The impact of Cash transfer on Children’s Nutrition outcome in Humanitarian context of Somalia, Systematic review.

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AHMED TAHIR AHMED, Abdikarim Mouse Duale, Abdifatah Elmi Farah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8273214/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Acute malnutrition is sustained problem in Somalia despite interventions. This is mainly due to many factors including protracted conflicts. The aim of this systemic review was to understand better the effect of cash transfer on child and pregnant and lactating women (PLW) nutrition outcome in Somalia as there wasn’t any pooled study done so far. Methods The Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines was used to conduct this systematic review of all studies including qualitative studies conducted on Cash transfer and nutrition outcome among children and PLW in humanitarian settings of Somalia. Wasting was the outcome of interest since humanitarian context was focused. However, stunting and underweight were also considered as primary outcome. In addition to manual searches, key phrases were searched in several databases, including PubMed/Medline, Science Direct, and Google Scholar. Two reviewers worked separately to choose, extract, and analyze data quality. Result Nine papers in total—two qualitative and the remaining randomized/nonrandomized trials—were included in this review; however, because study designs varied, we chose not to do a meta-analysis. According to qualitative research, cash transfers help beneficiaries' families and children nutrition better. Furthermore, two controlled trial studies on pregnant/lactating women and children found that cash with voucher and cash with behavioral change communication significantly (P < 0.05) reduce acute malnutrition in PLW and children, respectively. Many of included studies, however, concluded that, in the humanitarian context of Somalia, cash alone, cash plus cash, cash with voucher or nutrition counseling do not significantly (P > 0.05) reduce acute malnutrition in children. Conclusion This review concludes that although there is limited evidence that cash transfer programs combined with appropriate behavioral change communication, as well as cash or vouchers, can reduce acute undernutrition in Somalia among children and pregnant/lactating women respectively, cash transfers alone do not significantly impact under-five child undernutrition in Somalia. However, the qualitative findings show perceived benefits of cash transfers on children's and household nutrition. To address children's acute undernutrition in the humanitarian setting of Somalia, cash must be combined with other health interventions including effective behavioral change communication. Additionally, scaling up Health and Nutrition co-responsibility cash transfer initiated by Baxnaano program in Somalia is the way forward. Cash transfer Nutrition Somalia Humanitarian setting Figures Figure 1 Background Globally undernutrition among children is existing public health problem [1]. In 2023, about 22.3% and 6.6% of children were stunted and wasted respectively with great disparities among regions and countries [2]. This means, achieving global nutrition target set in 2030 is not on tract as child stunting is slightly decreasing and wasting persists [2]. Due to poverty, undernutrition is exceptionally higher (30% affected) in eastern Africa [2, 3]. This worsens during dry season and displacement in agro pastoral communities [4, 5]. Undernutrition has long term consequences including lower life expectance rate for African children [6]. Unlike chronic, acute malnutrition is sustained problem in Somalia despite interventions [7]. This is mainly due to protracted conflict and its consequence such as internal displaced peoples, diarrhea and household food insecurity [8, 9]. Humanitarian responses to nutrition emergencies were previously centered on direct food aid, supplementary feeding programs, and therapeutic feeding for treating acute malnutrition [10], Which is not effective if not integrated with nutrition sensitive interventions at crisis contexts [11, 12]. In recent years, however, humanitarian organizations adapted the use of cash and voucher to responding crisis with intention to expand in the future [13, 14]. Despite growing experience of cash transfer programs [14], the true impact on child nutritional status, particularly acute malnutrition is inconclusive [15–17] and thus humanitarian organizations spent less percentage of their many [14]. Globally, several studies including Systematic review show that cash transfers have a positive impact on childhood linear growth but not weight for height or weight for age in children [18,19]. However, other studies found that cash transfers had a positive influence on children's anthropometric indices [20–23]. In Somalia, there are many pocket studies on cash transfer and nutrition outcomes, with varying results [24–26]. While cash transfer improves food security including dietary diversity and coping strategy during crisis in low-income countries including Somalia (less controversial) [25, 27], the impact of cash on nutrition status among pregnant and lactating women (PLW) and children is difficult to understand. Therefore, this systemic review and meta-analysis was conducted to understand better the effect of cash transfer (conditional and unconditional) on PLW and child nutrition outcome in Somalia as we are unaware of any pooled study done so far. What is known? The impact of Cash transfer and child nutrition outcome is varied in different individual studies and there is no systematic review of effect of cash transfer on child’s anthropometric indices in Somalia. What is added value? This review provides better understating and insights of effect of cash transfer on nutrition status of PLW and children. Methods The Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines was used to conduct this systematic review [28]. Eligibility criteria (inclusion and exclusion criteria) We considered all published and unpublished interventional studies (randomized controlled trial, non-randomized controlled trial, Quasi-experimental and before and after studies) and observational qualitative and quantitative studies (cross-sectional, cohort and case-control studies) that were conducted in Somalia and available in the English language. Additionally, case studies and evaluation reports with the outcome of interest was also considered. The studies must report the following primary outcome to be included: Households with children under five years and/or PLW that received cash or in-kind nutritional supplements from nutrition sensitive programs to address nutritional outcome such as weight for height, height for age and body mass index. In contrast, concept papers, newsletters, and programs targeting animal insurance were excluded. Search strategy Except language, no restriction rules were applied whiles searching. Thus, an exhaustive search was conducted to identify all studies available in the English language, free, and published or preprint in the electronic databases such as PubMed/Medline, Science Direct, and Google scholar. This was complemented with a manual search of reference lists of eligible studies. The following search strategy, MeSH terms were applied to find published articles in Somalia at PubMed search engine: ("Cash transfer" OR "conditional cash transfer" OR "unconditional cash transfer" OR "income support" OR "Voucher" OR "social assistance" OR "social protection" OR "monetary transfer") AND ("child nutrition" OR "infant nutrition" OR "child growth" OR "malnutrition" OR "undernutrition" OR "stunting" OR "wasting" OR "Women nutrition" OR "Women undernutrition" OR "PLW" AND "Somalia"))). However, key terms like conditional cash transfer/ un-conditional cash transfer, child undernutrition, Pregnant and lactating nutrition, anthropometry, was searched in other databases. Study