Cash Plus Interventions for Prevention of Acute Malnutrition in Children Under 5 and Their Mothers in Somalia

NCT06642012 | Completed

• 2 other identifiers: IRB00024476200011671
• Study Type: interventional
• Target: 3,384
• Locations: 2 countries
• Sites: 2

Brief Summary

This trial studied different combinations of cash assistance to families that live in food insecure areas of Somalia and aimed to understand if this cash assistance provided reduced malnutrition of children and mothers.

Conditions

Malnutrition, Child; Wasting Disease; Stunting; Malnutrition; Malnutrition, Mother

Keywords

Social Behavior Change Communication; Cash Transfer; Humanitarian; Malnutrition; Wasting; Somalia

Outcome Measures

Primary Outcomes (4)

• Child Wasting Prevalence

  Child under 5 wasting prevalence was an aggregate measure of children's nutritional status based on the child's MUAC, weight-for-height z-score (WHZ) measurements, and the present of edema. Using the 2013 WHO guidelines on management of severe acute malnutrition in infants and children, at each study timepoint, children were measured and classified as: 1. without acute malnutrition (MUAC \>= 125 mm and WHZ \>= -2 SD and no edema), 2. with moderate acute malnutrition (115 mm \<= MUAC \< 124.9 mmm and/or -3\<=WHZ\<-2 and no edema), 3. severe acute malnutrition (MUAC \< 115 mm and/or WHZ \<-3 and/or edema). Prevalence was estimated with 95% confidence intervals and changes in prevalence were calculated between baseline, 3 months, and 6 months.

  Baseline, 3 months, and 6 months

• Maternal Wasting Prevalence

  Aggregate measure of maternal mid-upper arm circumference (MUAC) measured at each time point using standard MUAC tape to the nearest 0.1cm. Mothers were classified as 1) Overweight (MUAC \> 300 mm), 2) Normal (300\>MUAC\>=230mm) or 3) With moderate acute malnutrition (MUAC \< 230 mm). Prevalence was estimated with 95% confidence intervals and changes in prevalence were calculated between baseline, 3 months, and 6 months.

  Baseline, 3 months, and 6 months

• Child Mid-Upper Arm Circumference

  Child mid-upper arm circumference (MUAC) was measured to the nearest 0.1 cm by program staff at each study timepoint using standard MUAC tape.

  Baseline, 3 months, and 6 months

• Child Weight-for-Height

  Child weight-for-height is an aggregate measure using standard anthropometric measures for weight and height. Child weight was measured to the nearest 0.01 kg using a stand on scale and child height was measured to the nearest 0.1 cm using a wooden length board. Weight-for-height z-scores (WHZ) were calculated using 2006 Word Health Organization child growth standards module in STATA. Weight-for-height compares a child's weight to the weight of a child of the same height and sex from a standard 2006 WHO reference population. This weight-for-height z-score is measured in standard deviations from the median weight for children of the same height and sex. The calculation for Z-score is (X-m)/SD; X is the participant child's weight, m is the median weight for children of the same height and sex in the WHO reference population, and SD is the standard deviation of the weight of the reference population. Z-scores range from -5 to 5.

  Baseline, 3 months, and 6 months

Study Arms (3)

Arm 1: Cash only

ACTIVE COMPARATOR

Arm 1 participants received the cash only intervention. Households in this arm received 1 mobile cash transfer per month for 6 months.

Other: Cash only

Arm 2: Cash + Social Behavior Change Communication (SBCC)

EXPERIMENTAL

Arm 2 participants received the cash + social behavior change communication intervention. Household received 1 mobile cash transfer per month for 6 months but mothers also received an SBCC package that included interpersonal communication (1:1 consultations for mothers), bi-monthly group sessions on key health and nutrition topics, and cooking demonstrations.

Other: Cash + Social Behavior Change Communication

Arm 3: Cash + top-up cash

EXPERIMENTAL

Arm 3 participants received the cash + top-up cash intervention. Households received 1 mobile cash transfer per month for 6 months, receiving the base cash amount plus an additional cash top-up amount.

Other: Cash + top-up cash

Interventions

Cash only OTHER

Households received 1 mobile cash transfer per month for 6 months.

