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Impact of Ethiopia's productive safety net program on household food security and child nutrition: A marginal structural modeling approach.

ABSTRACT: Safety nets are expanding in African countries as a policy instrument to alleviate poverty and food insecurity. Whether safety nets have improved household food security and child diet and nutrition in sub-Saharan Africa has not been well documented. This paper takes the case of Ethiopia's Productive Safety Net Program (PSNP) and provides evidence of the impact of safety nets on household food security and child nutritional outcomes. Prior studies provide inconclusive evidence as to whether PSNP has improved household food security and child nutrition. These studies used analytical approaches that correct for selection bias but have overlooked the effect of time-varying confounders that might have resulted in biased estimation. Given that household food security status is both the criteria for participation and one of the desirable outcomes of the program, estimating the causal impact of PSNP on household food security and child nutrition is prone to endogeneity due to selection bias and time-varying confounders. Therefore, the objectives of this paper are (1) to examine the impacts of PSNP on household food security, child meal frequency, child diet diversity, and child anthropometry using marginal structural modeling approach that takes into account both selection bias and time-varying confounders and (2) to shed some light on policy and programmatic implications. Results show that PSNP has not improved household food insecurity, child dietary diversity, and child anthropometry despite its positive impact on child meal frequency. Household participation in PSNP brought a 0.308 unit gain on child meal frequency. Given the consequence of food insecurity and child undernutrition on physical and mental development, intergenerational cycle of poverty, and human capital formation, the program would benefit if it is tailored to nutrition-specific and nutrition-sensitive interventions.

SUBMITTER: Bahru BA

PROVIDER: S-EPMC7511729 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Impact of Ethiopia's productive safety net program on household food security and child nutrition: A marginal structural modeling approach.

Bahru Bezawit Adugna BA Jebena Mulusew G MG Birner Regina R Zeller Manfred M

SSM - population health 20200826

Safety nets are expanding in African countries as a policy instrument to alleviate poverty and food insecurity. Whether safety nets have improved household food security and child diet and nutrition in sub-Saharan Africa has not been well documented. This paper takes the case of Ethiopia's Productive Safety Net Program (PSNP) and provides evidence of the impact of safety nets on household food security and child nutritional outcomes. Prior studies provide inconclusive evidence as to whether PSNP ...[more]

PMID: 33005722

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Project description:BackgroundFood-assisted maternal and child health and nutrition programs are a widely used approach to address undernutrition. Little is known about the effects of these programs' combined household and individual food rations on household and individual food consumption. Tubaramure in Burundi targeted women and children during the first 1000 d of life, and included: 1) food rations (corn-soy blend and micronutrient-fortified vegetable oil); 2) health services strengthening and promotion of their use; and 3) behavior change communication on nutrition, hygiene, and health practices.ObjectivesThe objectives were: 1) to assess Tubaramure's impact on household food consumption and food security, maternal dietary diversity, and infant and young child feeding practices; 2) to explore the role of the food rations; and 3) assess 6-8 mo impacts around 8 mo after the end of the program.MethodsWe used a 4-arm cluster-randomized controlled repeated cross-sectional design (11,906 observations). The treatment arms received the same food ration but differed in the ration timing and duration: 1) the first 1000 d; 2) from pregnancy through 17.9 mo of age; or 3) from birth through 23.9 mo of age.ResultsTubaramure significantly (P < 0.05) improved the percentage of food secure households [from 4.5 to 7.3 percentage points (pp)], and increased household energy consumption (from 17% to 20%) and micronutrient consumption. The program had a positive effect on maternal dietary diversity (+0.4 food groups, P < 0.05) and increased the proportion of children aged 6-23.9 mo consuming ≥4 food groups (from 8.0 to 9.6 pp, P < 0.05). The effects on many outcomes were attributable to the food rations. Postprogram effects (P < 0.05) were found on household food security, maternal dietary diversity, and younger sibling's complementary feeding practices.ConclusionsPrograms such as Tubaramure have the potential to improve food security and household and individual energy and micronutrient consumption in severely resource-constrained populations, as seen in rural Burundi. This trial was registered at clinicaltrials.gov as NCT01072279.

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Project description:BackgroundMeasuring household food insecurity in specific geographic areas provides vital information that enables appropriate and effective intervention measures to be taken. To that end, this study aimed to assess the prevalence of food insecurity and associated factors among Urban Productive Safety Net Program (UPSNP) beneficiary households in Addis Ababa, Ethiopia's capital city.MethodsA community-based cross-sectional study was conducted among 624 UPSNP beneficiary households in nine districts of Addis Ababa from June to July 2019. A multi-stage sampling method was used; study participants were selected using a simple random sampling technique after establishing the proportionally allocated sample size for 9 districts. Data were collected by trained personnel using a pretested, structured questionnaire. The outcome variable was food insecurity as measured by Household Food Insecurity Access Scale (HFIAS), a tool developed by the Food and Nutrition Technical Assistance Scale (FANTA) and validated for developing countries, including Ethiopia. A binary (crude odds ratio [COR]) and multivariable (adjusted odds ratio [AOR]) logistic regression analysis were employed at 95% CI (confidence interval). From the bivariate analysis, factors having a p-value<0.25 were included in the multivariable analysis. From the multivariable analysis, any variable at p-value < 0.05 at 95% CI was declared significantly associated with household food insecurity. Model fitness was also checked using the Hosmer-Lemeshow test with p-value>0.05.ResultsThe prevalence of household food insecurity was 77.1% [95%CI:73.8-80.7] during the month prior to the survey. Illiteracy of household head [AOR: 2.56; 95%CI:1.08-6.07], family size of 4 or more [AOR: 1.87, 95%CI:1.08-3.23], high dependency ratio [AOR: 3.95; 95%CI:1.31-11.90], household lack of access to credit [AOR:2.85; 95%CI:1.25-6.49], low household income [AOR: 4.72; 95%CI:2.32-9.60] and medium household income [AOR: 9.78; 95%CI:4.29-22.35] were significantly associated with household food insecurity.ConclusionWe found that three in four of Addis Ababa's UPSNP beneficiary households were food-insecure. Implementation of measures to improve household income, minimize the dependency ratio of households, and arrange access to credit services are paramount ways to tackle food insecurity problems in Addis Ababa.

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Impact of Ethiopia's productive safety net program on household food security and child nutrition: A marginal structural modeling approach.

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Impact of Ethiopia's productive safety net program on household food security and child nutrition: A marginal structural modeling approach.

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