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To assess the effect of an unconditional cash transfer (CT) implemented as part of an emergency response to food insecurity during a declared state of emergency.
Pre–post intervention observational study involving two rounds of data collection, i.e. baseline (April 2012) and final survey (September 2012), on the same cohort of ‘poor’ and ‘very poor’ households enrolled by Save the Children in an unconditional CT programme.
Aguié district, Maradi, Niger.
Households with a non-acutely malnourished child aged 6–36 months (n 412).
The study showed that the living standards of ‘poor’ and ‘very poor’ households improved, as indicated by a reduction in poverty-related indicators and an improvement in household food security. Anthropometric outcomes for children aged 6–36 months improved significantly, despite a decline in child health and women’s well-being and autonomy. Risk factors for becoming acutely malnourished post-intervention were being from a very poor household at baseline, starting the lean season with low weight-for-height Z-score (WHZ <−1) and the presence of co-morbidity.
The results of the study are consistent with the published evidence regarding the general impact of CT and suggest it is plausible that giving cash during an emergency can help safeguard living standards of the very poor and poor. While improvements in childhood nutrition status were seen it is not possible to attribute these to the CT programme. However, knowledge of the risk factors for acute malnutrition in a particular setting can be used to influence the design of future CT interventions for which a controlled trial would be recommended if feasible.
To determine which interventions can reduce linear growth retardation (stunting) in children aged 6–36 months over a 5-year period in a food-insecure population in Ethiopia.
We used data collected through an operations research project run by Save the Children UK: the Child Caring Practices (CCP) project. Eleven neighbouring villages were purposefully selected to receive one of four interventions: (i) health; (iii) nutrition education; (iii) water, sanitation and hygiene (WASH); or (iv) integrated comprising all interventions. A comparison group of three villages did not receive any interventions. Cross-sectional surveys were conducted at baseline (2004) and for impact evaluation (2009) using the same quantitative and qualitative tools. The primary outcome was stunted growth in children aged 6–36 months measured as height (or length)-for-age Z-scores (mean and prevalence). Secondary outcomes were knowledge of health seeking, infant and young child feeding and preventive practices.
Children aged 6–36 months.
The WASH intervention group was the only group to show a significant increase in mean height-for-age Z-score (+0·33, P = 0·02), with a 12·1 % decrease in the prevalence of stunting, compared with the baseline group. This group also showed significant improvements in mothers’ knowledge of causes of diarrhoea and hygiene practices. The other intervention groups saw non-significant impacts for childhood stunting but improvements in knowledge relating to specific intervention education messages given.
The study suggests that an improvement in hygiene practices had a significant impact on stunting levels. However, there may be alternative explanations for this and further evidence is required.
The effectiveness of geographic targeting in nutrition programmes depends largely on the degree to which malnutrition clusters within particular areas. This study investigates the extent to which the childhood nutrition indicators, stunting (height-for-age Z-score <−2) and wasting (weight-for-height Z-score <−2), are spatially clustered; this information is used to determine the implications of spatial clustering for the effectiveness of geographic targeting.
Analysis of data from Demographic and Health Survey (DHS) results. Clustering is assessed by calculating intra-cluster correlation coefficients (ICCs). Estimating the proportion of malnourished children covered by a programme successfully targeting 10% of clusters with the highest malnutrition prevalences allows an assessment of the effectiveness of geographic targeting.
Fifty-eight DHS III (1992–1997) and DHS IV (1998–2001) reports from 46 developing countries.
Pre-school children of mothers interviewed by DHS.
Main results: The extent of clustering of nutritional status was surprisingly low (median ICC for national samples: stunting=0.054, wasting=0.032) and most countries were characterised by having an ICC <0.1 – i.e. low clustering – for childhood undernutrition (91% of countries for wasting and 78% for stunting). Our assessment of the effectiveness of geographic targeting showed that coverage was better for wasting than for stunting; for wasting, 23% of countries would achieve less than 20% coverage, compared with 76% of countries achieving less than 20% coverage for stunting. Coverage is dependent on the overall prevalence of malnutrition and the ICC.
Childhood nutritional status is determined at the household, or even individual, level; nutrition programmes that are geographically targeted may result in high levels of under-coverage and leakage, thereby compromising their cost-effectiveness; the lack of clustering questions the appropriateness of current nutrition interventions.
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