Evaluating Adherence to Locally Sourced Food Vouchers and Cash Transfer Modalities for the Treatment of Moderate Acute Malnutrition (MAM) Among Children Aged 6–59 Months in Ethiopia: A Sub-Study of a Cluster-Randomized Non-Inferiority Trial
Year: 2026
Type: preprint
Abstract: Food voucher and cash transfer approaches have gained attention as potential treatment strategies for managing moderate acute malnutrition (MAM); however, their effectiveness depends on caregivers’ adherence to the intended use of these approaches, including redeeming vouchers for recommended food items, using cash transfers to purchase recommended nutritious foods, and ultimately ensuring that the target child adequately consumes the foods. This study, embedded within a cluster-randomized controlled trial, assessed adherence to these treatment approaches among 1,982 children (voucher: 954; cash: 1,028). Data were collected using a structured adherence assessment tool and program records. Adherence to child food consumption was assessed using caregiver-reported information on the child’s consumption of provided foods and household food-sharing practices and was categorized into high, moderate, and low adherence levels. We found that, in the voucher group, 62.6% of children had high adherence, 23.8% moderate adherence, and 13.6% low adherence. In the cash group, 58.2% had high adherence, 18.1% moderate adherence, and 23.7% low adherence. Overall, the voucher group had a higher proportion of children with high adherence and a lower proportion with low adherence compared with the cash group. In addition, we found that both common and arm-specific factors were associated with food-consumption adherence in the voucher and cash arms. In both arms, household food security and adequate SBCC exposure were positively associated with high adherence. Compared with children from severely food-insecure households, those from food-secure households had higher odds of high adherence in the voucher (COR = 2.21, 95% CI: 1.43–3.42) and cash (AOR = 5.91, 95% CI: 3.72–9.37) arms. Adequate SBCC exposure was also associated with higher adherence in the voucher (AOR = 1.68, 95% CI: 1.26–2.23) and cash (AOR = 1.77, 95% CI: 1.32–2.39) arms. In contrast, higher household wealth was associated with lower odds of high adherence in both the voucher (AOR = 0.54, 95% CI: 0.39–0.73) and cash (AOR = 0.71, 95% CI: 0.53–0.96) arms. However, household size was associated with adherence only in the cash arm. Overall, the findings indicate that adherence to voucher- and cash-based treatment approaches is influenced by household food security, caregiver exposure to SBCC, and household characteristics. Strengthening SBCC, providing targeted caregiver support, and addressing household-level barriers may improve the appropriate use and enhance the potential effectiveness of the approaches for managing MAM.
Source: Preprints.org
Authors: Seifu Hagos Gebreyesus, Arsema Abebe, Genet kiflemariam Paulos, Eskeziaw Abebe Kassahun, Yakob Desalegne Nigatu, Meron Tamirat Fule, Feven Hailu Tesfaye, Tesfamichael Awoke, Sibhatu Biadgilign, Debritu Nane, Mufaro Chiriga, Kemeria Barsenga, Aweke Kebede, Tafara Ndumiyana, Mutinta Hambayi, Charles Uzodimma Nwokorie, Robert Ackatia-Armah, Hamid Yimam Hassen, Samson Gebremedhin
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7202265271