Africa can achieve this goal by improving its agricultural productivity and production of key food commodities. African Continental Free Trade Area ensures the creation of jobs and income to battle poverty and food insecurity through greater economic diversification value addition and intra-African trade. In these strategies, a special focus should be used on disadvantaged communities to benefit from nutrition services. Although Africa has sought ways to lessen the dire impact of the pandemic on food security, the need for more interventions to boost African food systems has been indicated by these stresses.
Short-term solutions should include social and economic relief initiatives such as monetary intervention and social safety net. While lifting COVID restrictions, the African countries, at the regional level, must preserve open and efficient social protection programs and cross-border supply and distribution networks for agricultural inputs. National Center for Biotechnology Information , U. Am J Trop Med Hyg. Published online Mar 8. Author information Article notes Copyright and License information Disclaimer.
E-mail: fa. E-mail: ku. Received Dec 15; Accepted Feb Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. This article has been cited by other articles in PMC. FAO , Accessed December 7, Am J Trop Med Hyg : — The World Bank , Accessed December 10, Akiwumi P, Accessed December 8, Dado MK, International Academy of Social Sciences. Accessed February 16, J Glob Health 11 : Pan Afr Med J 37 : AmJ Trop Med Hyg : — Lucero-Prisno DE, et al.
Public Health Pract. Current efforts and challenges facing responses to nCoV in Africa. Glob Health Res Pol 5 : Blanke J, Both cash transfers and food security may have important contributions to child cognitive development. This study examines the potential impact of combinations of cash transfers and food security status on child cognitive development and educational outcomes. Children and caregivers completed interview schedules comprised of standardised items on socio-demographics, household data, cash grant receipt and food security status, school achievement, and cognition.
A series of logistic and linear regression models and marginal effects analyses were undertaken to explore the impacts of differing levels of social protection none; either cash grant receipt or food secure status or, both in combination on child educational and cognitive outcomes.
Compared to no social protection, being in receipt of either component of social protection was found to be significantly associated with being in the correct class for age, higher scores of non-verbal cognition, and higher working memory scores.
Receiving both social protection measures in combination was found to be significantly associated with reduced educational risk scores, improved odds of being in the correct class for age, regular school attendance, missing less than a week of school in the previous two weeks, higher scores on measures of nonverbal cognition, higher working memory scores, and learning new things more easily. Educational and cognitive outcomes for children can be bolstered by social protection measures cash grant receipt or food security.
Benefits are enhanced when social protection is received in combination. Such findings support the notion of synergistic social protection responses for children living in environments impacted by high levels of HIV burden and deprivation.
In HIV- endemic countries, parental illness and child infection has Children face many obstacles across the life course. Child compounded these challenges [5, 9, 1]. As such— birth, avoidance of infections and illnesses, stimulating early from a life course perspective—the acquisition of skills and environments, access to health care, education, nutrition [1, opportunities throughout a lifetime are built on the foun- 2], and good parenting [3, 4].
In sub-Saharan Africa, chil- dational capacities established during early childhood [10]. Social Child cognitive and educational abilities have lasting impli- cations for not only the individual child as they progress through childhood, adolescence and adulthood i.
When a child 13 Vol:. Despite robust evidence, there has been hood this may be associated with long term negative eco- less evidence of the value of combinations for younger chil- nomic impacts, which in turn, perpetuates cycles of poverty dren and younger adolescents.
A series of studies of children, for generations to come. Such negative cycles have wide- utilising secondary data analyses, found that cash plus good spread impacts for national growth, Gross Domestic Prod- parenting was associated with better cognitive development uct GDP and, global contributions. Sub-Saharan Africa and educational outcomes [27], as well as improved nutrition remains the region with the highest number of births [10, outcomes [28].
There remains a need to evaluate alternative 12]. Successful child development is imperative comes for children and younger adolescents.
Nutrition related insufficiencies have been ical settings that cash transfers—both conditional and uncon- associated with poor child outcomes and even contributed to ditional—are a potential pathway to ameliorate challenging preventable child deaths [31], highlighting the importance of conditions [14, 15]. Unconditional transfers and sexual risk related to HIV [23, 35, 36], nutrition [37] or have also been introduced with similar benefits [17]. When education [18]. The majority educational provision for the children [18].
This obviates the of studies in this area are concentrated in Central and South problems associated with conditional cash transfers, where America, with fewer insights from Africa [42]. This study is supply of interventions such as school places, or parental one of the first to evaluate a broad range of child cognitive training places may have been a limiting factor, as well as and educational outcomes within the African context among the dilemma around withholding transfers to those who do younger children, where cash grants are part of government not adhere to conditions—but who in fact, may be the most provision rather than provided within a research study.
The type of recipient and the circumstances around As economic constraints increase, some policymak- the transfer are also seen as important factors within the ers are seeking guidance on whether they should abandon success of cash transfers [19]. It is therefore fer on child outcomes [20]. Much of this evidence emerges important to examine associations of a combined approach from secondary analyses of robust existing data.
