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

Boston Children's Hospital599 enrolled

Overview

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.

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

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

599

Conditions

Malnutrition, Child

Interventions

Cash TransferOTHER

Monthly cash transfers

Cash Transfers and Nutrition EducationOTHER

Cash transfers every month and structured nutrition education provided at household level by community health assistants based on a nutrition education handbook

Eligibility

Sex: ALLMin age: 6 MonthsMax age: 23 MonthsHealthy volunteers:

Medical Language ↔ Plain English

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

Locations (1)

Grand Geddeh County Health Office

Zwedru, Liberia

Outcomes

Primary Outcomes

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

Time frame: 6 months

Secondary Outcomes

Meal frequency

Mean self-reported meal frequency over the 24-hour period prior to monthly CHA visits

Time frame: 6 months

Increase in child weight in kilograms

changes in child weight in kilograms during the study period measured with digital scale (UNISCALE)

Time frame: 6 months

Increase in mid upper arm circumference in centimeters

changes in mid upper arm circumference in centimeters measured with MUAC tape measure

Time frame: 6 months

Increase in child length/height in centimeters

changes in child length/height in centimeters during the study period measured with Height Board

Time frame: 6 months

Health care utilization (clinic)

number of clinic visits for illnesses (including type of illness)

Time frame: 6 months

Health care utilization (hospital)

hospitalizations (if any) during the study period

Time frame: 6 months

Health care utilization (antimicrobials)

Data from ClinicalTrials.gov

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