Cash transfer, maternal and child health outcomes: a scoping review in sub-Saharan Africa

Figures & data

Figure 1. PRISMA flow chart for identification of studies.

Table 1. Description of reported MCH outcomes by categories of health outcomes.

Outcome	Number of articles reporting
Mortality	1 (4.8%)
Child survival	1
Fetal loss/fetal death	1
Stillborn	1
Infant death	1
Functional status	13 (61.9%)
Illness in the past 30 days	3
Illness that stopped normal activities in the past 30 days	1
Cognitive, language, and motor growth	1
Depression	3
Children anthropometric measures	1
Incidence of HIV, HSV-2	2
Well-being	3 (14.3)
Subjective well-being	2
Mother’s general health	1
Happiness	1
Quality of life	1
Health-promotion behaviours	4 (19.0)
Prevention of mother-to-child HIV transmission	3
Tetanus toxoid vaccination	1
Protective sexual behaviors (e.g. condom use, etc.)	1

Figure 2. Pathways through which CT programs impact MCH outcomes.

Table

Author(s)	Year	N (Sample)	Target Population	Exposure, Intervention	Outcome(s) assessed	Methods	Confounders
Akresh, R.; De Walque, D.; Kazianga, H.	2016	–	Young Children (under 5)	Cash transfers	C-reactive protein (CRP) Probability of being ill Anthropometric indicators	Multilevel linear regression models	Village characteristics (e.g. distance to province capital, source of water, rainfall, presence of a village market) Health facility characteristics (facility offers nutritional counseling/supplement/vaccinations, clinic funding sources, and recent village history of health epidemics)
Berk Özler, Kelly Hallman, Marie-France Guimond, Elizabeth A. Kelvin, Marian Rogers, Esther Karnley	2020	Liberia (N = 999 men aged 18–35)	Young girls 13–14	Cash transfer	Sexual violence, sexual and reproductive health, psychosocial wellbeing	ITT, using a linear regression model	age
Sylvia Shangani, Don Operario, Becky Genberg, Kipruto Kirwa, Miriam Midoun, Lukoye Atwoli, David Ayuku, Omar Galárraga, Paula Braitstein	2017	N = 655	10–18 years orphans and vulnerable adolescents	Unconditional cash transfer	Depression Anxiety Post-traumatic stress symptoms	Logistic regression models	Age, sex, orphan status, enrolled in school, number of siblings, deceased siblings, religion important, pair of shoes Medical (hospitalised in the past year) sexually abused, transactional sex. Caregiver characteristics
Yesim Tozan, Sicong Sun, Ariadna Capasso, Julia Shu-Huah Wang, Torsten B. Neilands, Ozge Sensoy Bahar, Christopher Damulira, Fred M. Ssewamala	2021	N = 1,383	Young people (10–16) in Uganda	Cash transfer through saving incentives	Self-rated health Sexual health (sexual risk-taking intention, HIV prevention attitudes, HIV knowledge) Mental health functioning (depression, hopelessness, self-concept, self-efficacy)	ITT, using multilevel models	Age, sex, wave of data collection
Winnie K Luseno, Kavita Singh, Sudhanshu Handa, Chirayath Suchindran	2014	1197	Children 6–17 years	Cash transfer program to address poor school-age children’s health outcomes (4 village groups were randomly selected to receive cash transfers and 4 others did not). The amount of cash depended on the household size. CCT	Illness in the past month Illness that stopped normal activities in the past month Missing school due to illness or injury in the past month Health care use for worst illness in past year	Multilevel logistic regression model	Household-level variables (e.g. number of working-age adults, number of sick adults in past 30 days, age head of household, sex head of household (HH), education head of household, number of children) Child-level variables (maternal orphan, paternal orphan, double orphan, child sex) control variables (age, relationship to HH, control for outcome at baseline)
Sudhanshu Handa, Carolyn Tucker Halpern, Audrey Pettifor, Harsha Thirumurthy	2014	–	Orphans Vulnerable Children (OVC), aged 0–17 years	Unconditional cash transfer of $20 per month to caregivers of young people. UCT	Sexual debut Sexual behaviours (e.g. condom use, number of partners, transactional sex)	Logistic regression model	Age of head, sex of head, education of head, relationship of child to respondent, residence, sex of child, age of child
Gustavo Angeles, Jacobus de Hoop, Sudhanshu Handa, Kelly Kilburn, Annamaria Milazzo, Amber Peterman	2019	3531 SCTP-eligible households 2782 youth	13–19	Unconditional cash transfer UCT	10-item short form of CES-D scale Depressive symptoms	Intention-to-treat using ANCOVA & Difference in difference for sensitivity analysis	Baseline youth characteristics (age, single or double orphan), baseline household characteristics (sex of caregivers, literacy status, household size) traditional authority ID
Carolyn Huang, Kavita Singh, Sudhanshu Handa, Carolyn Halpern, Audrey Pettifor, Harsha Thirumurthy	2017	0–7 years and under 5 years of age		Unconditional cash transfer of $20 per month to caregivers of young people	Incidence of illness (malaria/pneumonia) Health seeking behaviors	Generalized Linear Latent and mixed method estimation	Individual level (age, sex, orphan, relationship to HH, low Haz, low BMIZ) Characteristics of the head of household (education, age, sex). Environmental factors (household size, living environment index, crowding index, cook stove, cook fuel, toilet, diet diversity score, food groups as a proportion of diet)Wealth: monthly per capita income, livestock indexCommunity characteristics (distance malaria treatment, distance doctor, residence: rural/urban)
