Mixed-method study on the effects of conditional cash transfer program on the under- and overnutrition in children and adolescents: a school-based evidence from Caraga Region, the Philippines

Background: This study aimed to determine the effects of Pantawid Pamilyang Pilipino Program (4Ps), a CCT program in the Philippines, on the multiple faces of malnutrition in children and adolescents and examine the perceptions and experiences of parents and other stakeholders on how 4Ps influenced child nutrition. Methods: A concurrent mixed-method study was conducted in Caraga Region, the Philippines. Quantitative study utilized 5541 school-based data on child nutrition, socio-demographic and -cultural profiles, and inclusion to 4Ps from 10 representative schools in 4 school divisions. Associations between child nutritional status and inclusion to 4Ps, socio-demographic and -cultural factors, and their interactions were tested using the multilevel mixed-effect logistic models with school and year random effects. The qualitative study, on the other hand, was concurrently conducted through eight (8) focused group discussions (FGDs) cumulating 33 participants to enable triangulation and an in-depth description of the findings. A constructivist grounded theory analytical approach with four-level analysis was performed including identifying text, coding, and developing themes and theoretical framework. Results: The likelihood of stunting was lower among 4Ps children (AOR: 0.70, 95%CI: 0.52–0.93) compared with non-4Ps children. Ethnicity was associated with higher odds of stunting among indigenous children from major tribes (AOR: 1.67, 95%CI: 1.08–2.47) compared with non-indigenous children. However, inclusion in the 4Ps has no significant effect on children's concurrent undernutrition and overnutrition. Interactions were found between inclusion to 4Ps and locality, with higher odds of stunting among 4Ps children in Agusan del Sur (AOR = 2.45, 95%CI:1.40–4.30) compared with 4Ps children in Agusan del Norte. Finally, qualitative findings revealed the positive and negative effects of 4Ps on malnutrition which were strongly influenced by parenting styles, parents’ attitudes towards cash grants and cash card management, provisions of child nutrition interventions, and delivery conditions of 4Ps. Conclusions: Improving children's nutrition is bolstered in the 4Ps implementation strategies. Targeted strategies to prevent the negative implications of a cash grant and card mismanagement should be considered by policymakers and implementers for a scaled-up impact in decreasing malnutrition in children.