Shonjibon cash and counselling: a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh

Tanvir M Huda,Tazeen Tahsina,Gulshan Ara,Jasmin Khan,John Hoddinott,Nicholas Goodwin,Sumithra Muthayya,Afrin Iqbal,Munirul Islam,Nazia Binte Ali,Saad Ullah Al Amin,Mohammad Mehedi Hasan,Michael J Dibley,Shams El Arifeen,Kingsley Emwinyore Agho,Elizabeth K Kirkwood,Ashraful Alam,Tracey-Lea Laba

doi:10.1186/s12889-020-09780-5

Abstract

BackgroundUndernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months.MethodThe study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child’s age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Household food security (10) Number of events for child suffering from diarrhoea, acute respiratory illness and fever (11) Average costs of mobile phone BCC and cash transfer, and benefit-cost ratio for primary and secondary outcomes.DiscussionThe proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh.Trial registrationThe study has been registered in the Australian New Zealand Clinical Trials Registry (ACTRN12618001975280).

Highlights

Undernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries
The proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh
There remains an estimated 21 million people living in extreme poverty, and child stunting remains high in rural populations (30.8% for under-5 children), and especially amongst the poorest 20% of households (40.2% for under-5 children) [4]

Summary

Introduction

Undernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Of the world’s 736 million extreme poor (those living on less than US$1.90 a day or A$ 2.60) in 2015, 368 million, or half of the total, lived in India, Bangladesh, Nigeria, Democratic Republic of Congo and Ethiopia All of these countries recorded very high levels of undernutrition [2]. In 2017 in Bangladesh, 24% of people lived below the poverty line compared to 49% in 2000 [3] Reflecting this decline in poverty has been a corresponding improvement in child undernutrition. Despite this progress, there remains an estimated 21 million people living in extreme poverty, and child stunting remains high in rural populations (30.8% for under-5 children), and especially amongst the poorest 20% of households (40.2% for under-5 children) [4]. Improving maternal nutrition is critical to reducing low birth weight and improving child undernutrition

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