Micro-Loans, Insecticide-Treated Bednets, and Malaria: Evidence from a Randomized Controlled Trial in Orissa, India

Last registered on February 22, 2016

Pre-Trial

Trial Information

General Information

Title
Micro-Loans, Insecticide-Treated Bednets, and Malaria: Evidence from a Randomized Controlled Trial in Orissa, India
RCT ID
AEARCTR-0001050
Initial registration date
February 22, 2016

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
February 22, 2016, 12:52 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Region

Primary Investigator

Affiliation
Universitat Pompeu Fabra and Barcelona GSE

Other Primary Investigator(s)

PI Affiliation
National University of Singapore, Saw Swee Hock School of Public Health
PI Affiliation
Independent Science and Partnership Council Secretariat of CGIAR,
PI Affiliation
Research Division, Savvy Sherpa
PI Affiliation
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine
PI Affiliation
University of California, Berkeley

Additional Trial Information

Status
Completed
Start date
2007-05-01
End date
2009-04-30
Secondary IDs
Abstract
We describe findings from the first large-scale cluster randomized controlled trial in a developing country that evaluates the uptake of a health-protecting technology, insecticide-treated bednets (ITNs), through micro-consumer loans, as compared to free distribution and control conditions. Despite a relatively high price, 52 percent of sample households purchased ITNs, highlighting the role of liquidity constraints in explaining earlier low adoption rates. We find mixed evidence of improvements in malaria indices. We interpret the results and their implications within the debate about cost sharing, sustainability and liquidity constraints in public health initiatives in developing countries.

Registration Citation

Citation
, et al. 2016. "Micro-Loans, Insecticide-Treated Bednets, and Malaria: Evidence from a Randomized Controlled Trial in Orissa, India." AEA RCT Registry. February 22. https://doi.org/10.1257/rct.1050
Former Citation
, et al. 2016. "Micro-Loans, Insecticide-Treated Bednets, and Malaria: Evidence from a Randomized Controlled Trial in Orissa, India." AEA RCT Registry. February 22. https://www.socialscienceregistry.org/trials/1050/history/6951
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Experimental Details

Interventions

Intervention(s)
Insecticide treated bednets (ITN) are one of the most effective ways to fight malaria but there is significant debate about the most effective method of their distribution. Cohen and Dupas (2010) found that a remarkable 90 percent subsidy reduced adoption of insecticide treated bednets to 10 percent, relative to 99 percent achieved with free distribution. However, budget constraints impose significant limitations on free distribution. This paper tests an intermediate solution, in situations where liquidity constraints may prevent households from investing in ITNs, in the form of micro-loans on the uptake of ITNs relative to free distribution or control conditions.

Three equally sized groups of households are given information about the benefits of ITNs. The control group received no ITNs, the second group received free ITNs and the third was offered consumer loans with a one-year repayment period. The study follows the uptake, ownership, usage of the ITNs and the subsequent prevalence and incidence of malaria among randomly selected beneficiary households.
Intervention Start Date
2007-09-01
Intervention End Date
2007-10-01

Primary Outcomes

Primary Outcomes (end points)
ITN uptake, ITN ownership, ITN usage, malaria prevalence , malaria incidence
Primary Outcomes (explanation)
(i) ITN uptake: Measured by what fraction of households choose to take the ITN (offered free or with micro-loan)

(ii) ITN ownership: the number of ITNs in the sample household relative to baseline.

(iii) ITN usage: Bednet usage during the previous night and the actual presence of the net in the dwelling as seen by enumerators

(iv) Malaria prevalence: tested through presence of Plasmodium falciparum in the blood and level of Hb (anemia).

(v) Malaria incidence: self-reported incidence of diagnosed malaria in the past six months.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Out of 878 villages in Orissa that had the presence of partner NGO Bharat Integrated Social Welfare Agency (BISWA), 141 were randomly selected by stratified sampling. BISWA assigned these village to one of three groups thus each group had 47 villages. Within each village, 15 households were randomly selected from all those with preexisting BISWA accounts. Baseline survey was conducted in sample households, collecting information on current ITN ownership and usage and malaria prevalence and incidence. After the baseline a village-wide information campaign was carried out in all 141 villages after which the ITN offers were made. In one group, no ITNs were sold or offered from BISWA thus serving as the control. In the second group, ITNs were distributed for free (upto four depending on family size). In the third, clients were offered a micro-loan, payable over a year, to purchase ITNs. ITN offer price was not subsidized and included a mark-up to cover delivery and overhead costs to BISWA. The price was not negligible, corresponding approximately to three to five times the local daily agricultural wage.

A detailed post-intervention survey, similar to the baseline questionnaire was conducted on sample households measuring ITN ownership, usage, and health status. Malaria prevalence and Hb levels were measured by similar methodology to the baseline survey. A longitudinal dataset was created by
recontacting all baseline households whenever possible.
Experimental Design Details
Randomization Method
Randomization done in office by a computer
Randomization Unit
Villages with BISWA (NGO) presence.

First, 141 villages were selected from a sample of 878 villages stratified by district. Within each village, 15 households were randomly selected from all those with preexisting BISWA accounts regardless of whether they had an active loan at that time (all were selected if fewer than 15 were present in the BISWA rosters).
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
141 villages
Sample size: planned number of observations
1,844 households
Sample size (or number of clusters) by treatment arms
47 villages: control (no ITNs introduced)
47 villages: free ITNs distributed to sample households
47 villages: micro-loans offered for the purchase of ITNs to sample households
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Independent Ethics Committee (Mumbai, India).
IRB Approval Date
2009-06-18
IRB Approval Number
IEC/08/35
IRB Name
Institute for Financial Management and Research
IRB Approval Date
2009-08-20
IRB Approval Number
N/A
IRB Name
Indian Council of Medical Research
IRB Approval Date
2009-07-10
IRB Approval Number
(TDR/507/2008-ECD-II), UPF (2011/4543/I),
IRB Name
Stanford University
IRB Approval Date
2007-01-18
IRB Approval Number
8149
IRB Name
Duke University
IRB Approval Date
2007-03-14
IRB Approval Number
protocol #9447-07

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
October 01, 2007, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
April 30, 2009, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Same as pre-trial
Was attrition correlated with treatment status?
Yes
Final Sample Size: Total Number of Observations
1,768 households
Final Sample Size (or Number of Clusters) by Treatment Arms
Same as pre-trial
Data Publication

Data Publication

Is public data available?
Yes

Program Files

Program Files
Yes
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials