title: Factors Associated With the Risk of Acute Malnutrition Among Children Aged 6 to 36 Months in Households Targeted by an Emergency Cash Transfer Program.
abstract: BACKGROUND
  Assessing whether and how the expenditure of emergency cash transfer programs (CTPs) relates to child nutritional status is a necessary step for informed program design and targeting.
  
  
  OBJECTIVE
  We hypothesized that greater child food expenditures would have a protective effect against the risk of acute malnutrition in the context of a food crisis in Niger.
  
  
  METHODS
  We investigated the relationship between food and medical expenditures and acute malnutrition in children aged 6 to 36 months through an observational cohort study of 420 households enrolled in an emergency CTP in Niger. A Cox proportional hazards model was used to estimate the risk of acute malnutrition while adjusting for relevant child and household characteristics.
  
  
  RESULTS
  Seventy-four (18% of the cohort) children developed acute malnutrition. The risk was 1.79 times higher among ill children than healthy children (hazard ratio [HR]: 1.79; 95% confidence interval [CI]: 1.10-2.92; P < .05), nearly 3 times higher among children in the poorest households than those in wealthier households (HR: 2.98; 95% CI: 1.86-4.78; P < .001), and 2.85 times lower with each unit increase in baseline weight-for-height Z score (HR: 0.35; 95% CI: 0.23-0.53; P < .001). Food expenditures were not associated with risk (HR: 0.97; 95% CI: 0.87-1.07; P > .05).
  
  
  CONCLUSIONS
  Our findings highlight the importance of the health-related determinants of child undernutrition and suggest that a potential role of emergency CTPs may be to enable and promote health service access where services exist. They also indicate a need for more sustained poverty reduction and undernutrition prevention activities in concert with well-timed and strategic use of emergency interventions.
authors.affiliation: 1 Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bliss
authors.affiliation: 2 Department of Applied Economics and Management, Cornell University, Ithaca, NY, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Jensen
authors.affiliation: 3 Department of Development Sociology, Cornell University, Ithaca, NY, USA.|4 Department of Agricultural Economics, Sociology, and Education, Pennsylvania State University, State College, PA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Thiede
authors.affiliation: 5 Emergency Nutrition Network, London, United Kingdom.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Shoham
authors.affiliation: 5 Emergency Nutrition Network, London, United Kingdom.
authors.forename: Carmel
authors.initials: C
authors.lastname: Dolan
authors.affiliation: 6 Save the Children, London, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Sibson
authors.affiliation: 7 Independent consultant, Paris, France.
authors.forename: Bridget
authors.initials: B
authors.lastname: Fenn
keywords: Niger; acute malnutrition; emergency cash transfer program; emergency relief; food-first bias