selection All studies with English version that were available from databases and grey literatures such as reports and preprints that was accessed from the Google scholar/Google was uploaded into Zotero Citation Manager. After the duplicate studies was removed, the remaining studies were assessed by screening the titles and abstracts of all studies against the inclusion criteria by two independent reviewers (Ahmed Tahir Ahmed, and Abdikarim Mouse Duale). The two reviewers were assessed the full texts of all identified studies against the eligibility criteria. Any discrepancies was resolved through discussion and consensus by all reviewers. Data extraction Two independent reviewers (Ahmed Tahir Ahmed, and Abdikarim Mouse Duale) were extracted data of included studies (both quantitative and qualitative/mixed) by using Microsoft Excel. Specific information such as study characteristics, study participants and the outcome of interest were extracted. Primary study authors will be contacted if any information is unclear or lacking. The first reviewer of this review was contacted the corresponding authors of two included studies for further clarifications. The first included study [31] didn’t mention under the number of under-five children participated the study. While the second study [33] didn’t mention the number of focus group discussions (FGDs) and key informant interview (KIIs)s done. However, the reviewer didn’t get any response from corresponding authors for two months despite follow up. Data Items Wasting among children between 6–59 months, is % of weight for height/length < -2 SD or MUAC between 11-12.5cm and presence of bilateral pitting edema. Wasting for PLW is MUAC < 23cm. Cash transfer is direct provision of money to recipients in humanitarian settings, allowing them flexibility to meet their needs. Outcome The review investigated the studies and reports that assessed the impact of conditional/un-conditional cash transfer on nutrition outcome among cash transfer beneficiary (cash only or cash with other health interventions) households with children less than 5 years and PLW in Humanitarian settings in Somalia. Wasting was the outcome of interest since humanitarian context was focused. However, stunting and underweight were also considered as primary outcome. Risk of bias in individual studies (quality assessment) A standardized critical appraisal tool from JBI-SUMARI (29) was used to evaluate selected studies by independent reviewers (Ahmed Tahir Ahmed, and Abdikarim Mouse Duale). A different criteria items listed in each study design checklists were assessed for each included study including qualitative ones. A checklist containing 13 criteria for randomized controlled trial (RCT), 15 criteria for Cluster RCT, and 11 criteria for randomized impact evaluation studies were used to evaluate respectively. whereas nine criteria for Quazi-experimental, ten criteria for non-RCT, and 11 criteria for non-randomized prospective cohort studies were used to evaluate respectively. Moreover, a checklist with ten criteria were used to evaluate for qualitative studies. The third reviewer (Abdifatah Elmi Farah) was invited for final decision of all assessed studies (supplementary file 1). Data synthesis Zotero citation manager was used for study selection while Microsoft Excel sheet was used for data extraction. As statistical pooling was not possible due to variations of study design and measurement of association, the results of both quantitative and qualitative was described as narrative summary, illustrated and supported by tables and figure. To clearly interpret the finding, quantitative and qualitative findings were reported as combined with the help of concurrent data analysis [36]. Result Study selection A total of 302 studies were identified from the following databases: Pubmed/Medline, Science Direct and Google scholar and manual searching. Four studies were removed as a duplicate and 275 studies were removed when title and abstract was assessed. The remaining 24 full texts were assessed against eligibility criteria, 15 of them were excluded for different reasons such as, study protocol without result, studies that didn’t report the outcome of interest, and those studies conducted Somalis inhibited outside of Somalia. Finally, eligible nine studies were included to do this systematic review (Fig. 1). Description of included study characteristics Of the nine included studies, eight were randomized/nonrandomized/Quasi-experimental trials and prospective cohort studies [24–26, 30–32, 34} with low-moderate risk of bias and the rest two were mixed (descriptive with qualitative) studies with high risk of bias [33,35] mainly conducted in humanitarian settings in southern Somalia. Of the seven quantitative interventional studies, six were focused on children between 6–59 months [24–26, 30–31, 34], and one focused on pregnant and lactating women [32]. The rest of qualitative studies [33, 35] were focused on families of beneficiaries’ households including children and women. The modality of intervention was the effect of cash transfer only for three studies [25,33,35], cash plus cash for two studies [30–31], cash plus voucher in two studies [26,32] and rest of the three were cash with behavioral change communication/Nutrition counseling [24,30,34]. All included studies were appraised, and the overall appraisal decision was to include, including the two qualitative studies [31, 35] despite its low-grade result (Table 1 ). Table 1 Characteristics of included studies of systematic review s.n studies Participants charateristics: Number and type Study design Data collection tool Coefficient Mean OR/RR/HR Main conclusions Modality of cash transfer Risk of bias 24 Ali, M.K, et al 2022 255 care givers and 184 of 6–59 months IDPs Quasi experimental study For the NC + UCT group, we did not find any significant reduction in wasting(AOR:0.79,95%CI:0.26–2.36,p = 0.67),underweight(AOR:0.88,95%CI:0.33–2.35, p = 0.81),or stunting(AOR:1.51,95%CI:0.55–4.20,p = 0.43)compared to the control group. The study did not find any significant impacts of Nutrition Counselling or NC + UCT on child wasting, underweight, stunting, food security or household expenses. Cash with Nutrition counseling Low-moderate 25 Grijalva-Eternod CS, et al 2018 228 HHs and 332 6–59 months IDPs A non-randomised cluster trial 0.77 (95% CI 0.70; 1.21) The Cash based interventions (CBI) appeared to improve beneficiaries’ wealth and food security but did not appear to reduce acute malnutrition risk in IDP camp children. Cash transfer Low-moderate 26 Doocy S.et al, January 2020 656 children 6–59 months IDPs A non-randomised prospective cohort design 0.1 [− 0.2,0.4],0.125 Cash and Voucher Assistance (CVA) can improve food security and diet in humanitarian settings. However, these interventions are not significantly effective at preventing children from becoming malnourished, Cash plus voucher Low-moderate 30 Walton S., et al, 2025(preprint) 1490 HHs and 1894 6–59 months IDPs Adaptive Cluster Randomized Control Trial Mixed 0.52 (0.28, 0.97) 0.039 Cash plus SBCC significantly reduces acute malnutrition among children less than 5 years old. Cash with SBCC Low-moderate 30 Walton S., et al, 2025(preprint) 1490 HHs and 1894 of 6–59 months children IDPs Adaptive Cluster Randomized Control Trial Mixed 1.34 (0.73, 2.46) 0.35 Cash transfer plus cash didn’t improve acute malnutrition among children Cash transfer plus Cash Low-moderate 31 Hassan B, et al, 2018 800 households with children under-five. IDPs. We couldn’t find the total of under 5 children participated. Randomized impact evaluation in different arms Questionnaire -0.085 More cash transfer has negative impact on child nutrition (weight for height and weight for age) assets but no significant difference in their health and nutrition. Cash plus cash Low-moderate 32 Doocy S.et al, April,2020 514 PLW IDPs A non-randomized prospective cohort design for the study (1.3cm, CI: 1.1–1.5, p = 0.001) Mean