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
Monthly cash transfers
Cash transfers every month and structured nutrition education provided at household level by community health assistants based on a nutrition education handbook
Grand Geddeh County Health Office
Zwedru, Liberia
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
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)
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use of antibiotics/antimalarials during the study period
Time frame: 6 months
Health care utilization (nutritional support)
if the child received supplementary nutritional support (e.g. ready to use therapeutic food RUTF)
Time frame: 6 months
Knowledge, attitudes, and practices
caregiver's knowledge, attitudes, and practices (KAP) of infant and young child feeding
Time frame: 6 months