Arm 1: Cash only

Cash + Social Behavior Change Communication OTHER

Households received 1 mobile cash transfer per month for 6 months but mothers also received an SBCC package that included interpersonal communication (1:1 consultations for mothers), bi-monthly group sessions on key health and nutrition topics, and cooking demonstrations.

Arm 2: Cash + Social Behavior Change Communication (SBCC)

Cash + top-up cash OTHER

Households received 1 mobile cash transfer per month for 6 months, receiving the base cash amount plus an additional cash top-up amount.

Arm 3: Cash + top-up cash

Eligibility Criteria

• Age: 6 Months+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Enrolled in Save the Children Cash Plus for Nutrition Program
• Ages 6-59 months at baseline
• Mother is enrolled in the study

You may not qualify if:

• Received treatment for wasting at baseline
• Had an episode of severe acute malnutrition in the past 12 months
• Enrolled in Save the Children Cash Plus for Nutrition Program
• At least 18 years old at baseline
• Have a child that is 6-59 months old at baseline
• Voluntarily willing to participant through signed consent form.
• Currently receiving treatment for wasting
• Had an episode of severe acute malnutrition in the past 12 months

Sponsors & Collaborators

• Johns Hopkins Bloomberg School of Public Health: lead
• Save the Children: collaborator
• Elrha: collaborator
• Ministry of Health, Somalia: collaborator
• UK Foreign, Commonwealth & Development Office (FCDO): collaborator

Study Sites (2)

Johns Hopkins Bloomberg School of Public Health

Baltimore, Maryland, 21205, United States

Location

Save the Children Somalia Office

Mogadishu, Somalia

Location

Related Publications (2)

• Grounds S, Walton S, Alier KK, Garretson S, Mohamoud SA, Abdiqadir SM, Khattak Q, Nur MA, Mohamoud AM, Ismail MO, Mahat MB, Mohamed AA, Mohamed AA, Tripaldi M, Akseer N. Assessing the correlates of wasting among children under five and their mothers in the Bay and Hiran regions of Somalia. J Glob Health. 2025 Dec 12;15:04308. doi: 10.7189/jogh.15.04308.

  PMID: 41384499 DERIVED

• Garretson S, Walton S, Alier KK, Grounds S, Khattak Q, Mohamoud SA, Farah AA, Mohamud FM, Mohamoud AM, Mahdi A, Ismail MO, Mahat MB, Loddo F, Tripaldi M, Akseer N. Analysing concordance between MUAC, MUACZ, and WHZ in diagnosing acute malnutrition among children under five in Somalia. J Glob Health. 2025 Dec 12;15:04258. doi: 10.7189/jogh.15.04258.

  PMID: 41383165 DERIVED

MeSH Terms

Conditions

Child Nutrition Disorders; Wasting Syndrome; Growth Disorders; Malnutrition; Cachexia

Interventions

CASP8 and FADD-Like Apoptosis Regulating Protein

Condition Hierarchy (Ancestors)

Nutrition Disorders; Nutritional and Metabolic Diseases; Metabolic Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Weight Loss; Body Weight Changes; Body Weight; Signs and Symptoms; Thinness

Intervention Hierarchy (Ancestors)

Death Domain Receptor Signaling Adaptor Proteins; Adaptor Proteins, Signal Transducing; Intracellular Signaling Peptides and Proteins; Peptides; Amino Acids, Peptides, and Proteins; Tumor Necrosis Factor Receptor-Associated Peptides and Proteins; Apoptosis Regulatory Proteins; Carrier Proteins; Proteins

Study Officials

• Nadia Akseer, PhD

  Johns Hopkins University

  PRINCIPAL INVESTIGATOR

• Shelley Walton, MPH, RD

  Johns Hopkins University

  PRINCIPAL INVESTIGATOR

• Said Mohamoud

  Save the Children Somalia

  STUDY DIRECTOR

• Adam Abdulkadir

  Save the Children Somalia

  STUDY DIRECTOR

• Qundeel Khattak

  Save the Children International

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 9, 2024
• First Posted: October 15, 2024
• Study Start: May 17, 2023
• Primary Completion: December 25, 2023
• Study Completion: January 30, 2024
• Last Updated: September 8, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

US (1); SO (1)