MUAC increased significantly among both voucher (0.9cm, CI: 0.6–1.3, p = 0.001) and mixed transfer recipients (1.3cm, CI: 1.1–1.5, p = 0.001) over the intervention period in adjusted analysis, however, the differ ence in magnitude of change between the two groups was not statistically significant (0.4cm, CI:-0.1–0.08, p = 0.086) Cash plus voucher Low-moderate 33 Muriithi N,2018 FGD for Cash transfer benifetiories & KII for community leaders and program officers. IDPs. Couldn’t find the number of FGDs and KIIs done. Descriptive study design: quantitative and qualitative Questionnaire, FGD, KII Cash transfers have played a significant role in improving health and nutrition outcomes of the beneficiaries. Cash transfer high 34 Grijalva-Eternod CS, et al 2023 1430 HHs with 1244 Under 5 children in IDPs IDPs A 2 ×2 factorial cluster-randomised controlled trial 1.73(0.98; 3.07) M health audio messages and humanitarian cash transfer programmes are substantially increased the uptake of child vaccination services and diet diversity. While they failed to achieve any reductions in child malnutrition. Cash with Mhealth audio messages Low-moderate 35 Bliznashka L, et al, 2024 302 women and 11 KII Beneficiaries’ women of reproductive age and other key informative such as organizations in humanitarian setting In-depth interview (IDIs) was analysed using a combination of deductive and inductive thematic content analysis. Combined primary Survey and secondary data analysis Questionnaire and in-depth interview IDI respondents unanimously perceived health, nutrition, and education benefits of the program for children, families, and communities. Most respondents also perceived benefits to the local economy, benefits regarding food security and nutrition, and benefits for women’s empowerment. Cash transfers high Risk of bias in individual studies (quality assessment) The quality of each included studies was examined by using standardized critical appraisal tools from JBI-SUMARI (29) by two independent reviewers (Ahmed Tahir Ahmed, and Abdikarim Mous Duale). The third reviewer (Abdifatah Elmi Farah) was invited for final decision of all assessed studies. Our summary assessment finding shows that, from the nine included studies, two qualitative studies (33, 35) had high risk of bias and the rest seven longitudinal studies [24–26, 30–32, 34] had low-moderate risk of bias. In a nutshell, the overall study appraisal was to include for synthesis for all evaluated studies including qualitative (low quality) studies to avoid publication bias (Table 1 ). Impact of cash transfer on nutrition This systematic review included a total of 4310 children aged between 6–59 months and 514 PLW in seven randomized/nonrandomized/Quasi-Experimental trial studies. Additionally, 800 HHs with unknown number of under five children from one randomized study [31] were also included. Regarding qualitative studies [33, 35], total of 11KIIs and unknown number of KIIs and FGDs were included for this review. Nine papers in total, of which two qualitative and the remaining randomized/nonrandomized trials/Quasi-experimental were included in this review; however, because study designs varied, we chose not to do a meta-analysis. According to qualitative research [33, 35], cash transfers in humanitarian setting, had improved the beneficiaries' families and children nutrition status. Furthermore, two controlled trial studies, one on pregnant/lactating women [32] and another one on children aged 6–59 months [30], found that cash with voucher and cash with behavioral change communication significantly (P < 0.05) did reduce acute malnutrition in PLW and children, respectively. The rest of included studies [24–26, 31,34], however, concluded that, in the humanitarian context of Somalia, cash alone [25,33,35], cash plus cash [30–31], cash with voucher [26] and cash with nutrition counseling/Mobile health audio messages [24,34] didn’t not significantly (P > 0.05) reduce acute malnutrition in children (Table 2 ). Table 2 The impact of cash transfer on Nutrition in Somalia, Systematic review. Reference Studies Sample size Design of the study Overall appraisal Impact on Nutrition Significance (P-value < 0.05) 24 Ali, M.K, et al 2022 255 care givers and 184 of 6–59 months Quasi experimental study include The Nutrition Counselling and Cash transfer has negative impact on child wasting and underweight but has positive impact on child stunting. No 25 Grijalva-Eternod CS, et al 2018 228 HHs and 332 of 6–59 months A non-randomised cluster trial include The Cash based interventions (CBI) has negative impact on acute malnutrition among under five years children. No 26 Doocy S.et al, January 2020 656 children 6–59 months A Non-randomised prospective cohort design include Cash and Voucher Assistance (CVA) has negative impact on acute malnutrition among children less than 5 years old. No 30 Walton S., et al, 2025(preprint) 1490 HHs and 1894 6–59 months Adaptive Cluster Randomized Control Trial include Cash plus SBCC significantly has negative impact on acute malnutrition among children less than 5 years old. Yes 30 Walton S., et al, 2025(preprint) 1490 HHs and 1894 6–59 months Adaptive Cluster Randomized Control Trial include Cash plus cash (increased amount and frequency of Cash) has positive impact on acute malnutrition among children No 31 Hassan B, et al, 2018 800 households Randomized impact evaluation in different arms include More cash transfer has negative impact on child nutrition (weight for height and weight for age) No 32 Doocy S.et al, April,2020 514 PLW A non-randomized prospective cohort design for the study include Mixed transfer(Cash and Voucher) has negative impact on acute malnutrition among pregnant and lactating women. Yes 33 Muriithi N,2018 A # of KIIs and FGDs Descriptive study design: quantitative and qualitative include Cash transfers have negative impact on malnutrition among children. Has no P-value. It significantly improves nutritional status of children according to KII and FGDs 34 Grijalva-Eternod CS, et al 2023 1430 HHs with 1244 U 5 children in IDPs A 2 ×2 factorial cluster-randomised controlled trial include Integrated Mobile health audio messages and humanitarian cash transfer programmes has positive impact on child malnutrition No 35 Bliznashka L, et al, 2024 302 women and 11 KII In-depth interviews (IDIs) were analysed using a combination of deductive and inductive thematic content analysis. Combined primary Survey and secondary data analysis include Cash transfers programs have negative impact on malnutrition among under five children and women Has no P-value. It significantly improves nutritional status of children according to In-depth interviews Discussion A total of nine studies composed seven quantitative (longitudinal) and two qualitative studies conducted in humanitarian settings of Somalia with 4310 children between 6–59 months and 514 PLW, and 800 households more with unknown under five children were considered for this systematic review. Additionally, two qualitative studies composing 11 KIIs and unknown KIIs and FGDs were also considered for this review. The two qualitative study evidenced that cash transfer reduces malnutrition of children and mothers of beneficiary households. Additionally, two cluster randomized/non-randomized studies focused on children 6–59 months and PLW were evidenced that cash with SBCC and Cash with voucher assistance significantly (P-value < 0.05) reduced acute malnutrition in children and PLW respectively. However, the rest of seven studies evidenced that cash only or cash with other interventions like cash plus cash, nutrition counseling and M-health audio messages didn’t significantly (P-value > 0.05) reduce acute malnutrition among children 6–59 months in humanities settings of Somalia. This means that although there is limited evidence that cash transfer programs combined with appropriate health and nutrition interventions can reduce undernutrition, cash transfers alone do not significantly impact under-five child undernutrition in Somalia. Effect of Cash transfer only or cash plus cash (more cash) on Nutrition This systematic review shows that there is enough evidence of cash transfers including more cash transfer didn’t prevent children from acute undernutrition in humanitarian settings of Somalia. This finding is in line with two systematic reviews done in the world including Sub-Saharan countries [18–19]. It might be due to existing missing opportunities of cash transfers in Somalia as it is used for non-Nutrition and health related things such as to repay debt, school fee and clothing [37]. It is also affected by persistent gaps in service provision for vulnerable communities of Somalia due many factors including security, infrastructure, conflict, clan, etc. [33, 38]. This is against realistic review study done in Latin America where cash transfer programs improved health and nutrition among children of poor households. The important factors behind this success were strong political support with accountability and community participation [39]. However, in this review, there is limited evidence that supported cash transfer reduces acute malnutrition among under five children and PLW according to two qualitative studies on perception of beneficiaries and one non-randomized trial on PLW. This finding is consistent with systematic reviews done in Brazil [20], Ethiopia [22], Humanitarian context [21] and Low- and middle-income countries [23]. Effect of Cash with SBCC/Nutrition counseling/ M-health audio message on Nutrition In this review, there is little proof that cash and behavioral change communication reduces acute undernutrition among children as only one RCT study supported this matter. Moreover, it is also consistent with review study done in low- and middle-income countries that showed cash transfers with health intervention was more effective than cash alone [40]. In contrast, in this review, two studies on cash transfer with Mobile-health audio messages and cash with nutrition counseling didn’t improve undernutrition among children in humanitarian settings of Somalia. This might be due to inappropriate health and nutrition counseling in terms of time and culture that implemented with cash transfer [24, 34]. The finding of this review is consistent with study done in Bangladesh [41] that showed limited evidence of mobile nutrition counseling with cash transfer effectiveness on child nutrition. The strength of this review is that we comprehensively reviewed and considered all studies with outcome of interest to understand better the effect of cash transfers on nutrition status among children primarily and PLW in humanitarian context of Somalia. However, this review considered two studies with qualitative part that has poor quality score for doing the synthesis. Additionally, because study designs and population varied, we chose not to do a meta-analysis and therefore couldn’t synthesize the data qualitatively The implication of this systematic review is that while cash transfer programs is promising intervention which negatively impact malnutrition among children in humanitarian context of Somalia, there is limited evidence that cash transfers is significantly reduce malnutrition of children and PLW. Conclusion This review shows there is enough evidence that cash transfers alone do not prevent Somalian children from acute undernutrition. However, the qualitative findings show perceived benefits of cash transfers on children's and household nutrition. Additionally, there is little proof that cash and appropriate behavioral change communication, as well as cash with vouchers, can improve acute undernutrition in Somalia among children and pregnant/lactating women respectively. To address children's acute undernutrition in the humanitarian setting of Somalia, cash must be combined with health interventions including effective behavioral change communication. Additionally, scaling up Health and Nutrition co-responsibility cash transfer initiated by Baxnaano program in Somalia is the way forward for cash transfers in Somalia. Declarations Data availability Data are within the tables, figure and supporting information files. No additional data are available Conflict of interest No perceived or real conflict of interest Acknowledgmen t Not relevant Budget This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors Contributions of authors In addition to drafting the manuscript, Ahmed Tahir Ahmed participated in the concept, design, procedure, search, selection, title and full-text screening, and quality assessment. Additionally, the Abdikarim Mouse Duale and Abdifatah Elmi Farah have taken part in quality evaluation, screening, and selection. All authors contributed to the final text draft as well as the concept. The final report was reviewed and approved by all authors. Corresponding Author Ahmed Tahir Ahmed Declaration of ethics it doesn't apply. Consent for publication All reviewers consented for publication References Victora CG, Christian P, Vidaletti LP, Gatica-Domínguez G, Menon P, Black RE. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda. The Lancet. 2021 Apr 10;397(10282):1388-99. World Health Organization. Levels and trends in child malnutrition child malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates: Key findings of the 2023 edition. World Health Organization; 2023 May 24. Adeyeye SA, Ashaolu TJ, Bolaji OT, Abegunde TA, Omoyajowo AO. 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Joanna Briggs Institute Reviewers’ Manual: 2014 edition. Australia: 2014. Walton S, Alier KK, Garretson S, Grounds S, Khattak Q, Tripaldi M, Loddo F, Mohamoud SA, Nur MA, Abdiqadir S, Mitchell E. A Cluster-Randomized Trial to Compare Effectiveness and Cost-effectiveness of Cash Plus Interventions in Preventing Child Wasting in Somalia: An Evidence-Based Methodology. medRxiv. 2025 Feb 23:2025-02. Hassan B, Mutiso S, Sulaiman M. More cash, bigger impacts? A field experiment of cash transfers in Somalia. 2018 Doocy S, Busingye M, Lyles E, Colantouni E, Aidam B, Ebulu G, Savage K. Cash-based assistance and the nutrition status of pregnant and lactating women in the Somalia food crisis: A comparison of two transfer modalities. PloS one. 2020 Apr 23;15(4):e0230989. Muriithi N. Influence Of Cash Transfer Programmes On Health And Nutrition Outcomes Among Households: A Case Of Middle Shebelle Region In Southern Somalia. 2018 Grijalva-Eternod CS, Jelle M, Mohamed H, Waller K, Osman Hussein B, Barasa E, Solomon A, Mehjabeen S, Copas A, Fottrell E, Seal AJ. Evaluation of conditional cash transfers and mHealth audio messaging in reduction of risk factors for childhood malnutrition in internally displaced persons camps in Somalia: A 2× 2 factorial cluster-randomised controlled trial. PLoS medicine. 2023 Feb 27;20(2):e1004180. Bliznashka L, Nwabuikwu O, Diatta AD, Ray S, Iruhiriye E, Gelli A. Review of the shock responsive safety net for human capital project–Somalia. 2024 Creswell JW, Clark VL. Designing and conducting mixed methods research. Sage publications; 2017 Aug 31. Kureishy, S., Abdullahi, F. A., Qureshi, A., & Hassan, Y. I. (2024, July). Baxnaano: Integrating social protection, health, and nutrition in Somalia. Field Exchange , (73), 29–31. Emergency Nutrition Network. https://www.ennonline.net/fex/73/baxnaano Ahmed Z, Ataullahjan A, Gaffey MF, Osman M, Umutoni C, Bhutta ZA, Dalmar AA. Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study. Conflict and Health. 2020 May 27;14(1):35. Segura-Pérez S, Grajeda R, Pérez-Escamilla R. Conditional cash transfer programs and the health and nutrition of Latin American children. Revista Panamericana de Salud Pública. 2016;40:124 − 37. Little MT, Roelen K, Lange BC, Steinert JI, Yakubovich AR, Cluver L, Humphreys DK. Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low-and middle-income countries. PLoS medicine. 2021 Sep 28;18(9):e1003698. Huda TM, Alam A, Tahsina T, Hasan MM, Khan J, Rahman MM, Siddique AB, Arifeen SE, Dibley MJ. Mobile-based nutrition counseling and unconditional cash transfers for improving maternal and child nutrition in Bangladesh: pilot study. JMIR Mhealth Uhealth. 2018 Jul 18; 6 (7): e156. 10.2196/mhealth. 8832 [Internet]. Additional Declarations No competing interests reported. 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In 2023, about 22.3% and 6.6% of children were stunted and wasted respectively with great disparities among regions and countries [2]. This means, achieving global nutrition target set in 2030 is not on tract as child stunting is slightly decreasing and wasting persists [2]. Due to poverty, undernutrition is exceptionally higher (30% affected) in eastern Africa [2, 3]. This worsens during dry season and displacement in agro pastoral communities [4, 5]. Undernutrition has long term consequences including lower life expectance rate for African children [6]. Unlike chronic, acute malnutrition is sustained problem in Somalia despite interventions [7]. This is mainly due to protracted conflict and its consequence such as internal displaced peoples, diarrhea and household food insecurity [8, 9].\u003c/p\u003e \u003cp\u003eHumanitarian responses to nutrition emergencies were previously centered on direct food aid, supplementary feeding programs, and therapeutic feeding for treating acute malnutrition [10], Which is not effective if not integrated with nutrition sensitive interventions at crisis contexts [11, 12].\u003c/p\u003e \u003cp\u003eIn recent years, however, humanitarian organizations adapted the use of cash and voucher to responding crisis with intention to expand in the future [13, 14]. Despite growing experience of cash transfer programs [14], the true impact on child nutritional status, particularly acute malnutrition is inconclusive [15\u0026ndash;17] and thus humanitarian organizations spent less percentage of their many [14].\u003c/p\u003e \u003cp\u003eGlobally, several studies including Systematic review show that cash transfers have a positive impact on childhood linear growth but not weight for height or weight for age in children [18,19]. However, other studies found that cash transfers had a positive influence on children's anthropometric indices [20\u0026ndash;23].\u003c/p\u003e \u003cp\u003eIn Somalia, there are many pocket studies on cash transfer and nutrition outcomes, with varying results [24\u0026ndash;26]. While cash transfer improves food security including dietary diversity and coping strategy during crisis in low-income countries including Somalia (less controversial) [25, 27], the impact of cash on nutrition status among pregnant and lactating women (PLW) and children is difficult to understand.\u003c/p\u003e \u003cp\u003eTherefore, this systemic review and meta-analysis was conducted to understand better the effect of cash transfer (conditional and unconditional) on PLW and child nutrition outcome in Somalia as we are unaware of any pooled study done so far.\u003c/p\u003e \u003cp\u003eWhat is known?\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe impact of Cash transfer and child nutrition outcome is varied in different individual studies and there is no systematic review of effect of cash transfer on child\u0026rsquo;s anthropometric indices in Somalia.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eWhat is added value?\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThis review provides better understating and insights of effect of cash transfer on nutrition status of PLW and children.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines was used to conduct this systematic review [28].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria (inclusion and exclusion criteria)\u003c/h2\u003e \u003cp\u003eWe considered all published and unpublished interventional studies (randomized controlled trial, non-randomized controlled trial, Quasi-experimental and before and after studies) and observational qualitative and quantitative studies (cross-sectional, cohort and case-control studies) that were conducted in Somalia and available in the English language. Additionally, case studies and evaluation reports with the outcome of interest was also considered.\u003c/p\u003e \u003cp\u003eThe studies must report the following primary outcome to be included: Households with children under five years and/or PLW that received cash or in-kind nutritional supplements from nutrition sensitive programs to address nutritional outcome such as weight for height, height for age and body mass index.\u003c/p\u003e \u003cp\u003eIn contrast, concept papers, newsletters, and programs targeting animal insurance were excluded.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearch strategy\u003c/h3\u003e\n\u003cp\u003eExcept language, no restriction rules were applied whiles searching. Thus, an exhaustive search was conducted to identify all studies available in the English language, free, and published or preprint in the electronic databases such as PubMed/Medline, Science Direct, and Google scholar. This was complemented with a manual search of reference lists of eligible studies. The following search strategy, MeSH terms were applied to find published articles in Somalia at PubMed search engine:\u003c/p\u003e \u003cp\u003e(\"Cash transfer\" OR \"conditional cash transfer\" OR \"unconditional cash transfer\" OR \"income support\" OR \"Voucher\" OR \"social assistance\" OR \"social protection\" OR \"monetary transfer\") AND (\"child nutrition\" OR \"infant nutrition\" OR \"child growth\" OR \"malnutrition\" OR \"undernutrition\" OR \"stunting\" OR \"wasting\" OR \"Women nutrition\" OR \"Women undernutrition\" OR \"PLW\" AND \"Somalia\"))). However, key terms like conditional cash transfer/ un-conditional cash transfer, child undernutrition, Pregnant and lactating nutrition, anthropometry, was searched in other databases.\u003c/p\u003e\n\u003ch3\u003eStudy selection\u003c/h3\u003e\n\u003cp\u003eAll studies with English version that were available from databases and grey literatures such as reports and preprints that was accessed from the Google scholar/Google was uploaded into Zotero Citation Manager. After the duplicate studies was removed, the remaining studies were assessed by screening the titles and abstracts of all studies against the inclusion criteria by two independent reviewers (Ahmed Tahir Ahmed, and Abdikarim Mouse Duale). The two reviewers were assessed the full texts of all identified studies against the eligibility criteria. Any discrepancies was resolved through discussion and consensus by all reviewers.\u003c/p\u003e\n\u003ch3\u003eData extraction\u003c/h3\u003e\n\u003cp\u003eTwo independent reviewers (Ahmed Tahir Ahmed, and Abdikarim Mouse Duale) were extracted data of included studies (both quantitative and qualitative/mixed) by using Microsoft Excel. Specific information such as study characteristics, study participants and the outcome of interest were extracted. Primary study authors will be contacted if any information is unclear or lacking. The first reviewer of this review was contacted the corresponding authors of two included studies for further clarifications. The first included study [31] didn’t mention under the number of under-five children participated the study. While the second study [33] didn’t mention the number of focus group discussions (FGDs) and key informant interview (KIIs)s done. However, the reviewer didn’t get any response from corresponding authors for two months despite follow up.\u003c/p\u003e\n\u003ch3\u003eData Items\u003c/h3\u003e\n\u003cp\u003eWasting among children between 6–59 months, is % of weight for height/length \u0026lt; -2 SD or MUAC between 11-12.5cm and presence of bilateral pitting edema. Wasting for PLW is MUAC \u0026lt; 23cm. Cash transfer is direct provision of money to recipients in humanitarian settings, allowing them flexibility to meet their needs.