Conditional Cash Transfer and/or Lipid-Based Nutrient Supplement Targeting the First 1000 Days of Life Increased Attendance at Preventive Care Services But Did Not Improve Linear Growth in Young Children in Rural Mali: Results of a Cluster-Randomized Controlled Trial

Conditional Cash Transfer and/or Lipid-Based Nutrient Supplement Targeting the First 1000 Days of Life Increased Attendance at Preventive Care Services But Did Not Improve Linear Growth in Young Children in Rural Mali: Results of a Cluster-Randomized Controlled Trial

English

0002-9165

Background: In 2014, the World Food Programme added to an ongoing health and nutrition program named “Santé Nutritionnelle à Assise Communautaire dans la région de Kayes” (SNACK), the distribution of cash to mothers and/or lipid-based nutrient supplement (LNS) to children aged 6–23 mo, conditional upon attendance at community health centers (CHCs) during the first 1000 d of life. Objective: We evaluated the additional impact of the distribution of cash and/or LNS on mean height-for-age z scores (HAZ; primary outcome), stunting (HAZ < −2), and on intermediate outcomes along the program impact pathways. Methods: In a cluster-randomized controlled trial using a 2 × 2 factorial design, 76 CHCs were randomly assigned to deliver either SNACK, SNACK + Cash, SNACK + LNS, or SNACK + Cash + LNS. Cross-sectional surveys among 12- to 42-mo-old children and their mothers were conducted at baseline (2013, n = 5046) and at endline (2016, n = 5098). Results: Factorial analysis showed no interaction between cash and LNS treatments for HAZ, but found an antagonistic interaction for stunting (OR: 1.55; 95% CI: 1.05, 2.31; P = 0.03). There were no impacts of the cash, LNS, or cash + LNS treatments, compared with the SNACK alone, on either HAZ or stunting (treatment × time interaction). There were significant impacts of the LNS and cash + LNS treatments on attendance at ≥1 growth monitoring (GM) session (OR: 3.95; 95% CI: 1.69, 9.24; OR: 3.90; 95% CI: 1.73, 8.81, respectively) and half the expected sessions (OR: 4.72; 95% CI: 1.47, 15.17; OR: 5.25; 95% CI: 1.82, 15.11, respectively), mothers’ knowledge on importance of GM (OR: 1.98; 95% CI: 1.16, 3.39; OR: 3.12; 95% CI: 1.60, 6.09, respectively), and, only for the LNS group, appropriate timing for complementary feeding (OR: 1.62; 95% CI: 1.09, 2.41). Conclusions: Implementation constraints and suboptimal participation in program activities may explain the lack of impact on child linear growth in this rural region of Mali.

ART 157

eng

ANA-124989

124989