Melissa Hidrobo

Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries

This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include childrens educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging from 6·4 to 17·6, depending on preschool enrolment rate and discount rate.

Cash, Food, or Vouchers? Evidence from a Randomized Experiment in Northern Ecuador

The debate over whether to provide food assistance and the form that this assistance should take has a long history in economics. Despite the ongoing debate, little rigorous evidence exists that compares food assistance in the form of cash versus in-kind. This paper uses a randomized evaluation to assess the impacts and cost-effectiveness of cash, food vouchers, and food transfers. We find that all three modalities significantly improve the quantity and quality of food consumed. However, differences emerge in the types of food consumed, with food transfers leading to significantly larger increases in calories consumed, and vouchers leading to significantly larger increases in dietary diversity.

Cash transfers and domestic violence.

Violence against women is a major health and human rights problem yet there is little rigorous evidence as to how to reduce it. We take advantage of the randomized roll-out of Ecuadors cash transfer program to mothers to investigate how an exogenous increase in a womans income affects domestic violence. We find that the effect of a cash transfer depends on a womans education and on her education relative to her partners. Our results show that for women with greater than primary school education a cash transfer significantly decreases psychological violence from her partner. For women with primary school education or less, however, the effect of a cash transfer depends on her education relative to her partners. Specifically, the cash transfer significantly increases emotional violence in households where the womans education is equal to or more than her partners.

Socioeconomic gradients in child development in very young children: evidence from India, Indonesia, Peru, and Senegal.

Gradients across socio-economic position exist for many measures of childrens health and development in higher-income countries. These associations may not be consistent, however, among the millions of children living in lower- and middle-income countries. Our objective was to examine child development and growth in young children across socio-economic position in four developing countries. We used cross-sectional surveys, child development assessments, measures of length (LAZ), and home stimulation (Family Care Index) of children in India, Indonesia, Peru, and Senegal. The Extended Ages and Stages Questionnaire (EASQ) was administered to parents of all children ages 3–23 mo in the household (n =8,727), and length measurements were taken for all children 0–23 mo (n = 11,102). Household wealth and maternal education contributed significantly and independently to the variance in EASQ and LAZ scores in all countries, while controlling for childs age and sex, mothers age and marital status, and household size. Being in the fifth wealth quintile in comparison with the first quintile was associated with significantly higher EASQ scores (0.27 to 0.48 of a standardized score) and higher LAZ scores (0.37 to 0.65 of a standardized score) in each country, while controlling for maternal education and covariates. Wealth and education gradients increased over the first two years in most countries for both EASQ and LAZ scores, with larger gradients seen in 16–23-mo-olds than in 0–7mo-olds. Mediation analyses revealed that parental home stimulation activities and LAZ were significant mediating variables and explained up to 50% of the wealth effects on the EASQ.

Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition

The realisation of human potential for development requires age-specific investment throughout the 8000 days of childhood and adolescence. Focus on the first 1000 days is an essential but insufficient investment. Intervention is also required in three later phases: the middle childhood growth and consolidation phase (5-9 years), when infection and malnutrition constrain growth, and mortality is higher than previously recognised; the adolescent growth spurt (10-14 years), when substantial changes place commensurate demands on good diet and health; and the adolescent phase of growth and consolidation (15-19 years), when new responses are needed to support brain maturation, intense social engagement, and emotional control. Two cost-efficient packages, one delivered through schools and one focusing on later adolescence, would provide phase-specific support across the life cycle, securing the gains of investment in the first 1000 days, enabling substantial catch-up from early growth failure, and leveraging improved learning from concomitant education investments.

Delivery of iron-fortified yoghurt, through a dairy value chain program, increases hemoglobin concentration among children 24 to 59 months old in Northern Senegal: A cluster-randomized control trial

Background Innovative strategies are needed to enhance the nutritional impact of agriculture. Value chain approaches, which use supply chains to add value (usually economic) to products as they move from producers to consumers, can be used to increase access to nutritious foods and improve nutritional status. This study tested whether a dairy value chain could be used to distribute a micronutrient-fortified yoghurt (MNFY) (conditional upon the producer supplying a minimum amount of cow milk/day) to improve hemoglobin and reduce anemia among preschool children in a remote area in Northern Senegal. Methods A cluster randomized control trial was used to compare 204 children (24 to 59 months of age at baseline) from households who received the MNFY coupled to a behavior change communication (BCC) campaign focusing on anemia prevention to 245 children from a control group (receiving BCC only) after one year. Randomization was done at the level of the family concession (households from the same family) (n = 321). Eligible households had a child of the target age and were willing to deliver milk to the dairy factory. Changes in anemia and hemoglobin between groups were assessed using mixed regression models. Key findings Anemia prevalence was very high at baseline (80%) and dropped to close to 60% at endline, with no differences between intervention groups. Hemoglobin increased by 0.55 g/dL, 95%CI (0.27; 0.84) more in the intervention compared to the control group after one year, in models that controlled for potentially confounding factors. The impact was greater (0.72 g/dL, 95%CI (0.34; 1.12)) for boys, compared to girls (0.38 g/dL, 95%CI (-0.03; 0.80)). Conclusion The dairy value chain was a successful strategy to distribute MNFY among pastoralists in Northern Senegal, and increase Hb concentrations among their children. This study is one of the first proofs of concept showing that a nutrition-sensitive agriculture value chain approach can contribute to improved child nutrition in a remote pastoralist population. Trial registration ClinicalTrials.gov NCT02079961

