Abstract
BackgroundCash transfer programs (CTPs) aim to strengthen financial security for vulnerable households. This potentially enables improvements in diet, hygiene, health service access and investment in food production or income generation. The effect of CTPs on the outcome of children already severely malnourished is not well delineated. The objective of this study was to test whether CTPs will improve the outcome of children treated for severe acute malnutrition (SAM) in the Democratic Republic of the Congo over 6 months.MethodsWe conducted a cluster-randomised controlled trial in children with uncomplicated SAM who received treatment according to the national protocol and counselling with or without a cash supplement of US$40 monthly for 6 months. Analyses were by intention to treat.ResultsThe hazard ratio of reaching full recovery from SAM was 35% higher in the intervention group than the control group (adjusted hazard ratio, 1.35, 95% confidence interval (CI) = 1.10 to 1.69, P = 0.007). The adjusted hazard ratios in the intervention group for relapse to moderate acute malnutrition (MAM) and SAM were 0.21 (95% CI = 0.11 to 0.41, P = 0.001) and 0.30 (95% CI = 0.16 to 0.58, P = 0.001) respectively. Non-response and defaulting were lower when the households received cash. All the nutritional outcomes in the intervention group were significantly better than those in the control group. After 6 months, 80% of cash-intervened children had re-gained their mid-upper arm circumference measurements and weight-for-height/length Z-scores and showed evidence of catch-up. Less than 40% of the control group had a fully successful outcome, with many deteriorating after discharge. There was a significant increase in diet diversity and food consumption scores for both groups from baseline; the increase was significantly greater in the intervention group than the control group.ConclusionsCTPs can increase recovery from SAM and decrease default, non-response and relapse rates during and following treatment. Household developmental support is critical in food insecure areas to maximise the efficiency of SAM treatment programs.Trial registrationClinicalTrials.gov, NCT02460848. Registered on 27 May 2015.
Highlights
Cash transfer programs (CTPs) aim to strengthen financial security for vulnerable households
This paper presents the findings from a clusterrandomised trial comparing the outcome of a standard Outpatient Therapeutic Program (OTP) for severe acute malnutrition (SAM) and infant and young child feeding (IYCF) counselling with and without a monthly cash transfer over a 6-month period in the Democratic Republic of the Congo (DRC)
Some were admitted using the integrated management of acute malnutrition (IMAM) unisex weight-for-height table but were ineligible using sex-specific assessment, a few lived outside the catchment area and others were referred directly to the hospital
Summary
Cash transfer programs (CTPs) aim to strengthen financial security for vulnerable households This potentially enables improvements in diet, hygiene, health service access and investment in food production or income generation. Considerable progress has been made in treating SAM [2,3,4], one way to reduce the burden of acute malnutrition is to prevent its emergence among children by increasing the resilience of poor and vulnerable households. Cash transfer programs (CTPs), which deliver direct unconditional or conditional cash to households, are being tested in developing countries [9] Such programs have been used in developed countries for many years as the main method for poverty reduction and social security. It is possible that the additional cash could increase the cost-effectiveness of the nutrition intervention, if gains in effectiveness more than balance the added cost of the subvention
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