Safety Nets and Early Childhood Development

Last registered on March 18, 2022

Pre-Trial

Trial Information

General Information

Title
Safety Nets and Early Childhood Development
RCT ID
AEARCTR-0002897
Initial registration date
May 11, 2018

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
May 15, 2018, 1:04 PM EDT

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

Last updated
March 18, 2022, 8:56 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Primary Investigator

Affiliation
The World Bank

Other Primary Investigator(s)

PI Affiliation
World Bank
PI Affiliation
University of Illinois, Urbana Champaign
PI Affiliation
Oklahoma State University

Additional Trial Information

Status
On going
Start date
2017-12-17
End date
2022-06-30
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
We assess the impact of the different components of an integrated cash transfer safety net combined with home visits reinforcing health-nutrition practices and psycho-social child development on a broad range of ECD outcomes including anthropometrics, nutritional status, cognitive ability, and socio-emotional development of children ages 0 to 5 years old as well as on poverty indicators (such as household food and non-food consumption, accumulation of productive assets, and use of health services).
External Link(s)

Registration Citation

Citation
Akresh, Richard et al. 2022. "Safety Nets and Early Childhood Development." AEA RCT Registry. March 18. https://doi.org/10.1257/rct.2897
Former Citation
Akresh, Richard et al. 2022. "Safety Nets and Early Childhood Development." AEA RCT Registry. March 18. https://www.socialscienceregistry.org/trials/2897/history/139108
Experimental Details

Interventions

Intervention(s)
The intervention can be described as having two parts.

First, a baseline safety net intervention is being implemented in rural Burkina Faso and will provide cash transfers to 40,000 households in two of the three regions with the highest levels of chronic poverty and child malnutrition (Est, and Centre-Est). With an average of 7.9 members per household in poor households in rural areas, approximately 316,000 people will directly benefit from the project representing 16 percent of the chronically poor population in the two regions covered by the project. Since children and pregnant and lactating women are most affected by malnutrition, the project will focus on households with young children.

To reach the project objectives, it was decided with the Burkina Faso government to use a combination of targeting methods to reach the poorest households and households with children at risk of malnutrition.

First, the project uses geographic targeting (based on regional poverty data and provincial nutrition data) to select 5 provinces in 2 regions where both chronic poverty and under-5 chronic malnutrition (height-for-age) are the highest in the country. Also, only rural areas were selected as poverty and malnutrition are higher there. Second, it was decided that only households with young children would be eligible for the program. According to the latest household survey data 87% of poor, rural households have children under the age of 6 and close to 100% have children under the age of 15. Because the program also has other objectives beyond reducing childhood malnutrition, it was agreed to also include households with older children.

Finally, the poverty status of households in the participating areas will be assessed through a combination of consumption-based poverty indicators and non-monetary aspects of poverty such as social and physical aspects of exclusion. The project will combine both proxy-means testing and community-based targeting to derive a final set of households that are considered the poorest in the area.

The cash transfers (FCFA 10,000 per month on average, approximately $20 USD) aim to improve human development outcomes by supporting households with a small regular transfer and also providing information about better family practices to try to improve children’s nutritional and ECD outcomes and encourage households to engage in and invest in productive activities.

Supporting households with regular additional revenue allows them to increase the consumption of essential goods/services (more/better food, small assets, and pay for health care). It can also help women spend more time on productive activities and engage with their children if they can use some of the funds to avoid spending time on low return activities. It can also help prevent households from selling productive assets in times of negative shocks.

Second, the intervention will include village-level meeting, women meetings, and home visits by trained outreach teams who provide information and reinforce behavioral change regarding health/nutrition and psycho-social child development. The aim of these home visits is to increase the probability of the households breaking the intergenerational cycle of poverty, reduce the incidence of malnutrition, and improve human development goals related to MDG 1, 2, 4, and 5. The project will target pregnant women and young children, corresponding to the “window of opportunity”, which is a crucial time to ensure optimum physical growth and development of the individual child. The measures will use an approach of Social and Behavior Change Communication (SBCC) regarding the importance of health care and nutrition for pregnant women and children 0-24 months and promotion of cognitive development for children 24-60 months. Note that the accompanying measures will not support direct nutrition interventions such as targeted feeding, nutritional recuperation, food distribution, or provision of micronutrients.

The evaluation will evaluate both of these intervention components (the cash transfers and the home visits) and will also try to disentangle the importance of specific content messages given during the home visits.

The five study groups will be as follows:

Control group: No cash transfers, no information session at the village or group level and no home visit interventions

Treatment 1: Cash transfers only, no information session at the village or group level and no home visit interventions.

Treatment 2: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, plus home visits only for difficult / vulnerable cases.

Treatment 3: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, reinforced with at least two household visits per month for all beneficiaries focusing on health and nutrition practices.

