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A new study from Niger shows that specialized nutritious foods offer an effective and affordable approach to preventing acute malnutrition. But this isn't necessarily an argument against cash transfers, warns WFP's Saskia de Pee, one of the study's authors.
ROME -- Those of us working to prevent malnutrition around the world often grapple with the question of whether it is better to provide cash or specialized nutritious food to prevent acute child malnutrition. Both options have their benefits and their drawbacks. Now, new evidence from Niger shows that specialized foods are not only effective in preventing acute malnutrition, but are also the more affordable strategy. The study by Epicentre, Médecins Sans Frontières (MSF), the World Food Programme (WFP) and the Ministry of Public Health in Niger has just been published in the latest issue of the journal PLOS Medicine. Read the paper in full here.
Maradi, in Niger's south near the border with Nigeria, was chosen as the study location. Driving into the town, there are multinational billboards along the highway next to women selling groundnuts at small road-side stalls. It has annual ‘hunger gaps' where vulnerable households run low on food before the next harvest. Its particular social and economic make-up allowed a range of malnutrition interventions to be implemented which then meant, for the first time, the results of each option could be directly compared.
We focused on the incidence of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) among children aged 6-23 months over a five month period. We compared the effectiveness of seven preventive strategies including distribution of specialized nutritious foods (such as Plumpy'doz or Super Cereal Plus), with or without additional household support such as a family food ration or cash transfers, and cash transfer only.
The main finding is that acute malnutrition among the target group was equally well prevented by providing special nutritious foods to the child as by providing cash support to the household. But the cost of the nutritious food was only 8 euros per child per month (including operational costs), whereas the cash support was 43 euros per household per month. To put it another way, cash support cost four times as much as nutritious food support, with one targeting the household and the other the child, but the outcome on malnutrition prevention in the child was the same.
But this isn't an argument against cash transfers. The study finds that a combination of cash and nutritious foods may be best. Children of households that received both a cash transfer (slightly lower at 38 euro per month) and a nutritious food had the lowest incidence of acute malnutrition (1.7-2.5 times lower compared to nutritious food only or cash only).
These results show two things: 1) protecting young children from malnutrition requires good nutrition which is more cost-effectively provided in the form of special nutritious foods as compared to cash or ‘open' vouchers, and 2) programmes to prevent undernutrition are more impactful when household food security is also ensured, which may require providing food assistance to food insecure households.
This is in terms of programming for protecting a population during a hunger season in a context like Maradi, Niger. It means that vulnerable target groups, such as children aged 6-23 months and pregnant and lactating women, should be provided access to adequately fortified nutritious foods, either in-kind or through a voucher for obtaining specific foods where the market functions well. An additional income transfer in the form of cash, vouchers or a food ration, depending on how food can best be accessed, will benefit the most vulnerable households.
Read the study here: Preventing Acute Malnutrition among Young Children in Crises: A Prospective Intervention Study in Niger in PLOS Medicine. Authors: Céline Langendorf, Thomas Roederer, Saskia de Pee, Denise Brown, Stéphane Doyon, Abdoul-Aziz Mamaty, Lynda W.-M. Touré, Mahamane L. Manzo, Rebecca F. Grais.
Saskia de Pee is a Senior Technical Advisor for Nutrition at WFP
