Article Text

Cash transfers and child nutritional outcomes: a systematic review and meta-analysis
  1. James Manley1,
  2. Yarlini Balarajan2,
  3. Shahira Malm2,
  4. Luke Harman3,
  5. Jessica Owens4,
  6. Sheila Murthy5,
  7. David Stewart6,
  8. Natalia Elena Winder-Rossi6,
  9. Atif Khurshid6
  1. 1Economics, Towson University, Towson, Maryland, USA
  2. 2Nutrition Section, Programme Division, UNICEF, New York, New York, USA
  3. 3Save the Children Fund, London, UK
  4. 4Food and Agriculture Organization of the United Nations, Rome, Lazio, Italy
  5. 5Consultant, New York, New York, USA
  6. 6Social Policy and Inclusion Section Programme Division, UNICEF, New York, New York, USA
  1. Correspondence to Dr James Manley; jamesmanley32{at}


Background Cash transfer (CT) programmes are implemented widely to alleviate poverty and provide safety nets to vulnerable households with children. However, evidence on the effects of CTs on child health and nutrition outcomes has been mixed. We systematically reviewed evidence of the impact of CTs on child nutritional status and selected proximate determinants.

Methods We searched articles published between January 1997 and September 2018 using Agris, Econlit, Eldis, IBSS, IDEAS, IFPRI, Google Scholar, PubMed and World Bank databases. We included studies using quantitative impact evaluation methods of CTs with sample sizes over 300, targeted to households with children under 5 years old conducted in countries with gross domestic product per capita below US$10 000 at baseline. We conducted meta-analysis using random-effects models to assess the impact of CT programmes on selected child nutrition outcomes and meta-regression analysis to examine the association of programme characteristics with effect sizes.

Results Out of 2862 articles identified, 74 articles were eligible for inclusion. We find that CTs have significant effects of 0.03±0.03 on height-for-age z-scores (p<0.03) and a decrease of 2.1% in stunting (95% CI −3.5% to −0.7%); consumption of animal-source foods (4.5%, 95% CI 2.9% to 6.0%); dietary diversity (0.73, 95% CI 0.28 to 1.19) and diarrhoea incidence (−2.7%, 95% CI −5.4% to −0.0%; p<0.05). The effects of CTs on weight-for-age z-scores and wasting were not significant (0.02, 95% CI −0.03 to 0.08; p<0.42) and (1.2%, 95% CI: −0.1% to 2.5%; p<0.07), respectively. We found that specific programme characteristics differentially modified the effect on the nutrition outcomes studied.

Conclusion We found that CT programmes targeted to households with young children improved linear growth and contributed to reduced stunting. We found that the likely pathways were through increased dietary diversity, including through the increased consumption of animal-source foods and reduced incidence of diarrhoea. With heightened interest in nutrition-responsive social protection programmes to improve child nutrition, we make recommendations to inform the design and implementation of future programmes.

  • child health
  • health policy
  • systematic review

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Handling editor Seye Abimbola


  • Contributors JM conducted the review and developed the protocol with input from AK, LH, DS, JO, SMurthy and NEW-R. JM did the systematic search, selected studies for inclusion and extracted the data. YB, SMalm and JM substantially revised the paper and sharpened the analysis. JM did the analysis, generated figures and wrote the manuscript with input from all other authors. All authors critically engaged with the manuscript and approved the final submitted version.

  • Funding Funding for JM was provided by UNICEF grant 43254067.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request. Data available once published and/ or as needed by reviewers in the reviewing process.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.