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Sustainability of Impacts of Cash Transfers, Food Transfers, and Behavior Change Communication in Bangladesh (TMRI)

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ClinicalTrials.gov Identifier: NCT03810300
Recruitment Status : Completed
First Posted : January 18, 2019
Last Update Posted : January 18, 2019
Sponsor:
Collaborators:
Cornell University
Data Analysis and Technical Assistance Ltd
World Food Programme, Bangladesh
Information provided by (Responsible Party):
International Food Policy Research Institute

Brief Summary:
This study assesses the sustainability of impacts, 4 years post-program, from a pilot safety net program that was implemented from May 2012-April 2014. The intervention, called the Transfer Modality Research Initiative (TMRI), was assigned following a cluster-randomized controlled trial design in two zones of Bangladesh (north and south). Intervention arms were assigned at the village level, where arms were as follows: (1) cash transfers [north and south]; (2) cash transfers + nutrition behavior communication change (BCC) [north only]; (3) food transfers [north and south]; (4) food transfers + nutrition BCC [south only]; (4) food-cash split [north and south]; and (5) control [north and south]. Within treatment villages, women living in very poor households were targeted to receive benefits for two years.

Condition or disease Intervention/treatment Phase
Food Security Poverty Child Nutrition Child Development Intimate Partner Violence Gender Dynamics Other: Cash transfer Other: Food transfer Other: Food and cash transfer Behavioral: Nutrition behavior Communication Change (BCC) Other: Control Not Applicable

Detailed Description:

The objective of the study is to assess, 4 years after a pilot safety net intervention ended in April 2014, the sustainability of the intervention's impacts on households, children, and women. The intervention, called the Transfer Modality Research Initiative (TMRI), was assigned following a cluster-randomized controlled trial design in two zones of Bangladesh (north and south). WFP-Bangladesh implemented the intervention, and the International Food Policy Research Institute (IFPRI) conducted the impact evaluation research. Intervention arms were assigned at the village level, where arms were as follows: (1) cash transfers [north and south]; (2) cash transfers + nutrition behavior communication change (BCC) [north only]; (3) food transfers [north and south]; (4) food transfers + nutrition BCC [south only]; (5) food-cash split [north and south]; and (5) control [north and south]. Within treatment villages, women living in very poor households were targeted to receive benefits for two years, from May 2012-April 2014. For the original impact evaluation, longitudinal data on 5000 households were collected from 2012-2015 (ClinicalTrials.gov Identifier: NCT02237144).

For the sustainability study in 2018, given available funding, the sampling frame will include 4000 households. This will include all households that were originally in the following arms: (1) cash transfers [north and south]; (2) cash transfers + nutrition BCC [north only]; (3) food transfers [north and south]; (4) food transfers + nutrition BCC [south only]; (5) control [north and south].


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 5000 participants
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Sustainability of Impacts of Cash Transfers, Food Transfers, and Behavior Change Communication in Bangladesh: Transfer Modality Research Initiative
Actual Study Start Date : April 15, 2012
Actual Primary Completion Date : May 15, 2018
Actual Study Completion Date : May 15, 2018

Arm Intervention/treatment
Experimental: Cash transfer
1500 taka ($18.75) per household distributed monthly
Other: Cash transfer
1500 taka ($18.75) per household distributed monthly

Experimental: Food transfer
30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly
Other: Food transfer
30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly

Experimental: Food and cash transfer
15 kg of rice; 1 kg of lentils and 1 kg of micronutrient fortified cooking oil and 750 taka cash per household, distributed monthly
Other: Food and cash transfer
15 kg of rice, 1 kg of lentils, and 1 kg of micronutrient-fortified cooking oil, and 750 taka cash per household, distributed monthly

Experimental: Cash transfer + nutrition BCC
1500 taka ($18.75) per household distributed monthly. Nutrition behavior change communication (weekly, one-hour group-based meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings).
Other: Cash transfer
1500 taka ($18.75) per household distributed monthly

Behavioral: Nutrition behavior Communication Change (BCC)
Weekly, group-based, one-hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings

Experimental: Food transfer + nutrition BCC
30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly. Nutrition behavior change communication (weekly, one-hour group-based meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings).
Other: Food transfer
30 kg rice, 2 kg lentils, and 2 kg micro-nutrient fortified cooking oil per household distributed monthly

