Cash for Improved Nutrition in Somalia

INTERVENTION: The clusters being studied comprise camps for internally displaced people within the Afgooye Corridor area of peri‐urban Mogadishu. The camps vary in size and contain makeshift, temporary, houses. All camps in the area are regarded as requiring humanitarian assistance and twenty camps will be selected to take part in the study. There are 2 interventions being tested in this study; a cash transfer conditionality and a mHealth intervention. Cash will be provided to households as either an unconditional (UCT) or conditional (CCT) cash transfer. For ethical reasons all groups will receive cash transfers, as all households are considered to be suffering from extreme poverty and highly vulnerable. Randomization will be done at the cluster (camp) level and households in 10 camps will receive a CCT and the remainder will receive a UCT. Households living in the selected camps will be listed and registered by the Concern cash distribution team. The conditional cash transfer will require households with children, aged 6‐59 months, to have first attended the local health clinic where they will receive a health screening, any necessary vaccinations, de‐worming, and vitamin A supplementation as required; and they will be issued with a child health record card. All the study camps have similar access to local health clinics. Compliance with the health clinic visit will be verified by asking for the child health record cards during registration of the household for cash transfers. Checks of the child health card will be carried out monthly during the monthly monitoring household visits by CHW. The check will monitor whether all children in the household 0‐59 months are up to date on routine vaccination, vitamin A supplementation, and de‐worming. Cash transfers will follow the standard amounts set by the major donors of humanitarian cash transfers in Somalia, DFID and ECHO, which are based on a percentage of the Mo CONDITION: Child undernutrition ; Nutritional, Metabolic, Endocrine PRIMARY OUTCOME: ; 1. Measles vaccination coverage ‐ % of children 9‐<59 months of age who received measles vaccine ‐ EPI vaccination coverage ‐ % of children 0‐<59 months of age who received all vaccines required by the national vaccination protocols (measured at baseline and endline via Caregiver interview and health record card examination); 2. Child diet diversity score of children 6‐‐<24 months of age (measured at baseline and endline via Caregiver 24 hour dietary recall); 3. Parental/caretakers knowledge of BCC health and nutrition topics (measured monthly via questionnaire); SECONDARY OUTCOME: ; 1. Incidence of acute malnutrition ‐ MUAC<12.5 cm or oedema among children 6‐59 months (measured monthly during household visits); 2. Incidence of mortality among children 6‐59 months (assessed monthly by questionnaire during household visits); 3. Exclusive breastfeeding prevalence ‐ % of infants 0‐5 months who were exclusively breastfed during the last 24 hours (measured at baseline and endline via Caregiver 24 hour dietary recall); 4. Incidence of child morbidity (assessed monthly by questionnaire during household visits); 5. Causes of death ascertained by Verbal Autopsy (assessed by Caregiver interview following a mourning period); INCLUSION CRITERIA: Males and females between the ages of 0 and 59 months will be eligible to be recruited