Cash and voucher assistance and children's nutrition status in Somalia

Abstract

To address ongoing food insecurity and acute malnutrition in Somalia, a broad range of assistance modalities are used, including in‐kind food, food vouchers, and cash transfers. Evidence of the impact of cash and voucher assistance (CVA) on prevention of acute malnutrition is limited in humanitarian and development settings. This study examined the impact of CVA on prevention of child acute malnutrition in 2017/2018 in the context of the Somalia food crisis. Changes in diet and acute malnutrition were measured over a 4‐month period among children age 6–59 months from households receiving household transfers of approximately US$450 delivered either as food vouchers or a mix of in‐kind food, vouchers, and cash. Baseline to endline change in children's dietary diversity, meal frequency, minimum acceptable diet (MAD), mid‐upper arm circumference (MUAC), and acute malnutrition (MUAC < 12.5 cm) were compared using difference‐in‐difference analysis with inverse probability weighting. There were no statistically significant changes in dietary diversity, meal frequency, or the proportion of children with MAD for either intervention group. Adjusted change in mean MUAC showed increases of 0.5 cm (confidence interval [CI; 0.0, 0.7 cm]) in the food voucher group and 0.1 cm (CI [−0.1, 0.4]) in the mixed transfer group. In adjusted analysis, prevalence of acute malnutrition among children under 5 years increased by 0.7% (CI [−13.4, 14.4%]) among food voucher recipients and decreased by 4.8% (CI [−9.9, 8.1%]) in mixed transfer recipients. The change over time in both mean MUAC and acute malnutrition prevalence was similar for both interventions, suggesting that cash and vouchers had similar effects on child nutrition status.

Impact of conditional and unconditional cash transfers on health outcomes and use of health services in humanitarian settings: a mixed-methods systematic review

“…When comparing food voucher recipients with mixed transfer recipients, the change over time in both mean MUAC and prevalence of acute malnutrition was similar. 34 Likewise, a UCT programme targeting pregnant and lactating women found no significant difference in preventing acute malnutrition compared with a control group with no cash-related intervention. 33 When 6 monthly cash transfers (US$40 per month) were compared with food vouchers and food transfers in Northern Ecuador, all three arms significantly improved the quality and quantity of consumed food (measured by HDDS, Dietary Diversity Index (DDI), FCS, caloric intake, per capita food consumption).…”

Cash assistance programming and changes over time in ability to meet basic needs, food insecurity and depressive symptoms in Raqqa Governorate, Syria: Evidence from a mixed methods, pre-posttest

“…[36,37] Further longitudinal research is needed to provide nuanced understanding of how cash, including delivering modality and dosage, and contextual factors may influence nutrition related outcomes, beyond food insecurity. [38] While we are only able to assess changes in depressive symptoms and perceived household needs and daily stressors over time without a comparison group, data point to a potential relationship between cash assistance and mental health outcomes both during and after the assistance. Qualitatively, some women described cash meaningfully reducing the daily stressors facing women and their families.…”

Patterns of Wasting Among Pregnant and Lactating Women in Uganda, 2015-2018: Analysis of Nutrition Surveillance Data

“…Such interventions have helped improve the nutrition outcomes in similar contexts. Studies in multiple countries have shown that cash transfers alone or in combination with other interventions prevented malnutrition and improved outcomes (41)(42)(43).…”