Behavioral: Nutrition behavior Communication Change (BCC)
Weekly, group-based, one-hour meetings on maternal and child nutrition, sanitation and health knowledge, attitudes and practice; twice-a-month home visits; monthly community meetings

Experimental: Control
No transfer, no behavior change communication
Other: Control
No transfer, no behavior change communication




Primary Outcome Measures :
  1. Food Consumption Score [ Time Frame: After 4 years post-intervention ]
    The Food Consumption Score, as defined by the World Food Programme, is calculated as the number of food groups consumed by the household in the previous 7 days, weighted by each food group's nutritional value and frequency of consumption. Scale range is 0 to 112, with higher values reflecting higher food consumption.

  2. Child height-for-age z-score [ Time Frame: After 4 years post-intervention ]
    Calculated using the 2006 WHO growth reference. This is a continuous measure that represents the number of standard deviations from the mean among comparable children in the WHO growth reference.

  3. Prevalence of physical intimate partner violence [ Time Frame: After 4 years post-intervention ]
    Prevalence of any physical intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument


Secondary Outcome Measures :
  1. Household dietary diversity [ Time Frame: After 4 years post-intervention ]
    Measured by counting the number of food groups consumed by the household

  2. Value of total household consumption [ Time Frame: After 4 years post-intervention ]
    Aggregate value of household food and non-food consumption expenditures. This is a continuous measure calculated from household survey responses on consumption behavior, using the methodology and questionnaire modules described in Deaton and Zaidi (2002). Citation: A.Deaton,, and S. Zaidi. 2002. "Guidelines for Constructing Consumption Aggregates for Welfare Analysis." Washington, DC : World Bank.

  3. Value of household food consumption [ Time Frame: After 4 years post-intervention ]
    Value of household food consumption expenditures. This is a continuous measure calculated from household survey responses on consumption behavior, using the methodology and questionnaire modules described in Deaton and Zaidi (2002). Citation: A.Deaton,, and S. Zaidi. 2002. "Guidelines for Constructing Consumption Aggregates for Welfare Analysis." Washington, DC : World Bank.

  4. Value of household non-food consumption [ Time Frame: After 4 years post-intervention ]
    Value of household non-food consumption expenditures. This is a continuous measure calculated from household survey responses on consumption behavior, using the methodology and questionnaire modules described in Deaton and Zaidi (2002). Citation: A.Deaton,, and S. Zaidi. 2002. "Guidelines for Constructing Consumption Aggregates for Welfare Analysis." Washington, DC : World Bank.

  5. Household food insecurity [ Time Frame: After 4 years post-intervention ]
    Measured using the Household Food Insecurity Access Scale. Scale range is 0 to 27, with higher values reflecting higher food insecurity.

  6. Value of household labor income [ Time Frame: After 4 years post-intervention ]
    Value of annual labor income over all household members

  7. Value of household non-labor income [ Time Frame: After 4 years post-intervention ]
    Value of annual non-labor income over all household members

  8. Value of household asset ownership [ Time Frame: After 4 years post-intervention ]
    Total value of all assets owned

  9. Household land ownership [ Time Frame: After 4 years post-intervention ]
    Area of land owned

  10. Housing quality: interviews [ Time Frame: After 4 years post-intervention ]
    Quality of housing stock. This is measured using a module developed for the study context, and information is collected through household enumerator observation during interviews.

  11. Maternal nutrition knowledge score [ Time Frame: After 4 years post-intervention ]
    Number answered correctly on a test of maternal knowledge regarding infant and young child feeding practices developed for the survey, based on the curriculum of training sessions in the intervention.

  12. Maternal infant and young child feeding practices [ Time Frame: After 4 years post-intervention ]
    Maternal adherence to WHO-recommended infant and young child feeding practices

  13. Child score on Raven's Progressive Matrices [ Time Frame: After 4 years post-intervention ]
    Measured using Raven's Progressive Matrices set A and set B. This is constructed following the test's protocol for scoring.

  14. Child score on Early Grade Reading Assessment [ Time Frame: After 4 years post-intervention ]
    Measured using Early Grade Reading Assessment adapted to local context. This is constructed following the test's protocol for scoring.

