This ancillary/extension study ("Wave 2") measures child development and school readiness outcomes among children residing in households within host communities that participated in the Graduation to Resilience (G2R) randomized controlled trial in Uganda (G2R trial: AEARCTR-0004080 \[AEA RCT Registry\]; Wave 1 child assessments: NCT05531812). No new randomization or intervention assignment occurs in Wave 2; rather, we assess outcomes in children linked to households in communities previously randomized in the parent study. Wave 2 expands the eligible child age range (0-9 years) and includes age-appropriate outcomes (e.g., IDELA for school readiness; Raven's Progressive Matrices and executive function tasks for older children). We will compare children in households assigned to receive the Graduation program in the parent RCT (T1) to children in pure ("spillover") control households (C2) in host communities. Primary completion is anticipated in October 2025. Pre-analysis plans for Wave 1 and Wave 2 are posted.
Parent RCT \& groups: The G2R trial used staged randomization at the community level. In Wave 2 we sample host-community households only, comparing: T1 (Graduation): households in host communities assigned to receive the Graduation program in the parent trial; C2 (pure "spillover" control): households in host control communities. Wave 2 purpose: To measure child development and school readiness outcomes in an expanded age range (0-9 years) using validated, age-appropriate instruments. Design note: Wave 2 is observational with exposure defined by prior random assignment in the parent RCT; there is no new assignment of interventions in Wave 2. Documents: The Pre-Analysis Plan (PAP) for this Wave 2 is available under Study Documents and cross-references the PAP from Wave 1 (NCT05531812). Linkage to parent study: This record is explicitly linked to NCT05531812 and AEARCTR-0004080 \[AEA RCT Registry\].
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
2,100
"Graduation" is a multifaceted approach that aims to support ultra-poor households in permanently escaping poverty traps. The standard version of Graduation tested in this study includes: a one-time asset transfer; monthly cash transfers; life skills coaching on topics like health and nutrition; technical skills training on topics like financial literacy; and access to savings services.
Innovations for Poverty Action Uganda
Kampala, Uganda
Height-for-age z-score (HAZ)
Based on WHO Growth Standards
Time frame: 6 years after the introduction of Graduation
Anemia
Hemoglobin levels captured using HemoCue devices and categorized according to anemia status (\<11.5 g/dL)
Time frame: 6 years after the introduction of Graduation
Forward Digit Span score
Children are asked to repeated a sequence of numbers. Children who are successful are presented with progressively longer sequences.
Time frame: 6 years after the introduction of Graduation
Head-Toes-Knees-Shoulders-Revised (HTKS-R) score
A self-regulation game which taps children's cognitive flexibility, memory, and self-control. Children are presented with instructions and must remember the rules of a game, which require them to: inhibit the more natural response to instructions in favor of the correct, unnatural one; flexibly shift between old and new rules to commands when given, and; regulate their behavior in accordance with all of the above.
Time frame: 6 years after the introduction of Graduation
Raven's Progressive Matrices Second Edition score
A direct assessment of fluid intelligence. Children are presented with 36 items and for each item they are asked to identify the missing piece from a set of options that finishes the matrix/picture that is presented.
Time frame: 6 years after the introduction of Graduation
IDELA total score
International Development and Early Learning Assessment (IDELA) total score. Direct assessment of children with items across four domains: literacy, numeracy, motor, and socio-emotional.
Time frame: 6 years after the introduction of Graduation
Caregiver-Reported Early Development Index (CREDI) overall z-score
Caregivers report on their child's abilities in the domains of cognitive, language, motor, and social-emotional skills.
Time frame: 6 years after the introduction of Graduation
Diet diversity
Number of food groups consumed by the child in the previous 24 hours as reported by the caregiver
Time frame: 6 years after the introduction of Graduation
Caregiver-child interactions
Number of different types of interactions between caregiver and child in previous 3 days
Time frame: 6 years after the introduction of Graduation
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