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Impact d'un transfert monétaire et/ou d'un supplément nutritionnel pour la prévention du retard de croissance du jeune enfant en milieu rural au Mali : analyse d'un essai randomisé par clusters

Abstract : In 2014, on top of a community health and nutrition program running in the region of Kayes in Mali (SNACK), the World Food Program implemented distributions of i) cash to pregnant and mothers of children aged less than 24 months and ii) Lipid-Based Nutrient Supplements (LNS) to children aged 6-23 months. Both interventions were conditional upon attendance at community health centers (CHCs) for medical follow up throughout the first 1000 days of life (from conception to age 2 of the child). We evaluated the impact of these strategies on children’s anthropometric status, the mean height-for-age z-scores (HAZ) being our primary outcome, as well as on intermediary outcomes along the program’s impact pathways. We conducted a cluster randomized controlled trial, with CHCs randomized in 4 arms: 1) SNACK program only (comparison); 2) SNACK+Cash; 3) SNACK+LNS; 4) SNACK+Cash+LNS. Independent representative samples of 12-42 mo old children were surveyed at baseline (2013, n=5046) and at endline (2016, n=5098). Despite an increase in the mean HAZ and a decrease in stunting rates (HAZ<-2) between 2013 and 2016 in arm 2 (35.6% vs. 31.8%) and in arm 3 (34.6% vs. 29.5%), these changes were not statistically significant as compared with the SNACK arm. Combing the two strategies did not lead to any impact on growth outcomes, however it improved the mean weight-for-height z-scores (ß= +0.16 P<0.01). Attendance at children’s growth monitoring sessions and some of the mothers’ knowledge significantly increased in arms 3 and 4. Data on the program’s implementation suggested several barriers to impact achievement, including irregularity in cash/LNS provisioning and distributions due to low accessibility to CHCs, excessive workload of frontline workers, insufficient amount of cash transfers or sharing of LNS with siblings.
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Laura Adubra. Impact d'un transfert monétaire et/ou d'un supplément nutritionnel pour la prévention du retard de croissance du jeune enfant en milieu rural au Mali : analyse d'un essai randomisé par clusters. Santé publique et épidémiologie. Sorbonne Université, 2019. Français. ⟨NNT : 2019SORUS447⟩. ⟨tel-02931883⟩

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