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Evaluation of multi-annual and seasonal cash transfers to prevent acute malnutrition : the MAM’Out project

Abstract : Child wasting is a public health issue but evidence gaps remain concerning preventive strategies not primarily based on food products. Cash transfers, increasingly implemented in emergency and developing contexts, have the potential to prevent under-nutrition by acting on several underlying causes including food insecurity, access to basic services and goods. However, to date, no study with a strong design explored the link between seasonal unconditional cash transfers (UCTs) and the prevention of acute malnutrition. UCTs were proven to have positive effects on food availability and food access. Inconsistent evidence was reported concerning the effects of UCTs on the quality of children’s diet, health care and psychosocial well-being of families benefiting from UCTs. In this framework, the MAM’Out research project was launched to assess the effects of multiannual seasonal UCT targeted to women on the prevention of child acute malnutrition in rural areas of Burkina Faso. In this two-arm cluster randomized controlled trial, one group benefited from cash transfers via mobile phones during 5 months yearly and the other arm was a comparison group. Qualitative data were collected each month of the cash transfer period for two years among various participants. The two main declared domains of expenses were food and health care for the child and the whole family. The program was also associated with positive perceived changes at the household level, mainly related to gender equality and improvement of women’s status, and favored the social integration of the poorest at the community level through cash sharing. Unexpected reported effects of this program included increased pregnancy plans of some women. The effect of cash transfer on diet quality was assessed using two 24h-dietary recall surveys carried out in July and August 2014 on a subsample of children from both arms. Results showed that seasonal UCT are associated with improved child’s diet among 14 to 29-month old children, particularly higher consumption of animal products, higher intake of iron rich or iron fortified food and higher fat and vitamins B12 intake compared to the control group. No difference was found for energy and protein intake between both groups. Moreover, two third of the children from the cash group had an adequate minimum dietary diversity compared to only one third in the control group. However, children from both groups had a suboptimal quality of diet during the lean season. Besides, anthropometric measurements and morbidity were recorded on quarterly basis for more than two years. Children in the intervention group had a lower risk of self-reported respiratory tract infection compared to children in the control group. However, neither the number of cumulative episode of wasting nor the end point anthropometric markers of nutritional status differ between children from the intervention and control group. Seasonal UCT should be considered when looking at actions to improve child’s diet in the framework of safety net programs. As far as the reduction of child wasting is concerned, an integrated approach combining cash and one or several other components identified as a key factors leading to acute malnutrition in the region should be preferred.
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Audrey Tonguet-Papucci. Evaluation of multi-annual and seasonal cash transfers to prevent acute malnutrition : the MAM’Out project. Food and Nutrition. Institut agronomique, vétérinaire et forestier de France; Rijksuniversiteit te Gent, 2017. English. ⟨NNT : 2017IAVF0003⟩. ⟨tel-02948478⟩

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