Cash transfers and child nutritional outcomes: a systematic review and meta-analysis

Abstract

BackgroundCash transfer (CT) programmes are implemented widely to alleviate poverty and provide safety nets to vulnerable households with children. However, evidence on the effects of CTs on child health and nutrition outcomes has been mixed. We systematically reviewed evidence of the impact of CTs on child nutritional status and selected proximate determinants.MethodsWe searched articles published between January 1997 and September 2018 using Agris, Econlit, Eldis, IBSS, IDEAS, IFPRI, Google Scholar, PubMed and World Bank databases. We included studies using quantitative impact evaluation methods of CTs with sample sizes over 300, targeted to households with children under 5 years old conducted in countries with gross domestic product per capita below US$10 000 at baseline. We conducted meta-analysis using random-effects models to assess the impact of CT programmes on selected child nutrition outcomes and meta-regression analysis to examine the association of programme characteristics with effect sizes.ResultsOut of 2862 articles identified, 74 articles were eligible for inclusion. We find that CTs have significant effects of 0.03±0.03 on height-for-age z-scores (p<0.03) and a decrease of 2.1% in stunting (95% CI −3.5% to −0.7%); consumption of animal-source foods (4.5%, 95% CI 2.9% to 6.0%); dietary diversity (0.73, 95% CI 0.28 to 1.19) and diarrhoea incidence (−2.7%, 95% CI −5.4% to −0.0%; p<0.05). The effects of CTs on weight-for-age z-scores and wasting were not significant (0.02, 95% CI −0.03 to 0.08; p<0.42) and (1.2%, 95% CI: −0.1% to 2.5%; p<0.07), respectively. We found that specific programme characteristics differentially modified the effect on the nutrition outcomes studied.ConclusionWe found that CT programmes targeted to households with young children improved linear growth and contributed to reduced stunting. We found that the likely pathways were through increased dietary diversity, including through the increased consumption of animal-source foods and reduced incidence of diarrhoea. With heightened interest in nutrition-responsive social protection programmes to improve child nutrition, we make recommendations to inform the design and implementation of future programmes.

Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low- and middle-income countries

“…A recent meta-analysis of cash transfers (including cash transfers both with and without Nutrition BCC) found very small, but statistically significant improvements on stunting height-for-age z-scores (0.03+/−0.03 SD) compared to a no-intervention control, which accounts for a 2.1% reduction in stunting prevalence [ 4 ]. Among studies delivering Cash + Nutrition BCC, there was a statistically significant 3.1% reduction in stunting prevalence compared to a no-intervention control, but no impact on height-for-age z-score.…”

“…Cash transfers alone have had limited impact on distal outcomes for child well-being (e.g., on nutritional status and health [ 4 , 5 ]), despite strong evidence that cash transfers can improve more proximal outcomes, such as improving access to food [ 3 , 13 , 14 ]. Thus, cash-plus programmes were developed in hopes of achieving improvements in these distal, “third-order” outcomes.…”

“…A well-established evidence base indicates that cash transfers improve many aspects of children’s lives, including increased food security and improved school attendance [ 3 ]. Nevertheless, impacts have been more mixed and less overwhelming in more challenging areas of child development, including nutrition [ 4 ] and health [ 5 ].…”

Changes in household food security, access to health services, and income in northern Lao PDR during the COVID-19 pandemic

“…Systematic review and meta-analysis of 74 studies found that children from households who received cash transfers had reduced stunting by 2.5% and improved consumption of animal foods by 4.5% [44].…”

Balancing international trade and local production for food and nutrition security: animal-sourced foods’ contribution to human welfare

“…With the COVID pandemic still on the rise in many countries, these numbers are expected to worsen considerably in the future. An estimated 90-117 million children are likely to fall into poverty with severe consequences to their health, nutrition status, and possibly also their survival ( Fore, 2020 ; Manley et al, 2020 ). According to a modeling study carried out by Osendarp et al, in a “moderate” scenario, pandemic-related disruptions of the food and health system could result in an additional 9.3 million wasted children and 2.6 million stunted children by 2022 ( Osendarp et al, 2021 )…”