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1000 Titel
  • Evaluation of conditional cash transfers and mHealth audio messaging in reduction of risk factors for childhood malnutrition in internally displaced persons camps in Somalia: A 2 × 2 factorial cluster-randomised controlled trial
1000 Autor/in
  1. Grijalva-Eternod, Carlos Salvador |
  2. Jelle, Mohamed |
  3. Mohamed, Hani |
  4. Waller, Katie |
  5. Hussein, Bishar Osman |
  6. Barasa, Emmanuel |
  7. Solomon, Andrea |
  8. Mehjabeen, Sajia |
  9. Copas, Andrew |
  10. Fottrell, Edward |
  11. Seal, Andrew |
1000 Erscheinungsjahr 2023
1000 Publikationstyp
  1. Artikel |
1000 Online veröffentlicht
  • 2023-02-27
1000 Erschienen in
1000 Quellenangabe
  • 20(2):e1004180
1000 Copyrightjahr
  • 2023
1000 Lizenz
1000 Verlagsversion
  • https://doi.org/10.1371/journal.pmed.1004180 |
1000 Ergänzendes Material
  • https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004180#sec038 |
1000 Publikationsstatus
1000 Begutachtungsstatus
1000 Sprache der Publikation
1000 Abstract/Summary
  • BACKGROUND: Cash transfer programmes are increasingly used in humanitarian contexts to help address people’s needs across multiple sectors. However, their impact on the key objectives of reducing malnutrition and excess mortality remains unclear. mHealth interventions show great promise in many areas of public health, but evidence for their impact on reducing the risk factors for malnutrition is uncertain. We therefore implemented a trial to determine the impacts of 2 interventions in a protracted humanitarian context, a cash transfer conditionality and mHealth audio messages. METHODS AND FINDINGS: A 2 × 2 factorial cluster-randomised trial was implemented in camps for internally displaced people (IDP) near Mogadishu, Somalia, starting in January 2019. The main study outcomes were assessed at midline and endline and included coverage of measles vaccination and the pentavalent immunisation series, timely vaccination, caregiver’s health knowledge, and child diet diversity. Twenty-three clusters (camps) were randomised to receive or not receive conditional cash transfers (CCTs) and an mHealth intervention, and 1,430 households were followed up over 9 months. All camps received cash transfers made at emergency humanitarian level (US$70/household/month) for 3 months followed by a further 6 months at a safety net level (US$35). To be eligible to receive cash, households in camps receiving CCT were required to take their children <5 years age to attend a single health screening at a local clinic and were issued with a home-based child health record card. Participants in camps receiving the mHealth intervention were asked (but not required) to listen to a series of audio messages about health and nutrition that were broadcast to their mobile phone twice a week for 9 months. Participants and investigators were not blinded. Adherence to both interventions was monitored monthly and found to be high (>85%). We conducted intention-to-treat analysis. During the humanitarian intervention phase, the CCT improved coverage of measles vaccination (MCV1) from 39.2% to 77.5% (aOR 11.7, 95% CI [5.2, 26.1]; p < 0.001) and completion of the pentavalent series from 44.2% to 77.5% (aOR 8.9, 95% CI [2.6, 29.8]; p = < 0.001). By the end of the safety net phase, coverage remained elevated from baseline at 82.2% and 86.8%, respectively (aOR 28.2, 95% CI [13.9, 57.0]; p < 0.001 and aOR 33.8, 95% CI [11.0, 103.4]; p < 0.001). However, adherence to timely vaccination did not improve. There was no change in the incidence of mortality, acute malnutrition, diarrhoea, or measles infection over the 9 months of follow-up. Although there was no evidence that mHealth increased Mother’s knowledge score (aOR 1.32, 95% CI [0.25, 7.11]; p = 0.746) household dietary diversity increased from a mean of 7.0 to 9.4 (aOR 3.75, 95% CI [2.04, 6.88]; p < 0.001). However, this was not reflected by a significant increase in child diet diversity score, which changed from 3.19 to 3.63 (aOR 2.1, 95% CI [1.0, 4.6]; p = 0.05). The intervention did not improve measles vaccination, pentavalent series completion, or timely vaccination, and there was no change in the incidence of acute malnutrition, diarrhoea, measles infection, exclusive breastfeeding, or child mortality. No significant interactions between the interventions were found. Study limitations included the limited time available to develop and test the mHealth audio messages and the necessity to conduct multiple statistical tests due to the complexity of the study design. CONCLUSIONS: A carefully designed conditionality can help achieve important public health benefits in humanitarian cash transfer programmes by substantially increasing the uptake of child vaccination services and, potentially, other life-saving interventions. While mHealth audio messages increased household diet diversity, they failed to achieve any reductions in child morbidity, malnutrition, or mortality. TRIAL REGISTRATION: ISRCTN ISRCTN24757827. Registered November 5, 2018.
1000 Sacherschließung
lokal Child health
lokal Medical risk factors
lokal Food
lokal Vaccination and immunization
lokal Malnutrition
lokal Measles
lokal Diet
lokal Vaccine development
1000 Fächerklassifikation (DDC)
1000 Liste der Beteiligten
  1. https://orcid.org/0000-0002-2461-9954|https://orcid.org/0000-0002-2894-6549|https://frl.publisso.de/adhoc/uri/TW9oYW1lZCwgSGFuaQ==|https://frl.publisso.de/adhoc/uri/V2FsbGVyLCBLYXRpZQ==|https://frl.publisso.de/adhoc/uri/SHVzc2VpbiwgQmlzaGFyIE9zbWFu|https://frl.publisso.de/adhoc/uri/QmFyYXNhLCBFbW1hbnVlbA==|https://orcid.org/0000-0002-6340-3320|https://frl.publisso.de/adhoc/uri/TWVoamFiZWVuLCBTYWppYQ==|https://orcid.org/0000-0001-8968-5963|https://orcid.org/0000-0003-0518-7161|https://orcid.org/0000-0003-3656-4054
1000 Label
1000 Förderer
  1. Office of U.S. Foreign Disaster Assistance |
  2. Foreign, Commonwealth and Development Office |
1000 Fördernummer
  1. APS-OFDA-17-000002
  2. 205128-103
1000 Förderprogramm
  1. -
  2. -
1000 Dateien
1000 Förderung
  1. 1000 joinedFunding-child
    1000 Förderer Office of U.S. Foreign Disaster Assistance |
    1000 Förderprogramm -
    1000 Fördernummer APS-OFDA-17-000002
  2. 1000 joinedFunding-child
    1000 Förderer Foreign, Commonwealth and Development Office |
    1000 Förderprogramm -
    1000 Fördernummer 205128-103
1000 Objektart article
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1000 @id frl:6441165.rdf
1000 Erstellt am 2023-03-29T14:15:06.189+0200
1000 Erstellt von 284
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1000 Zuletzt bearbeitet Wed Mar 29 15:46:32 CEST 2023
1000 Objekt bearb. Wed Mar 29 15:46:13 CEST 2023
1000 Vgl. frl:6441165
1000 Oai Id
  1. oai:frl.publisso.de:frl:6441165 |
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