Effectiveness of unconditional cash transfers combined with lipid-based nutrient supplement and/or behavior change communication to prevent stunting among children in Pakistan: a cluster randomized controlled trial

Abstract

Background In Pakistan, the prevalence of stunting among children under-five years has remained above WHO critical thresholds (≥30%) over the last two decades. Objective We hypothesized that an unconditional cash transfer (UCT) combined with lipid-based nutrient supplement (LNS) and/or social and behavior change communication (SBCC) will prevent stunting among children 6-23 months of age. Design This was a four-arm, community-based cluster randomized controlled trial conducted in the district of Rahim Yar Khan, Pakistan. A total of 1729 children (UCT n = 434); (UCT+SBCC n = 433); (UCT+LNS n = 430) and (UCT+LNS+SBCC n = 432) were enrolled at 6 months of age and measured monthly for 18 months until the age of 24 months. Results At 24 months of age, children who received UCT+LNS (rate ratio [RR], 0.85 [95% CI 0.74, 0.97]; P = 0.015); and UCT+LNS+SBCC (RR, 0.86 [95% CI 0.77, 0.96]; P = 0.007) had significantly lower risk of being stunted as compared to the UCT arm. No significant difference was noted among children who received UCT+SBCC (RR, 1.03 [95% CI 0.91, 1.16]; P = 0.675) in the risk of being stunted as compared to the UCT arm. The pooled prevalence of stunting among children 6-23 months was 41.7%, 44.8%, 38.5% and 39.3% in UCT, UCT+SBCC, UCT+LNS and UCT+LNS+SBCC, respectively. In pairwise comparisons, a significant impact on stunting among children in UCT+LNS (P = 0.029) and UCT+LNS+SBCC (P = <0.001) was noted as compared to UCT arm. Conclusions UCT combined with LNS and UCT+LNS+SBCC were effective in reducing the prevalence of stunting among children aged 6-23 months in marginalized populations. UCT+SBCC was not effective in reducing the child stunting prevalence. Clinical trial registration number: ClinicalTrials.gov NCT03299218

Improving transportability of randomized controlled trial inference using robust prediction methods

“…Most RCTs use more "pragmatic designs" that attempt to recruit from routine clinical practices or other relevant convenience sample settings; indeed, a search of the ClinicalTrials.gov database at the (US) National Library of Medicine (https://clinicaltrials.gov/) using the key words "representative sample" and "probability sample" finds only 8 registered clinical trials out of over 450,000 that could be confirmed to have recruited subjects in something reasonably approximating a probability sample from a well defined population, of which 7 have reported results. [11][12][13][14][15][16][17] As noted by Olson, 18 bias in the estimation of population causal effects from RCT arises from heterogeneity in treatment effects and systematic selection bias in the RCT with respect to the effect modifiers. Hence the basic approach revolves around accounting for differences between RCT and population effect modifiers.…”

“…Most RCTs use more “pragmatic designs” that attempt to recruit from routine clinical practices or other relevant convenience sample settings; indeed, a search of the ClinicalTrials.gov database at the (US) National Library of Medicine (https://clinicaltrials.gov/) using the key words “representative sample” and “probability sample” finds only 8 registered clinical trials out of over 450,000 that could be confirmed to have recruited subjects in something reasonably approximating a probability sample from a well defined population, of which 7 have reported results. 11–17…”

Pengaruh Intervensi Gizi Sensitif terhadap Kejadian Stunting pada Balita Usia 6-24 Bulan selama Pandemi Covid-19

“…Menurut Little et al 86 , bantuan tunai yang dikombinasikan dengan pemberian makanan lebih efektif menurunkan stunting dibandingkan dengan bantuan tunai saja. Di Pakistan, Soofi et al 87 Separuh balita stunting (54,1%) mendapatkan bantuan Aseskin (Tabel 2). Proporsi ini lebih rendah dibandingkan dengan proporsi di Kota Palangkaraya, 91,9% 89 , dan Ghana, 70,1% 90 .…”

Evaluation of conditional cash transfers and mHealth audio messaging in reduction of risk factors for childhood malnutrition in internally displaced persons camps in Somalia: A 2 × 2 factorial cluster-randomised controlled trial

“…Among the reasons behind this greater acceptance is the perception that CBI increases beneficiary agency, as they can often decide how to use the cash for their specific needs of goods or services; it is a cost-effective intervention, has positive impacts on local economies, and improves beneficiary satisfaction. However, CBIs do not appear to consistently reduce the risk of malnutrition in children, and there is no evidence on its ability to reduce excess mortality [6][7][8][9][10]. Even in nonhumanitarian contexts debate continues on the relative merits of conditional and unconditional transfers on child health and nutrition and how that may play out in different contexts [11,12].…”