CAN CONDITIONAL CASH TRANSFER COMBINED WITH NUTRITIONAL SUPPLEMENTATION PLAY A ROLE IN REDUCING CHILD STUNTING IN RURAL MALI?

Background and objectives: The World Food Program implemented a conditional cash transfer intervention (~€z2.30 per month) coupled with a nutritional supplementation (Plumpy'doz®), targeting pregnant women and children under two during the 1,000-day window of opportunity, to prevent stunting in Kayes region, Mali. The objective of this study was to assess the impact of the intervention on child stunting. Methods: We conducted a cluster randomized trial, with health community centers (CHCs) randomized in 4 intervention arms: Arm 1, control; Arm 2, cash to women attending prenatal follow up and postnatal visits (childhood immunization and growth monitoring); Arm 3, distributions of Plumpy'doz® (PPDoz) to children attending growth monitoring sessions and Arm 4, cash and PPDoz. In all 4 arms, the program provided health and nutrition education activities as a basis. We compared repeated cross-sectional samples of 12-42 months old children surveyed before the intervention (2013, n=5046) and at the end of the intervention (2016, n=5098), through a difference-in-differences approach using logistic or linear regression. A qualitative process evaluation (PE) study conducted one year before the end of the program provided insights on program implementation. Results: In arms 2 and 3, the prevalence of stunting decreased from 36% to 32% and 34% to 29%, respectively, while it remained stable in the control arm as in arm 4. The interaction was not statistically significant (p-value=0.10). Significant impact of the program was measured on secondary outcomes: mothers' knowledge (p-value