Effects of cash transfers on Children’s health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial Wealth differentials in the impact of conditional and unconditional cash transfers on education: findings from a community-randomised controlled trial in Zimbabwe Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya. Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia. Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades A multilevel analysis of the effect of Malawi's Social Cash Transfer Pilot Scheme on school-age children's health. Does money buy happiness? Evidence from an unconditional cash transfer in Zambia Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries The Government of Kenya's Cash Transfer Program Reduces the Risk of Sexual Debut among Young People Age 15-25 Cash component of conditional cash transfer program is associated with higher body mass index and blood pressure in adults. The 3.5-year survival rates of primary molars treated according to three treatment protocols: a controlled clinical trial Conditional cash transfers to improve education and health: an ex ante evaluation of Red de Protección Social, Nicaragua. Mexico's conditional cash transfer programme increases cesarean section rates among the rural poor. Conditional Cash Transfers And Health Of Low-Income Families In The US: Evaluating The Family Rewards Experiment. Two-Year Experience with Continuous Subcutaneous Insulin Infusion in Relation to Retinopathy and Neuropathy Child-focused state cash transfers and adolescent risk of HIV infection in South Africa: a propensity-score-matched case-control study.
Background Unconditional and conditional cash transfer programmes ( UCT and CCT ) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS ( OVC ) . We address the gap in current underst and ing about the extent to which household-based cash transfers differentially impact individual children ’s outcomes , according to risk or protective factors such as orphan status and household assets . Methods Data were obtained from a cluster-r and omised controlled trial in eastern Zimbabwe , with r and om assignment to three study arms – UCT , CCT or control . The sample included 5,331 children ages 6 - 17 from 1,697 households . Generalized linear mixed models were specified to predict OVC health vulnerability ( child chronic illness and disability ) and social protection ( birth registration and 90 % school attendance ) . Models included child-level risk factors ( age , orphan status ) ; household risk factors ( adults with chronic illnesses and disabilities , greater household size ) ; and household protective factors ( including asset-holding ) . Interactions were systematic ally tested . Results Orphan status was associated with decreased likelihood for birth registration , and paternal orphans and children for whom both parents ’ survival status was unknown were less likely to attend school . In the UCT arm , paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans . Effects of study arms on outcomes were not moderated by any other risk or protective factors . High household asset-holding was associated with decreased likelihood of child ’s chronic illness and increased birth registration and school attendance , but household assets did not moderate the effects of cash transfers on risk or protective factors . Conclusion Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based setting s. UCT and CCT each produced direct effects on children ’s social protection which are not moderated by other child- and household-level risk factors , but orphans are less likely to attend school or obtain birth registration . The effects of UCT and CCT are not moderated by asset-holding , but greater household assets predict greater social protection outcomes . Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children . These efforts might include caregiver education , and additional incentives based on efforts made specifically for orphaned children Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children , but few studies have rigorously assessed their effectiveness in sub-Saharan Africa . We investigated the effects of unconditional cash transfers ( UCTs ) and conditional cash transfers ( CCTs ) on birth registration , vaccination uptake , and school attendance in children in Zimbabwe . Methods We did a matched , cluster-r and omised controlled trial in ten sites in Manical and , Zimbabwe . We divided each study site into three clusters . After a baseline survey between July , and September , 2009 , clusters in each site were r and omly assigned to UCT , CCT , or control , by drawing of lots from a hat . Eligible households contained children younger than 18 years and satisfied at least one other criteria : head of household was younger than 18 years ; household cared for at least one orphan younger than 18 years , a disabled person , or an individual who was chronically ill ; or household was in poorest wealth quintile . Between January , 2010 , and January , 2011 , households in UCT clusters collected payments every 2 months . Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing . Eligible households in all clusters , including control clusters , had access to parenting skills classes and received maize seed and fertiliser in December , 2009 , and August , 2010 . Households and individuals delivering the intervention were not masked , but data analysts were . The primary endpoints were proportion of children younger than 5 years with a birth certificate , proportion younger than 5 years with up-to- date vaccinations , and proportion aged 6–12 years attending school at least 80 % of the time . This trial is registered with Clinical Trials.gov , number NCT00966849 . Findings 1199 eligible households were allocated to the control group , 1525 to the UCT group , and 1319 to the CCT group . Compared with control clusters , the proportion of children aged 0–4 years with birth certificates had increased by 1·5 % ( 95 % CI −7·1 to 10·1 ) in the UCT group and by 16·4 % ( 7·8–25·0 ) in the CCT group by the end of the intervention period . The proportions of children aged 0–4 years with complete vaccination records was 3·1 % ( −3·8 to 9·9 ) greater in the UCT group and 1·8 % ( −5·0 to 8·7 ) greater in the CCT group than in the control group . The proportions of children aged 6–12 years who attended school at least 80 % of the time was 7·2 % ( 0·8–13·7 ) higher in the UCT group and 7·6 % ( 1·2–14·1 ) in the CCT group than in the control group . Interpretation Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa , but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region . Funding Wellcome Trust , the World Bank through the Partnership for Child Development , and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children Abstract We investigated ( 1 ) how household wealth affected the relationship between conditional cash transfers ( CCT ) and unconditional cash transfers ( UCT ) and school attendance , ( 2 ) whether CCT and UCT affected educational outcomes ( repeating a year of school ) , ( 3 ) if baseline school attendance and transfer conditions affected how much of the transfers participants spent on education and ( 4 ) if CCT or UCT reduced child labour in recipient households . Data were analysed from a cluster-r and omized controlled trial of  CCT and UCT in 4043 households from 2009 to 2010 . Recipient households received $ 18 dollars per month plus $ 4 per child . CCT were conditioned on above 80 % school attendance , a full vaccination record and a birth certificate . In the poorest quintile , the odds ratio of above 80 % school attendance at follow-up for those with below 80 % school attendance at baseline was 1.06 ( p = .67 ) for UCT vs. CCT . UCT recipients reported spending slightly more ( 46.1 % ( 45.4–46.7 ) ) of the transfer on school expenses than did CCT recipients ( 44.8 % ( 44.1–45.5 ) ) . Amongst those with baseline school attendance of below 80 % , there was no statistically significant difference between CCT and UCT participants in the proportion of the transfer spent on school expenses ( p = .63 ) . Amongst those with above 80 % baseline school attendance , CCT participants spent 3.5 % less ( p = .001 ) on school expenses than UCT participants . UCT participants were no less likely than those in the control group to repeat a grade of school .  CCT participants had .69 ( .60–.79 ) lower odds vs. control of repeating the previous school grade . Children in CCT recipient households spent an average of .31 fewer hours in paid work than those in the control group ( p < .001 ) and children in the UCT arm spent an average of .15 fewer hours in paid work each week than those in the control arm ( p = .06 ) PURPOSE This study investigates the causal effect of Kenya 's  unconditional cash transfer program on  mental health outcomes of young people . METHODS Selected locations in Kenya were r and omly assigned to receive unconditional cash transfers  in the first phase of Kenya 's Cash Transfer Program for orphans and Vulnerable Children . In intervention locations , low-income households and those with orphans and vulnerable childrens began receiving monthly cash transfers of $ 20 in 2007 . In 2011 , 4 years after program onset , data were collected on the psychosocial status for youth aged 15 - 24 years from households in intervention and control locations ( N = 1960 ) . The primary outcome variable was an indicator of depressive symptoms using the 10- question Center for Epidemiologic Studies Depression Scale . Secondary outcomes include an indicator for hopefulness and physical health measures . Logistic regression models that adjusted for individual and household characteristics were used to determine the effect of the cash transfer program . RESULTS The cash transfer reduced the odds of depressive symptoms by 24 percent among young persons living in households that received cash transfers . Further analysis by gender and age revealed that the effects were only significant for young men and were larger among men aged 20 - 24 years and orphans . CONCLUSIONS This study provides evidence that poverty-targeted unconditional cash transfer programs , can improve the mental health of young people in low-income countries There is promising recent evidence that poverty-targeted social cash transfers have potential to improve maternal health outcomes ; however , questions remain surrounding design features responsible for impacts . In addition , virtually no evidence exists from the African region . This study explores the impact of Zambia 's Child Grant Program  on a range of maternal health utilization outcomes using a r and omized design and difference-in-differences multivariate regression from data collected over 24 months from 2010 to 2012 . Results indicate that while there are no measurable program impacts among the main sample , there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services . The latter result is particularly interesting because of the overall low level of health care availability in program areas suggesting that dedicated program design or matching supply-side interventions may be necessary to leverage unconditional cash transfers in similar setting s to impact maternal health BACKGROUND Many governments have implemented conditional cash transfer ( CCT ) programmes with the goal of improving options for poor families through interventions in health , nutrition , and education . Families enrolled in CCT programmes  receive cash in exchange for complying with certain conditions : preventive health requirements and nutrition supplementation , education , and monitoring design ed to improve health outcomes and promote positive behaviour change . Our aim was to disaggregate the effects of cash transfer from those of other programme components . METHODS In an intervention that began in 1998 in Mexico , low-income communities ( n=506 ) were r and omly assigned to be enrolled in a CCT programme  ( Oportunidades , formerly Progresa ) immediately or 18 months later . In 2003 , children ( n=2449 ) aged 24 - 68 months who had been enrolled in the programme their entire lives were assessed for a wide variety of outcomes . We used linear and logistic regression to determine the effect size for each outcome that is associated with a doubling of cash transfers while controlling for a wide range of covariates , including measures of household socioeconomic status . FINDINGS A doubling of cash transfers was associated with higher height-for-age Z score ( beta 0.20 , 95 % CI 0.09 - 0.30 ; p<0.0001 ) , lower prevalence of stunting ( -0.10 , -0.16 to -0.05 ; p<0.0001 ) , lower body-mass index for age percentile ( -2.85 , -5.54 to -0.15 ; p=0.04 ) , and lower prevalence of being overweight ( -0.08 , -0.13 to -0.03 ; p=0.001 ) . A doubling of cash transfers was also associated with children doing better on a scale of motor development , three scales of cognitive development , and with receptive language . INTERPRETATION Our results suggest that the cash transfer component of Oportunidades is associated with better outcomes in child health , growth , and development OBJECTIVE The primary goal was to examine whether Malawi Social Cash Transfer Pilot Scheme , initially implemented in a rural district in central Malawi , improved health outcomes for children aged 6 - 17 . Secondary goals were to examine the effects of individual child- ( orphan status and gender ) and household-level factors ( number of working-age adults and sick adults ) on health outcomes . Another secondary goal was to examine whether orphan status modified the cash transfer effect on health outcomes . METHODS This multilevel study used panel data collected in 2007 - 08 from a r and omized controlled evaluation study of phase one of the programme . The analyses included 1197 children aged 6 - 17 in 486 households . The four outcomes of interest were : illness in the past month , illness that stopped normal activities in the past month , missing school due to illness or injury in the past month and health care use for worst illness in the past year . FINDINGS Approximately two-thirds of children in cash transfer eligible households were orphans . Compared with children in non-beneficiary households , those in beneficiary households had a 37 % lower odds of child illness ( P<0.05 ) , 42 % lower odds of illness that stopped normal activities ( P<0.01 ) and substantially higher odds of utilizing health services for a serious illness ( odds ratio=10.98 ; P<0.01 ) . An increase in the household number of working-age adults was associated with 34 % lower odds of child illness ( P<0.01 ) . An increase in the household number of sick adults increased the odds of child illness by 97 % ( P<0.01 ) and serious illness by 49 % ( P<0.01 ) . No statistically significant differences were observed by orphan status and child 's gender . Consistent differential programme effects by orphan status were not observed . CONCLUSION Unconditional cash transfer programmes to poor households have the potential to improve health outcomes for all vulnerable children aged 6 - 17 The relationship between happiness and income has been at the center of a vibrant debate , with both intrinsic and instrumental importance , as emotional states are an important determinant of health and social behavior . We investigate whether a government-run unconditional cash transfer paid directly to women in poor households had an impact on self-reported happiness . The evaluation was design ed as a cluster-r and omized controlled trial in rural Zambia across 90 communities . The program led to a 7.5 to 10 percentage point impact on women ’s happiness after 36- and 48-months , respectively ( or 0.19–0.25 st and ard deviations over the control group mean ) . In addition , women have higher overall satisfaction regarding their young children ’s well-being , including indicators of satisfaction with their children ’s health and positive outlook on their children ’s future . Complementary analysis suggests that self-assessed relative poverty ( as measured by comparison to other households in the community ) is a more important mediator of program effects on happiness than absolute poverty ( as measured by household consumption expenditures ) . Although typically not the focus of such evaluations , impacts on psychosocial indicators , including happiness , should not be discounted as important outcomes , as they capture different , non- material , holistic aspects of an individual ’s overall level of well-being People living with HIV ( PLWH ) experience greater psychological distress than the general population . Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms , quality of life , and HIV care engagement . However , little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries ( LMICs ) , where the large majority of PLWH reside . This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these setting s. A systematic search strategy was undertaken to identify peer- review ed published papers of intervention trials addressing negative psychological states or disorders ( e.g. depression , anxiety ) among PLWH in LMIC setting s. Search results were assessed against pre-established inclusion and exclusion criteria . Data from papers meeting criteria were extracted for synthesis . Twenty-six papers , published between 2000 and 2014 , describing 22 unique interventions were identified . Trials were implemented in sub-Saharan Africa ( n = 13 ) , Asia ( n = 7 ) , and the Middle East ( n = 2 ) , and addressed mental health using a variety of approaches , including cognitive-behavioral ( n = 18 ) , family-level ( n = 2 ) , and pharmacological ( n = 2 ) treatments . Four r and omized controlled trials reported significant intervention effects in mental health outcomes , and 11 preliminary studies demonstrated promising findings . Among the limited mental health intervention trials with PLWH in LMICs , few demonstrated efficacy .  Mental health interventions for PLWH in LMICs must be further developed and adapted for re source -limited setting s to improve effectiveness The aim of this study is to assess whether the Government of Kenya 's Cash Transfer for Orphans and Vulnerable Children ( Kenya CT-OVC ) can reduce the risk of HIV among young people by postponing sexual debut . The program provides an unconditional transfer of US$ 20 per month directly to the main caregiver in the household . An evaluation of the program was implemented in 2007–2009 in seven districts . Fourteen Locations were r and omly assigned to receive the program and fourteen were assigned to a control arm . A sample of households was enrolled in the evaluation in 2007 . We revisited these households in 2011 and collected information on sexual activity among individuals between 15–25 years of age . We used logistic regression , adjusted for the respondent 's age , sex and relationship to caregiver , the age , sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline , to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program . Our results , adjusted for these covariates , show that the program reduced the odds of sexual debut by 31 percent . There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use , number of partners and transactional sex . Since the CT-OVC provides cash to the caregiver and not to the child , and there are no explicit conditions associated with receipt , these impacts are indirect , and may have been achieved by keeping young people in school . Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa The cash component of Oportunidades , a large conditional cash transfer ( CCT ) program in Mexico , has previously been shown to be associated with better outcomes for child growth and development . The objective of this analysis was to determine whether the cash transfers were also associated with positive outcomes for adult health .  Oportunidades  was originally r and omized across 506 rural ( < 2500 inhabitants ) communities assigned to immediate incorporation into the program in 1997 or incorporation 18 mo later . Adults ( n = 1649 early , n = 2039 late intervention ) aged 18 - 65 y were then assessed in 2003 . All of the households included in the analysis reported here complied with Oportunidades 's requirements for the entire period , but some received higher cumulative cash transfers because they were living in communities r and omized to begin receiving transfers earlier and /or they accumulated cash at a faster rate because they had more school-aged children at baseline . Our primary findings were that a doubling of cumulative cash transfers to the household was associated with higher BMI ( beta = + 0.83 , 95 % CI 0.46 , 1.20 ; P < 0.0001 ) , higher diastolic blood pressure ( beta = + 1.19 , 95 % CI 0.09 , 2.29 ; P = 0.03 ) , and higher prevalence of overweight [ odds ratio ( OR ) = 1.41 , 95 % CI 1.18 , 1.67 ; P < 0.0001 ) , grade I obesity ( OR = 1.41 , 95 % CI 1.14 , 1.75 ; P = 0.002 ) , and grade II obesity ( OR = 1.57 , 95 % CI 1.05 , 2.36 ; P = 0.03 ) , while controlling for a wide range of covariates , including household composition at baseline . Oportunidades has been portrayed as a model for CCT programs worldwide , but