Treatment 4: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, reinforced with at least two household visits per month for all beneficiaries focusing on health and nutrition practices and the psycho-social development of the child
Intervention Start Date
2018-06-01
Intervention End Date
2020-12-31

Primary Outcomes

Primary Outcomes (end points)
The key outcomes are:
• Anthropometric indicators of children under 5 (height, weight, and arm circumference).

• Health outcomes: vaccinations, illnesses, health clinic utilization

• ECD outcomes as measured by age and culturally appropriate standard ECD instruments, such as the Denver Prescreening Developmental Questionnaire, the Strengths and Difficulties test, and the head-toes-knee-shoulder test.

• Change in household consumption, consumption of food (quality, quantity, and variety), accumulation and selling of productive assets, expenditures on health and education.

These indicators will be collected at the baseline and two years later at the follow-up survey.

The key intermediate level indicators are:
• Monthly attendance at village-level meetings promoting better family practices.

• Reports from home visits (in the relevant study arms) conducted at least two times per month

• Parental child-rearing practices and child time use (school enrollment, school attendance, and child labor): We will have time diary for how much time parents spend with children or try to measure what the children are doing during the day. We will have a specific module asking questions about the types of games and toys children play with at home and then who do they play with (mother/father/brother/sister/other) and the frequency they play with them. We have used this module in previous research in Burkina Faso and we have adapted it to the specific context. We will have a specific module asking about nutrition and foods eaten and health practices during the past week/past year. These questions will include indicators about changes in key family practices including infant and young child feeding practices (e.g., exclusive breastfeeding, colostrum feeding, complimentary feeding), hygiene and sanitation (e.g., hand washing with soap), and prenatal care (e.g., onset of antenatal consultation, frequency of antenatal consultation).

There are also some sub-group indicators:
• Gender disaggregated data, both for children and adults will be collected for all outcomes.

• Precise age information in months will also be collected

• Income, wealth, and consumption: even though this project is targeting poor households, we will also collect data about income, wealth, and consumption in order to be able to perform analyses by socio-economic status.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The five study groups will be as follows:

Control group: No cash transfers, no information session at the village or group level and no home visit interventions

Treatment 1: Cash transfers only, no information session at the village or group level and no home visit interventions.

Treatment 2: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, plus home visits only for difficult / vulnerable cases.

Treatment 3: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, reinforced with at least two household visits per month for all beneficiaries focusing on health and nutrition practices.

Treatment 4: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, reinforced with at least two household visits per month for all beneficiaries focusing on health and nutrition practices and the psycho-social development of the child
Experimental Design Details
Randomization Method
Randomization was carried out by the PI, using an do file on Stata.
The randomization was stratified at the commune level. Villages with less than 90 households were excluded to to get enough beneficiaries to survey (at least 21 households). Villages with more than 400 households were excluded to avoid very large villages where the households to be interviewed would be very spread out.



Randomization Unit
The treatment is given at the village level, therefore the randomization is at the village level as well. It is stratified at the commune level.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
225 villages will be covered.
Update December 2021: Note that for security reasons the endline cannot be conducted in the Est region, and will therefore only be conducted in the Centre-Est region. So the endline will be conducted in 111 villages only.
Sample size: planned number of observations
4725 households will be surveyed. Update December 2021: Note that for security reasons the endline cannot be conducted in the Est region, and will therefore only be conducted in the Centre-Est region. So the endline will be conducted in 2329 households only.
Sample size (or number of clusters) by treatment arms
45 village in control group and 45 village in each treatment arm.
Update December 2021: Note that for security reasons the endline cannot be conducted in the Est region, and will therefore only be conducted in the Centre-Est region. So for the endline the cluster size will be 22 villages in each study arm.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The table below summarizes the key parameters used for the power calculations. We consider five outcomes of interest: weight-for-age z-scores, height-for-age z-scores, arm circumference z-scores and two Denver Developmental Screening tests (personal-social skills and language). The means for these variables are taken from a survey conducted in the Nahouri province of Burkina Faso in 2008. Akresh, de Walque and Kazianga (2012, 2013, and 2014) describe the survey in more details. The intra-cluster correlations are calculated at the village level. Denver Anthropometrics Language Social WAZ HAZ ACZ Minimum Detectable Size Effect 0.188 0.182 0.157 0.150 0.157 Parameters Mean 0.683 0.031 -1.315 -1.452 -0.570 Standard Deviation 0.951 0.947 1.353 1.664 1.129 ICC 0.070 0.063 0.039 0.033 0.123
IRB

Institutional Review Boards (IRBs)

IRB Name
INNOVATIONS FOR POVERTY ACTION IRB – USA
IRB Approval Date
2016-01-01
IRB Approval Number
14156

Post-Trial

Post Trial Information

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials