PC2102: Cash Transfers and Nutrition Education to Improve Dietary Diversity Among Children Aged 6-23 Months in Grand Gedeh County, Liberia: A Cluster Randomized Trial

Background: Inadequate dietary diversity is common in the West African country of Liberia and may lead to long-term sequelae. Our objective was to evaluate the efficacy of a cash transfer and nutrition education program on dietary diversity among children aged 6-23 months in Liberia. We hypothesized that a multi-pronged intervention would result in improved dietary diversity among children.

Methods: We conducted a three-armed, cluster randomized study in 42 communities (12 children per community) in Grand Gedeh County, Liberia over a 12-month period. We randomly assigned communities to control (n=14 communities), communities that received both bimonthly cash transfers and a structured nutrition education program (n=14 communities), and communities that received bimonthly cash transfers only (n=14 communities). The primary outcome was the proportion of children aged 6-23 months who met minimum dietary diversity score (i.e., ≥4 food groups consumed per day) over the study period. Secondary outcomes included meal frequency and healthcare utilization for illnesses. Community health assistants conducted bimonthly assessments in participants’ homes. (NCT04101487)

Results: There were 599 children aged 6-23 months enrolled in this study and 533 (88.9%) were retained through the 12-month trial period. Though the proportion of children who consumed ≥4 food groups per day did not differ among the three arms, children randomized to the cash transfers only arm had significantly higher median dietary diversity scores than the control group during each of the six home visits during the trial (P < 0.001-0.004). Children in both intervention arms consumed significantly more meals per day than the control communities. Children in both intervention arms were less likely to have visits to clinics or hospitals for illnesses during the trial.

Conclusion: Bimonthly, unconditional cash transfers and nutrition education were associated with higher dietary diversity scores, greater meal frequency, and fewer healthcare visits for illnesses among children aged 6-23 months.