the results reported here support the notion that the cash component of Oportunidades may be negatively associated with some adult health outcomes Objectives This study aim ed to test the hypothesis that there is no difference in the survival rates of molars treated according to the conventional restorative treatment ( CRT ) using amalgam , atraumatic restorative treatment ( ART ) using high-viscosity glass ionomer , and ultraconservative treatment ( UCT ) protocol after 3.5 years . Material s and methods Cavitated primary molars were treated according to CRT , ART , and UCT ( small cavities were restored with ART and medium/large cavities were daily cleaned with toothpaste/toothbrush under supervision ) . Molar extraction s result ing from toothache , sepsis , or pulp exposure were failures . The Kaplan – Meier method was used to estimate the survival curves . Results The numbers of treated teeth , among the 302 6–7-year-old children , were 341 ( CRT ) , 244 ( ART ) , and 281 ( for UCT group : 109 small ART , 166 open cavities , and 6 combinations ) . Protocol groups were similar at baseline regarding gender and mean decayed missing filled tooth score , but not regarding age and type of surface . The numbers of molars extracted were 22 ( CRT ) , 16 ( ART ) , and 26 ( UCT ) . Fistulae were most often recorded . After 3.5 years , the cumulative survival rate ± st and ard error for all molars treated was 90.9 ± 2.0 % with CRT , 90.4 ± 2.4 % with ART , and 88.6 ± 1.9 % with UCT ( p = 0.13 ) . Only a type of surface effect was observed over the 3.5-year period : survival rates for molars were higher for single- than for multiple-surface cavities . Conclusion There was no difference in the cumulative survival rates of primary molars treated according to the CRT , ART , and UCT protocol s over a 3.5-year period . Clinical relevance Keeping cavities in primary molars biofilm-free might be another treatment option alongside restoring such cavities through conventional and ART protocol Using baseline data from a r and omized experiment , this article extends and tests in the context of health , the feasibility of a recently proposed reduced form approach to ex ante evaluations of social programs with an application to a  conditional cash transfer program in Nicaragua . It uses a behavioural model to estimate the impact on preventive care utilization outcomes for children younger than 3 years . It vali date s the model with the results of the experiment and then simulates two alternate policy scenarios . The model performs well in predicting the health related outcomes and shows different results for the two sets of policy scenarios . In addition , simulations are also carried out for the school component of the cash transfer program BACKGROUND Caesarean section rates are increasing in Mexico and Latin America . This study evaluates the impact of a large-scale , conditional cash transfer programme in Mexico on caesarean section rates . The programme provides cash transfers to participating low income , rural households in Mexico conditional on accepting health care and nutrition supplements . METHODS The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states . Using multivariate and instrumental variable analyses , we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting . Programme participation is measured by beneficiary status , programme months and cash transfers . RESULTS More than two-thirds of poor rural women delivered in a health facility . Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates ; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for > or=6 months before delivery . Beneficiaries had significantly higher caesarean delivery rates in social security facilities ( 24.0 compared with 5.6 % among non-beneficiaries ) and in other government facilities ( 19.3 compared with 9.5 % ) . CONCLUSION The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities . This effect appears to be driven by the increases in disposable income from the cash transfer . These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements Opportunity  NYC-Family Rewards was the first conditional cash transfer , r and omized controlled trial for low-income families in the United States . From 2007 to 2010 , Family Rewards offered 2,377 New York City families cash transfers  that were conditional upon their investments in education , preventive health care , and parental employment . Their health and other outcomes were compared to those of a  control group of 2,372 families . The experiment led to a modest improvement in health insurance coverage and a large increase in the use of preventive dental care . It improved parents ' perception of their own health and levels of hope , mainly through improvements in reported financial well-being . While the program 's impacts on physical health were weaker , our study might not have captured effects on chronic disease risk that take longer to accrue . In the context of New York City 's operating social-safety-net programs , conditional cash transfers may have led to positive , albeit modest , improvements in the health of poor families Thirty patients with insulin-dependent diabetes mellitus ( IDDM ) who had advanced background retinopathy were r and omized to unchanged conventional treatment ( UCT ) or to