Cash Transfers and Child and Adolescent Development

Poverty has significant, detrimental, and long-ranging effects on child development (Walker and others 2011). Programs and policies around the world have attempted to address poverty to improve outcomes for children and adolescents, and one popular approach is to use cash transfer (CT) programs (Engle and others 2011). CT programs support vulnerable populations by distributing transfers to low-income households to prevent shocks; protect the chronically poor; promote capabilities and opportunities for vulnerable households; and transform systems of power that exclude certain marginalized groups, such as women or children (Devereux and Sabates-Wheeler 2004). The economic rationale for CT programs is that they can be an equitable and efficient way to address market failures and reach the most vulnerable populations (Fiszbein and others 2009). When the provision of CTs is tied to mandatory behavioral requirements, they are conditional cash transfer (CCT) programs, which operate by giving cash payments to families only if they comply with a set of requirements (the “conditions” of the cash transfer), usually related to health and education (de Janvry and Sadoulet 2006). For example, many CCT programs distribute benefits conditional on the use of preventive health care services, attendance at health and nutrition education sessions designed to promote positive behavioral changes, or school attendance for school-age children (Barrientos and DeJong 2006; Lagarde, Haines, and Palmer 2007). Definitions of age groupings and age-specific terminology used in this volume can be found in chapter 1 (Bundy and others 2017). Unconditional cash transfer (UCT) programs are those in which families receive cash benefits because the household falls below a certain income cutoff or lives within a geographically targeted region; however, no conditions are tied to the transfer (Barrientos and DeJong 2006). Given that UCTs do not monitor the behavior of households or require visits to health clinics, these programs are operationally less complex and easier for governments to implement because they do not require a well-functioning health care sector. Thus, administrative costs are often substantially lower for UCTs than for CCTs. School feeding is an example of a noncash transfer and is discussed in chapter 12 of this volume (Drake and others 2017). Both CCTs and UCTs assume that parents are income constrained, and thus do not have the money to spend to meet the most pressing needs of their families (for example, nutritious food, medical treatment). Providing greater purchasing power allows parents to choose what goods to buy and in what quantity and of what quality. The economic rationale for conditioning transfers on certain behaviors is that individuals or households do not always behave rationally because they have imperfect information, they behave myopically, or there are conflicts of interest between parents and children (Fiszbein and others 2009). In addition, conditioning transfers on human capital creates positive externalities and usually

Nutrition incentives in dairy contract farming in northern Senegal

Abstract In developing countries contract farming faces numerous challenges that many times lead to its failure. Innovations that help overcome the difficulties of contracting with a large pool of small farmers in such settings can enhance the viability of such schemes. We use a randomized control trial design combined with high frequency data to investigate the impact of adding a nutrition‐based incentive in contracts between a Senegalese dairy processing factory and its semi‐nomadic milk suppliers. The incentive rewarded suppliers for consistent milk deliveries with daily delivery of a micro‐nutrient fortified yogurt for each young child in corresponding households. Findings show large and significant impacts on the frequency and amount of milk delivered, albeit limited to the dry season. We also find larger impacts on milk deliveries when contracts are managed by women.

Improving diets and nutrition through an integrated poultry value chain and nutrition intervention (SELEVER) in Burkina Faso: study protocol for a randomized trial

BackgroundThe SELEVER study is designed to evaluate the impact of an integrated agriculture–nutrition package of interventions (including poultry value chain development, women’s empowerment activities, and a behavior change communications strategy to promote improved diets and feeding, care, and hygiene practices) on the diets, health, and nutritional status of women and children in Burkina Faso. This paper presents the rationale and study design.MethodsThe impact evaluation involves a cluster randomized controlled trial design that will be implemented in 120 rural communities/villages within 60 communes supported by SELEVER in the Boucle de Mouhoun, Centre-Ouest, and Haut-Bassins regions of Burkina Faso. Communities will be randomly assigned to one of three treatment arms, including: (1) SELEVER intervention group; (2) SELEVER with an intensive WASH component; and (3) control group without intervention. Primary outcomes include the mean probability of adequacy of diets for women and children (aged 2–4 years at baseline), infant and young child feeding practices of caregivers of children aged 0–2 years, and household poultry production and sales. Intermediate outcomes along the agriculture and nutrition pathways will also be measured, including child nutrition status and development. The evaluation will follow a mixed-methods approach, including a panel of child-, household-, community-, and market-level surveys, and data collection points during post-harvest and lean seasons, as well as one year after implementation completion to examine sustainability.DiscussionTo our knowledge, this study is the first to rigorously examine from a food systems perspective, the simultaneous impact of scaling-up nutrition-specific and nutrition-sensitive interventions through a livestock value-chain and community-intervention platform, across nutrition, health, and agriculture domains. The findings of this evaluation will provide evidence to support the design of market-based nutrition-sensitive interventions.Trial registrationISRCTN registry, ISRCTN16686478. Registered on 2 December 2016.

Economic Transfers and Social Cohesion in a Refugee-Hosting Setting

There is increasing interest in understanding if social protection has the ability to foster social cohesion, particularly between refugees and host communities. Using an experimental evaluation of transfers, including cash, food and food vouchers to Colombian refugees and poor Ecuadorians in urban and peri-urban areas we examine if transfers resulted in changes in social cohesion measures. The evaluation was a cluster-randomized control trial examining a short-term programme implemented over six months by the World Food Programme. We examine six aggregate dimensions of social cohesion, derived from 33 individual indicators, in addition to an overall index of social cohesion. Overall results suggest that the programme contributed to integration of Colombians in the hosting community through increases in personal agency, attitudes accepting diversity, confidence in institutions, and social participation. However, while having no impact for the Ecuadorian population. There were no negative impacts of the programme on indicators or domains analysed. Although we are not able to specifically identify mechanisms, we hypothesize that these impacts are driven by joint targeting, messaging around social inclusion and through interaction between nationalities at mandated monthly nutrition trainings.