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOutcome\u003c/h2\u003e \u003cp\u003eThe review investigated the studies and reports that assessed the impact of conditional/un-conditional cash transfer on nutrition outcome among cash transfer beneficiary (cash only or cash with other health interventions) households with children less than 5 years and PLW in Humanitarian settings in Somalia. Wasting was the outcome of interest since humanitarian context was focused. However, stunting and underweight were also considered as primary outcome.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRisk of bias in individual studies (quality assessment)\u003c/h3\u003e\n\u003cp\u003eA standardized critical appraisal tool from JBI-SUMARI (29) was used to evaluate selected studies by independent reviewers (Ahmed Tahir Ahmed, and Abdikarim Mouse Duale). A different criteria items listed in each study design checklists were assessed for each included study including qualitative ones. A checklist containing 13 criteria for randomized controlled trial (RCT), 15 criteria for Cluster RCT, and 11 criteria for randomized impact evaluation studies were used to evaluate respectively. whereas nine criteria for Quazi-experimental, ten criteria for non-RCT, and 11 criteria for non-randomized prospective cohort studies were used to evaluate respectively. Moreover, a checklist with ten criteria were used to evaluate for qualitative studies. The third reviewer (Abdifatah Elmi Farah) was invited for final decision of all assessed studies (supplementary file 1).\u003c/p\u003e\n\u003ch3\u003eData synthesis\u003c/h3\u003e\n\u003cp\u003eZotero citation manager was used for study selection while Microsoft Excel sheet was used for data extraction. As statistical pooling was not possible due to variations of study design and measurement of association, the results of both quantitative and qualitative was described as narrative summary, illustrated and supported by tables and figure. To clearly interpret the finding, quantitative and qualitative findings were reported as combined with the help of concurrent data analysis [36].\u003c/p\u003e"},{"header":"Result","content":"\u003ch2\u003eStudy selection\u003c/h2\u003e\u003cp\u003eA total of 302 studies were identified from the following databases: Pubmed/Medline, Science Direct and Google scholar and manual searching. Four studies were removed as a duplicate and 275 studies were removed when title and abstract was assessed. The remaining 24 full texts were assessed against eligibility criteria, 15 of them were excluded for different reasons such as, study protocol without result, studies that didn’t report the outcome of interest, and those studies conducted Somalis inhibited outside of Somalia. Finally, eligible nine studies were included to do this systematic review (Fig.\u0026nbsp;1).\u003c/p\u003e\u003ch2\u003eDescription of included study characteristics\u003c/h2\u003e\u003cp\u003eOf the nine included studies, eight were randomized/nonrandomized/Quasi-experimental trials and prospective cohort studies [24–26, 30–32, 34} with low-moderate risk of bias and the rest two were mixed (descriptive with qualitative) studies with high risk of bias [33,35] mainly conducted in humanitarian settings in southern Somalia. Of the seven quantitative interventional studies, six were focused on children between 6–59 months [24–26, 30–31, 34], and one focused on pregnant and lactating women [32]. The rest of qualitative studies [33, 35] were focused on families of beneficiaries’ households including children and women.\u003c/p\u003e\u003cp\u003eThe modality of intervention was the effect of cash transfer only for three studies [25,33,35], cash plus cash for two studies [30–31], cash plus voucher in two studies [26,32] and rest of the three were cash with behavioral change communication/Nutrition counseling [24,30,34]. All included studies were appraised, and the overall appraisal decision was to include, including the two qualitative studies [31, 35] despite its low-grade result (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of included studies of systematic review\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003es.n\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003estudies\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eParticipants charateristics: Number and type\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eData collection tool\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOR/RR/HR\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMain conclusions\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eModality of cash transfer\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eRisk of bias\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAli, M.K, et al 2022\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 care givers and 184 of 6–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIDPs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi experimental study\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFor the NC + UCT group, we did not find any significant reduction in wasting(AOR:0.79,95%CI:0.26–2.36,p = 0.67),underweight(AOR:0.88,95%CI:0.33–2.35, p = 0.81),or stunting(AOR:1.51,95%CI:0.55–4.20,p = 0.43)compared to the control group.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eThe study did not find any significant impacts of Nutrition Counselling or NC + UCT on child wasting, underweight, stunting, food security or household expenses.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash with Nutrition counseling\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLow-moderate\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrijalva-Eternod CS, et al 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e228 HHs and 332 6–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIDPs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA non-randomised cluster trial\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.77 (95% CI 0.70; 1.21)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eThe Cash based interventions (CBI) appeared to improve beneficiaries’ wealth and food security but did not appear to reduce acute malnutrition risk in IDP camp children.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash transfer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLow-moderate\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoocy S.et al, January 2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e656 children 6–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIDPs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA non-randomised prospective cohort design\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.1 [− 0.2,0.4],0.125\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCash and Voucher Assistance (CVA) can improve food security and diet in humanitarian settings. However, these interventions are not significantly effective at preventing children from becoming malnourished,\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash plus voucher\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLow-moderate\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWalton S., et al, 2025(preprint)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1490 HHs and 1894 6–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIDPs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdaptive Cluster Randomized Control Trial\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMixed\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.52 (0.28, 0.97) 0.039\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCash plus SBCC significantly reduces acute malnutrition among children less than 5 years old.