Effectiveness of unconditional Cash transfers and mobile behaviour change communications to reduce child under nutrition in rural Bangladesh

INTERVENTION: Intervention plan Pregnancy Surveillance: Our surveillance worker will then conduct door‐to‐door bi monthly visits to identify women missing two menstrual periods in a row. All such woman will undergo pregnancy test with a sensitive pregnancy urine test kit (Excel®). Women tested positive will be invited to participate in the study with appropriate informed written consent. We will conduct recruitment during the pre‐monsoon season (January to June) to enrol pregnant women during the hungry season. Based on experience with our previous study with similar design and settings, we expect at least 95% of mothers will consent. Mobile platform Once registered, each woman will receive a mobile phone with standard connection and limited credit (2‐3 calls/month). We will provide mobile credit till the end of the study. However the family will retain the mobile phone after the study. The efficiency of using mobile phones for cash transfers and delivering counselling provides the rationale for this additional non‐cash transfer to these poor families. Each phone will be preinstalled with a cash transfer application, and we will assist participants to open a mobile bank account with bKash, the largest mobile bank in Bangladesh. We will train the women about basic phone maintenance, using the phone for cash transfers, receiving & listening to voice messages, and about collecting their cash from mobile bank agents. Mobile nutrition behaviour change communication The mobile phone nutrition BCC intervention will consist of 2 main components: voice messages about nutrition; and nutrition counselling by phone. Life cycle stage‐appropriate, pre‐scheduled, voice messages will be sent to the women every week. These messages were developed and tested in the pilot and cover; diet and care during pregnancy, breastfeeding, complementary feeding, care in child illness, and basic hygiene. They aim to increase both caloric intake and dietary diversity. They will be tran CONDITION: Chilld hood Stunting;Low Birth Weight; ; Chilld hood Stunting ; Low Birth Weight Diet and Nutrition ‐ Other diet and nutrition disorders Public Health ‐ Epidemiology PRIMARY OUTCOME: The primary trial outcome will be changes in the percentage of stunted children (height‐for‐age <‐2 Z) assessed by the study staff using seca height measuring tape monthly for 6 months from birth and then at 9th month of age, 12th month of age, 18th months of age and 24 months of age(primary endpoint); [Monthly for 6 months from birth and then at 9th month of age, 12th month of age, 18th months of age and 24 months of age(primary endpoint)] ; ; [At birth] Mean child intake of carbohydrate assessed by study staff using standard questionnaire (designed specifically for this study)[At 9th months, 12 months, 18th months and 24 months post birth] Mean child intake of energy assessed by study staff using standard questionnaire (designed specifically for this study) INCLUSION CRITERIA: Eligibility criteria to participate in surveillance • All married women between 15‐49 years • Currently not using any family planning methods, • Have not had any permanent method of contraception (either women or their husbands) • Permanent residents of the study area Eligibility criteria to participate in study • Women tested positive with pregnancy urine test kit (Excel®). SECONDARY OUTCOME: Average cost per stunted child prevented (Data for the cost‐effectiveness analysis will be based on costs and outcomes observed in the trial. The perspective to be adopted will be that of the health sector. Average costs per individual in each treatment group will be estimated over the period of follow‐up. Costs of delivering the intervention (start‐up costs, staff, training, mobile phone service, cash transfers) will be collected via facility and project records. Also, a sub‐sample of participants will be asked to record use and costs of health services at each follow‐up interview). [At 30 month post enrolment] Changes in the percentage of wasted children (Weight‐for‐length Z scores) by the study staff using seca height measuring tape and seca weight measuring scale.[Monthly for 6 months from birth and then at 9th month of age, 12th month of age and 18th months of age ] Household food security at baseline and at 6th months, 12 months, 18th months and 24 months post birth assessed by study staff by standard questionnaire (Household food Insecurity Access scale ‐ FANTA)[At 6th months, 12 months, 18th months and 24 months post birth] Mean birthweight, percentage with low birthweight & percentage with small for gestational age assessed by the study staff using seca weight measuring scale. ; [At 9th months, 12 months, 18th months and 24 months post birth] Mean child intake of micro nutrients assessed by study staff using standard questionnaire (designed specifically for this study)[At 9th months, 12 months, 18th months and 24 months post birth] Mean child intake of protein assessed by study staff using standard questionnaire (designed specifically for this study)[At 9th months, 12 months, 18th months and 24 months post birth] Mean child intake of fat assessed by study staff using standard questionnaire (designed specifically for this study)[At 9th months, 12 months, 18th months and 24 months post birth] Mean days with acute respiratory illness among children assessed by study staff with standard questionnaire adopted from Bangladesh Demographic and Health Survey[At 24 months post birth] Mean days with diarrhoea among children assessed by study staff with standard questionnaire adopted from Bangladesh Demographic and Health Survey[At 24 months post birth] Mean days with fever among children assessed by study staff with standard questionnaire adopted from Bangladesh Demographic and Health Survey[At 24 months post birth] Mean duration of exclusive breastfeeding, and any breastfeeding assessed by study staff using standard questionnaire ( Demographic and Health Survey questionaire)[Monthly till 6 months post birth] Percentage of children consuming >4 food groups assessed by study staff using standard questionnaire (Adapted from household and Individual food diversity questionnaire of food and agriculture organisation)[At 9th months, 12 months, 18th months and 24 months post birth] Percentage of women initiating Breastfeeding within 1 hr assessed by the study staff using standard questionnaire (Demographic and Health Survey questionaire)[Within 1 month post birth ] Percentage of women at risk of inadequate nutrient intakes assessed by study staff using standard questionnaire (designed specifically for this study)[At enrolment and 3rd trimester of pregnancy] Percentage of women exclusively breastfeeding their infants assessed by study staff using standard questionnaire ( Demographic and Health Survey questionaire)[Monthly for 6 months from birth]