Millions of children worldwide, particularly in low and middle income countries, suffer from nutritional deficiencies affecting their survival, health, development, and well-being. Targeted nutrition interventions to improve this situation include breastfeeding promotion, behaviour change and communication strategies to improve complementary feeding practices, supplementation and food fortification to improve micro-nutrient status, health interventions aimed at reducing infectious diseases among infants and young children, and the effective management of severe acute malnutrition. Common to all of these strategies is the fact that they address the immediate causes of childhood undernutrition, that is, inadequate food and nutrient intake, and poor health.
The sustainability of these interventions, however, is questionable if they are implemented without simultaneously addressing the key underlying determinants of undernutrition. Childhood undernutrition is rooted in poverty, food insecurity, gender inequity, and lack of access to health and other services. The failure to address the underlying causes of malnutrition – or the global context in which malnutrition occurs – is likely to undermine the long-term impacts and sustainability of interventions focusing only on the immediate determinants of undernutrition.
The authors reviewed the evidence regarding the impact of conditional cash transfer (CCT) programmes on child nutrition outcomes, using a programme theory framework. They developed a programme impact model and synthesised evidence regarding the pathways through which CCTs may improve child nutrition. CCT programmes significantly improve child anthropometry but have very little impact on micronutrient status. The programmes also have a positive impact on several of the outcomes in the pathways to improved nutrition. The authors found an enormous gap in knowledge about the mechanisms by which CCT programmes improve nutrition. In order to reach their full potential, the programmes need to have a better defined set of nutrition actions grounded in programme theory.