continuous subcutaneous insulin infusion ( CSII ) . They were followed prospect ively for 2 yr . The mean blood glucose and hemoglobin A1c ( HbA1c ) were significantly lower in the CSII group than in the UCT group . The mean blood glucose and HbA1c did not change from the first to the second year in either of the treatment groups in spite of less frequent home-monitoring of blood glucose and less frequent outpatient visits during the second year . Four patients in the CSII group and five in the UCT group developed proliterative retinopathy . However , a marginally significant trend was found toward more frequent improvement of retinal morphology in the CSII group ( 47 % ) than in the UCT group ( 13 % ) . Beat-to-beat variation was found to deteriorate significantly with UCT compared with a nonsignificant improvement with CSII therapy . Vibration sense was unchanged in both treatment groups . It is concluded that near-normal blood glucose levels can be maintained with CSII therapy in spite of less frequent home-monitoring of blood glucose and outpatient visits . Furthermore , established background retinopathy may progress to proliferative retinopathy in spite of 2 yr of near-normal blood glucose levels . However , a marginally significant trend toward more frequent improvement of retinal morphology was found among CSII-treated patients compared with conventionally treated patients . Large-scale , prospect i ve , r and omized studies are needed to confirm these results BACKGROUND Effective and scalable HIV prevention for adolescents in sub-Saharan Africa is needed . Cash transfers can reduce HIV incidence through reducing risk behaviours . However , questions remain about their effectiveness within national poverty-alleviation programmes , and their effects on different behaviours in boys and girls . METHODS In this case-control study , we interviewed South African adolescents ( aged 10 - 18 years ) between 2009 and 2012 . We r and omly selected census areas in two urban and two rural districts in two provinces in South Africa , including all homes with a resident adolescent . We assessed household receipt of state-provided child-focused cash transfers , incidence in the past year and prevalence of transactional sex , age-disparate sex , unprotected sex , multiple partners , and sex while drunk or after taking drugs . We used logistic regression after propensity score matching to assess the effect of cash transfers on these risky sexual behaviours . FINDINGS We interviewed 3515 participants ( one per household ) at baseline , and interviewed 3401 at follow-up . For adolescent girls ( n=1926 ) , receipt of a cash transfer was associated with reduced incidence of transactional sex ( odds ratio [ OR ] 0·49 , 95 % CI 0·26 - 0·93 ; p=0·028 ) , and age-disparate sex ( OR 0·29 , 95 % CI 0·13 - 0·67 ; p=0·004 ) , with similar associations for prevalence ( for transactional sex , OR 0·47 , 95 % CI 0·26 - 0·86 ; p=0·015 ; for age-disparate sex , OR 0·37 , 95 % CI 0·18 - 0·77 ; p=0·003 ) . No significant effects were shown for other risk behaviours . For boys ( n=1475 ) , no consistent effects were shown for any of the behaviours . INTERPRETATION National , child-focused cash transfers to alleviate poverty for households in sub-Saharan Africa can substantially reduce unsafe partner selection by adolescent girls . Child-focused cash transfers are of potential importance for effective combination strategies for prevention of HIV . FUNDING UK Economic and Social Research Council , South African National Research Foundation , Health Economics and AIDS Research Division at University of KwaZulu-Natal , South African National Department of Social Development , Claude Leon Foundation , John Fell Fund , Nuffield Foundation , and Regional Interagency Task Team for Children affected by AIDS-Eastern and Southern Africa
The evidence was uncertain for whether UCTs impacted livestock ownership , extreme poverty , participation in child labour , adult employment or parenting quality .
This body of evidence suggests that unconditional cash transfers ( UCTs ) may not impact a summary measure of health service use in children and adults in LMICs .
However , UCTs probably or may improve some health outcomes ( i.e. the likelihood of having had any illness , the likelihood of having been food secure , and the level of dietary diversity ) , one social determinant of health ( i.e. the likelihood of attending school ) , and healthcare expenditure .
BACKGROUND Unconditional cash transfers ( UCTs ; provided without obligation ) for reducing poverty and vulnerabilities ( e.g. orphanhood , old age or HIV infection ) are a type of social protection intervention that addresses a key social determinant of health ( income ) in low- and middle-income countries ( LMICs ) .
The relative effectiveness of UCTs compared with conditional cash transfers ( CCTs ; provided so long as the recipient engages in prescribed behaviours such as using a health service or attending school ) is unknown .
OBJECTIVES To assess the effects of UCTs for improving health services use and health outcomes in vulnerable children and adults in LMICs .
Secondary objectives are to assess the effects of UCTs on social determinants of health and healthcare expenditure and to compare to effects of UCTs versus CCTs .