  15. Child score on Early Grade Mathematics Assessment [ Time Frame: After 4 years post-intervention ]
    Measured using Early Grade Mathematics Assessment adapted to local context. This is constructed following the test's protocol for scoring.

  16. Child score on Strengths and Difficulties Questionnaire [ Time Frame: After 4 years post-intervention ]
    Measured using Strengths and Difficulties Questionnaire, part of the Development and Well-Being Assessment family of mental heath measures. This is constructed following the test's protocol for scoring.

  17. Child weight-for-height z-score [ Time Frame: After 4 years post-intervention ]
    Calculated using the 2006 WHO growth reference. This is a continuous measure that represents the number of standard deviations from the mean among comparable children in the WHO growth reference.

  18. Prevalence of child stunting [ Time Frame: After 4 years post-intervention ]
    Calculated using the 2006 WHO growth reference

  19. Prevalence of child wasting [ Time Frame: After 4 years post-intervention ]
    Calculated using the 2006 WHO growth reference

  20. Child illness [ Time Frame: After 4 years post-intervention ]
    Mother's report of child illness in previous 2 weeks

  21. Parental interaction with child [ Time Frame: After 4 years post-intervention ]
    Time spent on child stimulation activities in previous 7 days, measured using modules developed for the survey

  22. Parental discipline of the child [ Time Frame: After 4 years post-intervention ]
    Disciplinary measures used in the past month, measured using modules developed for the survey

  23. Community norms on gender [ Time Frame: After 4 years post-intervention ]
    Community leaders' attitudes toward gender, measured using modules developed for the survey

  24. Prevalence of emotional violence [ Time Frame: After 4 years post-intervention ]
    Prevalence of any emotional intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument

  25. Prevalence of controlling behaviors [ Time Frame: After 4 years post-intervention ]
    Prevalence of any controlling behaviors in the past 12 months measured using the WHO Violence Against Women instrument

  26. Prevalence of individual acts of intimate partner violence [ Time Frame: After 4 years post-intervention ]
    Prevalence of individual acts of intimate partner violence in the past 12 months measured using the WHO Violence Against Women instrument

  27. Individual decisionmaking [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's decisionmaking modules adapted from pro-WEAI

  28. Individual asset ownership [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's asset ownership modules developed for the survey

  29. Individual mobility [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's mobility modules adapted from pro-WEAI

  30. Individual labor force participation [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's labor modules developed for the survey

  31. Individual attitudes toward gender and intimate partner violence [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's attitudes toward gender and intimate partner violence modules developed for the survey

  32. Individual social capital [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's social capital modules developed for the survey

  33. Individual stress [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's Perceived Stress Scale scores

  34. Individual depression [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's Patient Health Questionnaire-9 Depression Test scores

  35. Individual aspirations [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's aspirations modules developed for the survey

  36. Spousal relationship [ Time Frame: After 4 years post-intervention ]
    Measured using men's and women's relationship modules developed for the survey



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   15 Years to 65 Years   (Child, Adult, Older Adult)
Sexes Eligible for Study:   Female
Gender Based Eligibility:   Yes
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Former participant of Transfer Modality Research Initiative study (in cash, food, cash+BCC, food+BCC, or control arms)

Exclusion Criteria:

-


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03810300


Sponsors and Collaborators
International Food Policy Research Institute
Cornell University
Data Analysis and Technical Assistance Ltd
World Food Programme, Bangladesh
Investigators
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Principal Investigator: Akhter Ahmed, PhD International Food Policy Research Institute
Principal Investigator: Shalini Roy, PhD International Food Policy Research Institute
Principal Investigator: John Hoddinott, DPhil Cornell University
Principal Investigator: Melissa Hidrobo, PhD International Food Policy Research Institute

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Responsible Party: International Food Policy Research Institute
ClinicalTrials.gov Identifier: NCT03810300     History of Changes
Other Study ID Numbers: 12835
First Posted: January 18, 2019    Key Record Dates
Last Update Posted: January 18, 2019
Last Verified: January 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by International Food Policy Research Institute:
Cash transfers
Food transfers
Behavior change communication
Sustainability
Social protection
Nutrition
Gender
Additional relevant MeSH terms:
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Nutrients
Micronutrients
Growth Substances
Physiological Effects of Drugs