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash with SBCC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLow-moderate\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWalton S., et al, 2025(preprint)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1490 HHs and 1894 of 6–59 months children\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIDPs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdaptive Cluster Randomized Control Trial\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMixed\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.34 (0.73, 2.46) 0.35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCash transfer plus cash didn’t improve acute malnutrition among children\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash transfer plus Cash\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLow-moderate\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHassan B, et al, 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e800 households with children under-five.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIDPs. We couldn’t find the total of under 5 children participated.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized impact evaluation in different arms\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQuestionnaire\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-0.085\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMore cash transfer has negative impact on child nutrition (weight for height and weight for age) assets but no significant difference in their health and nutrition.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash plus cash\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLow-moderate\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoocy S.et al, April,2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e514 PLW\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIDPs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA non-randomized prospective cohort design for the study\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(1.3cm,\u003c/p\u003e \u003cp\u003e CI: 1.1–1.5, p = 0.001)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMean MUAC increased significantly among both voucher (0.9cm, CI: 0.6–1.3, p = 0.001) and mixed transfer recipients (1.3cm,\u003c/p\u003e \u003cp\u003e CI: 1.1–1.5, p = 0.001) over the intervention period in adjusted analysis, however, the differ\u003c/p\u003e \u003cp\u003eence in magnitude of change between the two groups was not statistically significant\u003c/p\u003e \u003cp\u003e (0.4cm, CI:-0.1–0.08, p = 0.086)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash plus voucher\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLow-moderate\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuriithi N,2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFGD for Cash transfer benifetiories \u0026amp; KII for community leaders and program officers.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIDPs. Couldn’t find the number of FGDs and KIIs done.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDescriptive study design: quantitative and qualitative\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQuestionnaire, FGD, KII\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCash transfers have played a significant role in improving health and nutrition outcomes of the beneficiaries.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash transfer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ehigh\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrijalva-Eternod CS, et al 2023\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1430 HHs with 1244 Under 5 children in IDPs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIDPs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA 2 ×2 factorial cluster-randomised controlled trial\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.73(0.98; 3.07)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eM health audio messages and humanitarian cash transfer programmes are substantially increased the uptake of child vaccination services and diet diversity. While they failed to achieve any reductions in child malnutrition.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash with Mhealth audio messages\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLow-moderate\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBliznashka L, et al, 2024\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e302 women and 11 KII\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeneficiaries’ women of reproductive age and other key informative such as organizations in humanitarian setting\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIn-depth interview (IDIs) was analysed using a combination of deductive and inductive thematic content analysis. Combined primary Survey and secondary data analysis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQuestionnaire and in-depth interview\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIDI respondents unanimously perceived health, nutrition, and education benefits of the \u003c/p\u003e \u003cp\u003eprogram for children, families, and communities. Most respondents also perceived benefits to the \u003c/p\u003e \u003cp\u003elocal economy, benefits regarding food security and nutrition, and benefits for women’s \u003c/p\u003e \u003cp\u003eempowerment.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCash transfers\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ehigh\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eRisk of bias in individual studies (quality assessment)\u003c/h2\u003e\u003cp\u003eThe quality of each included studies was examined by using standardized critical appraisal tools from JBI-SUMARI (29) by two independent reviewers (Ahmed Tahir Ahmed, and Abdikarim Mous Duale). The third reviewer (Abdifatah Elmi Farah) was invited for final decision of all assessed studies. Our summary assessment finding shows that, from the nine included studies, two qualitative studies (33, 35) had high risk of bias and the rest seven longitudinal studies [24–26, 30–32, 34] had low-moderate risk of bias. In a nutshell, the overall study appraisal was to include for synthesis for all evaluated studies including qualitative (low quality) studies to avoid publication bias (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eImpact of cash transfer on nutrition\u003c/h2\u003e\u003cp\u003eThis systematic review included a total of 4310 children aged between 6–59 months and 514 PLW in seven randomized/nonrandomized/Quasi-Experimental trial studies. Additionally, 800 HHs with unknown number of under five children from one randomized study [31] were also included. Regarding qualitative studies [33, 35], total of 11KIIs and unknown number of KIIs and FGDs were included for this review.\u003c/p\u003e\u003cp\u003eNine papers in total, of which two qualitative and the remaining randomized/nonrandomized trials/Quasi-experimental were included in this review; however, because study designs varied, we chose not to do a meta-analysis. According to qualitative research [33, 35], cash transfers in humanitarian setting, had improved the beneficiaries' families and children nutrition status. Furthermore, two controlled trial studies, one on pregnant/lactating women [32] and another one on children aged 6–59 months [30], found that cash with voucher and cash with behavioral change communication significantly (P \u0026lt; 0.05) did reduce acute malnutrition in PLW and children, respectively. The rest of included studies [24–26, 31,34], however, concluded that, in the humanitarian context of Somalia, cash alone [25,33,35], cash plus cash [30–31], cash with voucher [26] and cash with nutrition counseling/Mobile health audio messages [24,34] didn’t not significantly (P \u0026gt; 0.05) reduce acute malnutrition in children (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe impact of cash transfer on Nutrition in Somalia, Systematic review.