Peer-reviewed article
Effects of productive safety net program on children's nutritional outcomes in Ethiopia: a systematic review without meta-analysis.
Abdu Oumer, Muluken Yigezu, Milkiyas Solomon Getachew, Berhanu Abebaw Mekonnen ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined nine studies involving over 14,000 people to understand how Ethiopia's Productive Safety Net Program affects child nutrition. The program improved income, food security, and dietary diversity, and reduced acute malnutrition (wasting), but had limited effects on stunting. Food aid or cash plus food aid worked better than cash transfers alone for improving child nutrition, though results were constrained by factors like food inflation and parents' knowledge about feeding children.
Key points
- Nine studies with 14,114 participants assessed PSNP effects using pre-post, survey, and cohort designs
- PSNP improved income, food security, dietary diversity, and reduced acute malnutrition (wasting)
- Limited evidence showed PSNP reduced stunting in children
- Food aid or cash transfer plus food aid was more effective than cash transfer alone
- Effects were limited by food inflation, household expenditure patterns, and caregivers' knowledge and attitudes about child feeding
Limitations
The review could not perform meta-analysis due to study heterogeneity. Most included studies used survey and observational designs rather than experimental comparisons, making it difficult to establish clear causal links between the program and outcomes, with potential confounding factors not fully controlled.
Abstract
BACKGROUND: Productive Safety Net Program (PSNP) is a livelihood intervention to improve food insecurity among the poor and has been implemented in Ethiopia. However, there is inconsistent evidence on the impacts of PSNP on improving the nutritional status of vulnerable segments (children). The current review was to synthesize evidence on the effects of PSNP on the nutritional status of children in Ethiopia. METHODS: A comprehensive search for Google, Google Scholar, PubMed, and other relevant repositories, coupled with a manual search (till March 15, 2024), was done using a combination of relevant key words. Hence, the search was conducted on "productive safety net," "Ethiopia," "nutritional status," and "undernutrition." An updated systematic review without meta-analysis guideline was used to select relevant literature. Data were extracted using MS Excel format by two reviewers and cross-checked. The extracted data were grouped, and summarized in narrative summaries, descriptions, and quantitative summaries whenever applicable. The risk of bias was assessed, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess the strength of the evidence. RESULTS: A total of nine studies (n = 14,114) were included in this review, and the studies assessed the risk of undernutrition among PSNP members and non-PSNP members, in the form of pre- and post-design, survey, and cohort studies. The program has the potential to improve income, food security, dietary diversity, and reduce the occurrence of acute malnutrition, with a limited effect on stunting reduction. Moreover, food aid or cash transfer plus food aid was found to be superior compared to cash transfer mode in improving child nutrition than cash transfer alone, which could be frustrated by food inflation, subjects' knowledge and attitude about child feeding. Overall, evidence from survey studies reporting the comparative risk of undernutrition could limit the conclusiveness of the causation which could be confounded. CONCLUSION: PSNP could improve wasting with limited evidence on stunting reduction, where the causal pathway could be frustrated by the purchasing power of cash vouchers, household income expenditure patterns, and subjects' knowledge and attitude limiting its impact. Well-designed implementation research could further help. A comprehensive review, considering more recent evidence, could help. CLINICAL TRIAL REGISTRATION: Not applicable.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Productive Safety Net Program (PSNP) - a livelihood intervention providing food aid, cash transfers, or cash plus food aid to poor households
- Population
- Children in PSNP member households and non-member households in Ethiopia (14,114 total across nine studies)
Key finding
PSNP improved income, food security, and dietary diversity