Kelly Kilburn, Harsha Thirumurthy, Carolyn Tucker Halpern, Audrey Pettifor, Sudhanshu Handa	2016	2,210	15–24 young persons	UCT (CT-OVC)	CES-D (Depression Index)	Logistic regression model (estimating Presence of depressive symptoms)	Age, sex, participant’s relationship to head of HH, head of household characteristics (sex, age, schooling attainment), Nairobi residence status, indicator of morbidity status (except for physical outcomes)
Marie CD STONER, Audrey PETTIFOR, Jessie K. EDWARDS, Allison E. AIELLO, Carolyn T HALPERN, Aimée JULIEN, Amanda SELIN, Rhian TWINE, James P. HUGHES, Jing WANG, Yaw AGYEI, F. Xavier GOMEZ-OLIVE, Ryan G. WAGNER, Catherine MACPHAIL, Kathleen KAHN	2018	2,328	13–20 years	CCT conditional on school attendance	Incidence of HIV and HSV-2	Inverse probability-of-exposure weighted survival curves and a marginal structural Cox model.	Age, household wealth, ever repeated a grade, partner in 5 years or older, double, or single orphan, maximum age difference with partners, ever had sex, unprotected sex in last 3 months, given money or gift in exchange for sex, alcohol use, children depression index, children manifest depression index
Kelly Kilburn, Sudhanshu Handa, Gustavo Angeles, Maxton Tsoka, Peter Mvula	2018		Ultra-poor population (identified by appointed community leaders)	UCT	Subjective Well-being (SWB): QoL, future expectations, and relative well-being	Difference in Difference regression model	Control variables included individual and household characteristics plus a full set of treatment-covariate interactions
Edward N. Okeke, Isa S. Abubakar	2020	10582 women	Pregnant women	CCT	Child survival, fetal loss, fetal death, stillborn, infant death (neonatal vs post-natal death)	ITT	dummies for mother’s age (<18, 18–24, 25–29,30–34, and>35 years), dummies for mother’s educational attainment (no schooling, Islamic schooling, some primary school, some secondary school, and some tertiary schooling), a dummy denoting Hausa or Fulani extraction, dummies for mother’s number of prior births, dummies indicating a prior fetal loss or a stillbirth, and household wealth quintile dummies
Jenny X. Liu, Jennifer Shen, Nicholas Wilson, Svetha Janumpalli, Patrick Stadler, Nancy Padian	2019	554	Pregnant women tested HIV positive	PMTCT	Administration of nevirapine, administration of EID	ITT
Nadia Nguyen, Kimberly A. Powers, William C. Miller, Annie Green Howard, Carolyn T. Halpern, James P. Hughes, Jing Wang, Rhian Twine, Xavier Gomez-Olive, Catherine MacPhail, Kathleen Kahn, Audrey E. Pettifor	2019	1,034	Young girls 13–23	Sexual Partners Anonymous out-of-school partner	Incidence of HIV	Latent Class Analysis
Luisa Natali, Sudhanshu Handa, Amber Peterman, David Seidenfeld, Gelson Tembo, On behalf of the Zambia Cash Transfer Evaluation Team	2018		Women who are primary caregiver of eligible child	UCT	Happiness Child’s wellbeing	Linear probability	woman’s age, education and marital status, household size and household demographic composition, and districts. Each outcome in column 3–12 reflects the woman’s level of agreement with each of these statements measured using a five-point Likert Scale ranging from one to five (where 1 capture strong disagreement and 5 strong agreement)
Edward N. Okeke, Zachary Wagner, Isa S. Abubakar	2020	180 Primary Health Facility/1.2M people	Pregnant women	CCT to deliver in hospitals	Mother’s General Health Delivery complications	ITT
Christopher R Sudfeld, Lilia Bliznashka, Geofrey Ashery, Aisha K Yousafzai, Honorati Masanja	2021	12 Villages	Pregnant women with child < 1 year	Community Health Worker (CHW) alone or CHW with CCT	Child Cognitive, language and motor development (Bayley scale) Child length/height-for-age-z-score (HAZ)	ITT
Jessica Londeree Saleska, Abigail Norris Turner, Maria F. Gallo, Abigail Shoben, Bienvenu Kawende, Noro Lantoniaina Rosa Ravelomanana, Harsha Thirumurthy, Marcel Yotebieng	2021	434 HIV pregnant women	HIV positive women	CCT	Retention in HIV care Uptake of prevention of mother-to-child transmission services	Binomial models	Wealth index, depression symptoms, alcohol use in pregnancy
Yousafzai, Aisha K1 (AUTHOR), Asheri, Geofrey2 (AUTHOR), Masanja, Honorati2 (AUTHOR), Sudfeld, Christopher R1,3 (AUTHOR)	2020	12 villages	Pregnant women and children	CHW, CHW + CCT	Maternal depressive symptoms	Hopkins Symptoms Check List 25 (HSCL-25)	age, pregnancy status at enrollment, education, parity, marital status, perceived social support, household wealth, child age
Angeles, Gustavo, de Hoop, Jacobus, Handa, Sudhanshu, Kilburn, Kelly, Milazzo, Annamaria, Peterman, Amber	2019	330,000 households		CCT	Child anthropometry	10-items short form of CES-D scale
Ryoko Sato and Benjamin Fintan	2019	2,530 Women 15–35	Women 15–35 years	CCT	Tetanus toxoid vaccination	Logistic regression model	Sociodemographic, distance to clinic, transport to clinic