For example, where cash transfers are combined with nutritional input among adolescents, studies have shown that cash transfers to potential booster effects [43].
Both cash transfers and can reduce adolescent risk behaviours and promote adoles- adequate nutrition have important independent contribu- cent wellbeing [21, 22]. Furthermore, when cash transfers tions to child development. This study examines associations were combined with care in the form of parenting support, between a combination of cash transfers and food security the effects were boosted [23].
In some populations where cash status on child development outcomes—operationalised as transfers alone had no effect, combinations of cash with good educational outcomes and child cognitive development— parental care were effective.
These studies showed that when to explore potential contributors to child outcomes and the cash, safe schools and parenting were considered, specific unlocking of child potential within the sub-Saharan African benefits were recorded for adolescent outcomes [24]. Evalua- region. For example, one Methods study in Tanzania, suggested that cash in combination with financial education, likely reduced female adolescent engage- Participants ment in transactional sex [25].
CBOs were randomly selected Cash Grant Receipt stratified by funding organisation and geographical loca- tion from a list of CBOs working within South Africa Grant receipt was determined by caregiver reports. Eight hundred and fifty-four children 5—15 years conditional and unconditional grants as well as grants based and their caregivers were considered for inclusion within on specific criteria i. Participants were only included if they recipient household to be below a predetermined income responded to all measures of interest which resulted in level and for the child to be issued with a birth certificate.
A usable cases Some grants were mutually exclusive. Questionnaires For the purpose of analyses, a composite measure of food were administered by specifically trained data collec- security status was derived from two sources with reports tors using mobile phone technology [44].
All participants from both child and primary caregiver reporting items received detailed information on the study. Informed written drawn from the CSI tool [45, 46].
Children within the study consent caregivers and assent children was also obtained reported whether they went to bed hungry the previous even- from all participants within the study. Caregivers reported whether all questionnaires and consent forms in the language of their their child had sufficient food all the time, regularly, less choice.
All study information, consent forms and question- food than needed or regularly had no food to eat. The final composite into English for checking. The analyses food security based on both child and caregiver responses presented within this manuscript utilise cross-sectional data. Scores ranged from class for his or her age?
A series of logistic and linear regression models were Number of educational risks was a composite meas- used to examine the associations of cash grant receipt or ure based on the five binary educational outcomes above. Confirmatory responses were coded as 1 for each separately. For all regression analyses presented, Model 1 variable, resulting in a total school ranging from 0—5 with shows the unadjusted univariate associations between cash greater scores indicative of greater educational risk.
Model 2 presents the multivariate Cognitive Outcomes associations between exposure variables cash receipt and good food security status and the outcome variables cogni- Attention and working memory were assessed using the tive and educational outcomes inclusive of potential covari- digit-span sub-test of the Wechsler Intelligence Scale for ates. Children were asked by a trained multiplicative effects of cash and nutrition on cognitive or interviewer to recall a series of dictated digits in series educational outcomes.
The exponential coefficients Beta of both forwards and backwards. An age-standardised score such interactions are presented using linear probability mod- was recorded 0—20 , with higher scores indicative of better els to aid with interpretation [51, 52].
Where associations attention and working memory. This screening task is based on interactions were additive or synergistic. Age standardised scoring was ables are included in the second and third step models.
This recorded for each drawing and mean scores were calcu- includes child gender, child age, child disability, child HIV lated range 40— Higher scores are indicative of more status, child school status and number of household assets. Caregivers responded to questions relating to explore the impact of cash grant receipt and food security differing domains of child development. Questions relating status on child educational and cognitive outcomes where to learning, remembering, and comprehension ques- associations were identified.
Statistical Analyses Results All analyses were undertaken using Stata v. Differ- ences between three groups 1 those who reported receiv- Participant Characteristics ing both a cash grant and being food secure, 2 those who reported receiving either a cash grant or being food secure, Most children in the sample Just over half being food secure were explored with regard to participant The average characteristics inclusive of cognitive and educational out- age of children in the sample was Results living with HIV.
The sample on the whole high poverty lev- are reported using measures of central tendency mean els, with an average number of reported household assets of and standard deviations [SD] for continuous variables, 3. Receiving a combination of both a house- household in receipt of a cash grant. Over half Overall, Just under a For most outcomes found to be associated with combined third Comparative to South Africa However, synergistic effects were higher proportion of children in Malawi These syner- or being food secure, or no component of social protection.
For these outcomes, the effect of social protections in grant and being food insecure Predicted the assessment of non-verbal cognitive ability, and caregiv- probability of regular school attendance was Most children within the Children living in a household in receipt of either compo- sample did not miss less than a week of school within the nent of interest cash grant, good food security status had previous two weeks, thus predicted probabilities were found greater odds of being in the correct class for age compara- to be similar Tables 2 and 3 show interest.
Being food secure and receiving a cash grant were the additive associations of for continuous variables found to associated with reduced educational risk scores, greater odds be associated with cash grant receipt and good food security of being in the correct class for age, greater odds of regular status educational risk score, non-verbal cognitive ability school attendance and greater odds of missing less than a and, attention and working memory.
These models show week of school in the previous two weeks see Table 2. Household assets M: 3. It is important also to note that for some outcomes, these Discussion components had no effect. These data suggest that combina- tion interventions may be more effective for improving out- In this study we show that receiving either a cash grant or comes across a range of cognitive and educational indicators being food secure had positive impacts for both educational for children but are not a catch all solution and other types outcomes being in the correct class for age and cogni- of intervention combinations may need to be explored.
For tive outcomes non-verbal cognitive ability, attention and some of the cognitive outcomes, a lack of impact remains working memory among children affected by HIV. This unsurprising as difficulties i. For those children to improve developmental outcomes e. Results from these 54]. Among children experiencing developmental delays, analyses do also suggest a need for integrated planning and alternative intervention may be required inclusive of devel- processing.
The attainment of food security can be to intervention and explores pathways for enhanced impact achieved through numerous avenues inclusive of providing and harmony of public provision. These findings endorse direct nutritional support, household assets, and improving the importance of a more rounded approach to families that access to food sources [32]. There is strong evidence that allows for strategic approaches for those who carry very high cash transfers themselves improve household food con- levels of risk and adversity in multiple domains.
However, as these analyses detail, which combined approaches to social protection i. The way forward needs to tion provision [14, 42] and, highlight the potential ben- incorporate a strategic approach where the benefits of dif- eficial role of attaining food security within combined ferent intervention combinations is understood, and gaps approaches. Child malnutrition remains a prominent are highlighted.
In this study, all children, by definition, issue within sub-Saharan Africa [29, 57], with the cur- were vulnerable—living in HIV infected or affected fami- rent study highlighting that there would be clear benefits lies.
Adjusted for child biological sex female , child 50 age years , child HIV status 40 positive , number of household assets proxy wealth indicator 30 20 10 Despite the availability of grants, This study utilises a large sample of children identified many children did not receive them.
Children with HIV through CBOs living in two high HIV endemic countries themselves should have heightened eligibility for grants, within sub-Saharan Africa South Africa and Malawi to and our findings suggest they were significantly less explore the impact of cash grant receipt and good nutri- likely to receive grants.
Reaching the hard-to-reach chil- tional status on a broad range of child educational and dren and enabling broad access to interventions remains cognitive outcomes.
This unique community level data pro- a challenge. Firstly, these data are cross-sectional, drawn within high HIV-endemic countries or being HIV-exposed from a study with a non-randomised study design which uninfected face additional burdens i. Secondly, the exposure and social determinants such as poverty. As exposure variables utilised are based on self-report measures such, these children may be disadvantaged with regard which may bias some of the findings reported.
However, to access and engagement with education [61], and such these analyses report on field data from a particularly hard burdens, both biological and social, may have negative to reach population and similar self-report measures have implications for cognition [62].
These data suggest that been utilised in previous studies [27, 28, 42]. As such, the engagement with education and some cognitive outcomes large sample reporting on such measures within a resource for such children may be enhanced through combining confined setting provides a novel and unique contribution social protection interventions that are often already in to the literature regarding combined social protection for place within many low and middle income communities.
Thirdly, in line with previous studies in the The sustainable development goals provide a challenge field [23, 26, 27, 42], theses analyses focused on the mecha- for governments to work towards optimal child develop- nism of cash transfers as a form of social protection, and ment.
Multiple services and accelerated impacts [24] may it was beyond the scope of this study explore cash grants provide a strategic pathway to achieve this. The constant according to reason for receipt i. Despite similar policy and programming development a syndemic approach where well-established existing between South African and Malawi, the distribution of cash interventions can be harnessed in a coordinated way to grants varied between countries, with receipt substantially provide multiple avenues of support.
This data provides a lower in Malawi; possibly due to variation within the condi- blueprint for such strategies, which may be needed in the tionality of cash grants and the roll out of national program- light of global pandemic driven changes such as the cur- ming.
This study was set up to report on regional data and as rent Covid response where demand is enhanced, and such specific country level outcomes are not reported.
Future resources become scarce. Fourthly, due to the small number of participants experiencing some of the outcome variables i. However, it should be noted that these children have provide a link to the Creative Commons licence, and indicate if changes previously been identified as being particularly vulnerable were made. The images or other third party material in this article are [63]. Sixthly, to ensure permitted by statutory regulation or exceeds the permitted use, you will a robust sample size, this study focuses on children and ado- need to obtain permission directly from the copyright holder.
Finally, these data also do not report on a specific inter- vention programmes and, rely on child and caregiver report References of cash or nutrition receipt. However, it should be noted that 1. Early childhood devel- the use of both caregiver and child report relating to food opment coming of age: science through the life course.
Nurturing care: promoting early childhood development. Smith M. Good parenting: making a difference. Early Human Dev.
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