Effects of unconditional cash transfers on the outcome of treatment for severe acute malnutrition (SAM): a cluster-randomised trial in the Democratic Republic of the Congo

BMC Medicine

Research Article

Emmanuel Grellety¹  Pélagie Babakazo²  Gustave Mwamba³  Noël Marie Zagre⁴  Ines Lezama⁵  Amina Bangana⁵  Eric-Alain Ategbo⁵ 

[1] Independent Consultant, Paris, France;Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo;Save the Children United Kingdom, Kinshasa, Democratic Republic of the Congo;United Nations International Children Emergency Fund West and Central Africa Regional Office, Dakar, Senegal;United Nations International Children Emergency Fund, Kinshasa, Democratic Republic of the Congo;

关键词: Malnutrition;    Severe acute malnutrition;    Cash transfer;    Community-based management of acute malnutrition;    CMAM;    Democratic Republic of the Congo;    Cluster-randomised trial;   

DOI  :  10.1186/s12916-017-0848-y

 received in 2016-11-22, accepted in 2017-03-30,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017