The effect of nurturing care groups and maternal cash transfers on early childhood nutrition: Evidence from Ethiopia

Last registered on August 18, 2022

Pre-Trial

Trial Information

General Information

Title
The effect of nurturing care groups and maternal cash transfers on early childhood nutrition: Evidence from Ethiopia
RCT ID
AEARCTR-0009923
Initial registration date
August 13, 2022

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
August 18, 2022, 2:49 PM EDT

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

Locations

Primary Investigator

Affiliation
IFPRI

Other Primary Investigator(s)

PI Affiliation
IFPRI
PI Affiliation
IFPRI

Additional Trial Information

Status
On going
Start date
2022-08-05
End date
2026-12-31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
The objective of this project is to evaluate the effectiveness of nurturing care groups and nurturing care groups implemented in conjunction with maternal cash transfers in enhancing infant and young child feeding practices and nutritional outcomes in rural Ethiopia. The sample is constituted by households who are Productive Safety Net Program beneficiaries, and thus presumptively among the poorest 10% of households; and all have a pregnant woman or an infant under nine months present in the household at baseline.
External Link(s)

Registration Citation

Citation
Gilligan, Daniel, Kalle Hirvonen and Jessica Leight. 2022. "The effect of nurturing care groups and maternal cash transfers on early childhood nutrition: Evidence from Ethiopia." AEA RCT Registry. August 18. https://doi.org/10.1257/rct.9923-1.0
Experimental Details

Interventions

Intervention(s)
The objective of this evaluation is to evaluate two innovations in nutrition-related programming centered around enhancing infant and young child feeding (IYCF) practices in Ethiopia, focusing particularly on suboptimal complementary feeding practices that have been widely speculated to be inhibiting child growth and development (Golan, Headey, Hirvonen, & Hoddinott, 2019). The Nurturing Care Group (NCG) model, pioneered by World Vision in a wide range of other contexts, is based on groups of 10–15 community-based trained volunteer agents who cascade down BCC messages and activities to caregiver groups at the community level. Non-experimental studies conducted in other contexts suggest that the model can significantly increase BCC contact rates and improve IYCF practices and child growth outcomes (Davis et al., 2013). However, large-scale experimental evidence on the effectiveness of this strategy is largely unavailable.

In addition, improving caregiver knowledge may not be sufficient to improve complementary feeding practices if households cannot afford to purchase nutritious foods. Therefore, the second intervention arm introduces maternal grants of $20/month during the child’s first 24 months of life to relax possible financial constraints to child feeding. (Households in both intervention arms are also included in an integrated package of livelihoods activities, centered around the organization of village economic and social associations (VESAs) and the provision of associated trainings.)
Intervention Start Date
2022-11-01
Intervention End Date
2026-09-30

Primary Outcomes

Primary Outcomes (end points)
Height-for-age (continuous variable, children 30-48 months) (endline)
Prevalence of children 6–23 months consuming a diet of minimum diversity (MDD-C) (midline)
IYCF knowledge (midline, endline)
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Early childhood development score (midline, endline)
Percent of children 6–23 months receiving a minimum acceptable diet (midline)
Height-for-age (continuous variable, children 6-23 months) (midline)
Stunting (binary variable, children 6-23 months) (midline)
Stunting (binary variable, children 30-48 months) (endline)
Wasting (binary variable, children 30-48 months) (endline)
Weight-for-height Z-score (continuous variable, children 6-23 months) (midline)
Prevalence of healthy weight (WHZ ≤ 2 and ≥ -2) (binary variable, children 30-48 months) (endline)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The proposed evaluation is a cluster randomized control trial (cRCT) where the cluster is defined as the kebele (lowest administrative level in Ethiopia). The sample is comprised of households that are all beneficiaries of the Productive Safety Net Program (PSNP) and thus around the 15% poorest households in rural Ethiopia; all are served by the PSNP under the program SPIR (Strengthen PSNP4 Institutions and Resilience SPIR-II) II, delivered by our partner organization World Vision.

The impact evaluation will have three study arms:
T1. PSNP implemented by government with SPIR II support for provision of cash and food transfers only (no supplemental programming) (79 kebeles)
T2. PSNP + SPIR II + NCG model (79 kebeles)
T3. PSNP + SPIR II + NCG + maternal grants (79 kebeles)

The study arm T1 serves as a control group of PSNP households against which the impacts of SPIR-II programming will be measured. PSNP households in arm T2 benefit from SPIR-II resilience programming and will be exposed to the NCG intervention. The study arm T3 receive the same intervention package as households in T2 but also benefit from the maternal grants.

(While this planned research paper will focus only on nutritional outcomes, a second pooled analysis will compare the effects of T2 and T3 versus T1 to evaluate the effects of SPIR livelihoods programming on livelihoods-related outcomes.) All households will be surveyed 12 months post-baseline and 36 months post-baseline.
Experimental Design Details
Not available
Randomization Method
Randomization was conducted in Stata by the research team.
Randomization Unit
Kebele
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
237 kebeles
Sample size: planned number of observations
3,081 households
Sample size (or number of clusters) by treatment arms
82 kebeles were assigned to the control arm; 77 were assigned to T2 (SPIR II with nurturing care groups only); 78 kebeles were assigned to T3 (SPIR II with nurturing care groups + cash transfers)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Please see attached pre-analysis plan.
IRB

Institutional Review Boards (IRBs)

IRB Name
IFPRI IRB
IRB Approval Date
2022-07-19
IRB Approval Number
PHND-22-0740
IRB Name
Ethiopian Public Health Association IRB
IRB Approval Date
2022-08-03
IRB Approval Number
N/A
Analysis Plan

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