Household Food Insecurity Access Scale (HFIAS)
Time frame: 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.
Time frame: 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
Time frame: 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)
Time frame: 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.
Time frame: After 24 months and 48 months of program implementation
Women's empowerment
Measured by pro-WEAI instrument adapted to local context
Time frame: 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
Time frame: 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
Time frame: After 24 months and 48 months of program implementation
Child Mid-upper Arm Circumference
Time frame: After 24 months and 48 months (only in cross-sectional survey) of program implementation
Maternal hemoglobin concentration
Time frame: After 48 months (only in cross-sectional survey) of program implementation
Maternal anemia
Time frame: After 48 months (only in cross-sectional survey) of program implementation
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