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudies\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDesign of the study\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOverall appraisal\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eImpact on Nutrition\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificance (P-value \u0026lt; 0.05)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAli, M.K, et al 2022\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 care givers and 184 of 6–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuasi experimental study\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe Nutrition Counselling and Cash transfer has negative impact on child wasting and underweight but has positive impact on child stunting.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrijalva-Eternod CS, et al 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e228 HHs and 332 of 6–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA non-randomised cluster trial\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe Cash based interventions (CBI) has negative impact on acute malnutrition among under five years children.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoocy S.et al, January 2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e656 children 6–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA Non-randomised prospective cohort design\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCash and Voucher Assistance (CVA) has negative impact on acute malnutrition among children less than 5 years old.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWalton S., et al, 2025(preprint)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1490 HHs and 1894 6–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdaptive Cluster Randomized Control Trial\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCash plus SBCC significantly has negative impact on acute malnutrition among children less than 5 years old.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWalton S., et al, 2025(preprint)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1490 HHs and 1894 6–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdaptive Cluster Randomized Control Trial\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCash plus cash (increased amount and frequency of Cash) has positive impact on acute malnutrition among children\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHassan B, et al, 2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e800 households\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRandomized impact evaluation in different arms\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMore cash transfer has negative impact on child nutrition (weight for height and weight for age)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoocy S.et al, April,2020\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e514 PLW\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA non-randomized prospective cohort design for the study\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMixed transfer(Cash and Voucher) has negative impact on acute malnutrition among pregnant and lactating women.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuriithi N,2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA # of\u0026nbsp;KIIs and FGDs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDescriptive study design: quantitative and qualitative\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCash transfers have negative impact on malnutrition among children.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHas no P-value. It significantly improves nutritional status of children according to KII and FGDs\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrijalva-Eternod CS, et al 2023\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1430 HHs with 1244 U 5 children in IDPs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA 2 ×2 factorial cluster-randomised controlled trial\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntegrated Mobile health audio messages and humanitarian cash transfer programmes has positive impact on child malnutrition\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBliznashka L, et al, 2024\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e302 women and 11 KII\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIn-depth interviews (IDIs) were analysed using a combination of deductive and inductive thematic content analysis. Combined primary Survey and secondary data analysis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003einclude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCash transfers programs have negative impact on malnutrition among under five children and women\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHas no P-value. It significantly improves nutritional status of children according to In-depth interviews\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eA total of nine studies composed seven quantitative (longitudinal) and two qualitative studies conducted in humanitarian settings of Somalia with 4310 children between 6\u0026ndash;59 months and 514 PLW, and 800 households more with unknown under five children were considered for this systematic review. Additionally, two qualitative studies composing 11 KIIs and unknown KIIs and FGDs were also considered for this review. The two qualitative study evidenced that cash transfer reduces malnutrition of children and mothers of beneficiary households.\u003c/p\u003e \u003cp\u003eAdditionally, two cluster randomized/non-randomized studies focused on children 6\u0026ndash;59 months and PLW were evidenced that cash with SBCC and Cash with voucher assistance significantly (P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) reduced acute malnutrition in children and PLW respectively. However, the rest of seven studies evidenced that cash only or cash with other interventions like cash plus cash, nutrition counseling and M-health audio messages didn\u0026rsquo;t significantly (P-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05) reduce acute malnutrition among children 6\u0026ndash;59 months in humanities settings of Somalia. This means that although there is limited evidence that cash transfer programs combined with appropriate health and nutrition interventions can reduce undernutrition, cash transfers alone do not significantly impact under-five child undernutrition in Somalia.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eEffect of Cash transfer only or cash plus cash (more cash) on Nutrition\u003c/h2\u003e \u003cp\u003eThis systematic review shows that there is enough evidence of cash transfers including more cash transfer didn\u0026rsquo;t prevent children from acute undernutrition in humanitarian settings of Somalia. This finding is in line with two systematic reviews done in the world including Sub-Saharan countries [18\u0026ndash;19]. It might be due to existing missing opportunities of cash transfers in Somalia as it is used for non-Nutrition and health related things such as to repay debt, school fee and clothing [37]. It is also affected by persistent gaps in service provision for vulnerable communities of Somalia due many factors including security, infrastructure, conflict, clan, etc. [33, 38]. This is against realistic review study done in Latin America where cash transfer programs improved health and nutrition among children of poor households. The important factors behind this success were strong political support with accountability and community participation [39].\u003c/p\u003e \u003cp\u003eHowever, in this review, there is limited evidence that supported cash transfer reduces acute malnutrition among under five children and PLW according to two qualitative studies on perception of beneficiaries and one non-randomized trial on PLW. This finding is consistent with systematic reviews done in Brazil [20], Ethiopia [22], Humanitarian context [21] and Low- and middle-income countries [23].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eEffect of Cash with SBCC/Nutrition counseling/ M-health audio message on Nutrition\u003c/h2\u003e \u003cp\u003eIn this review, there is little proof that cash and behavioral change communication reduces acute undernutrition among children as only one RCT study supported this matter. Moreover, it is also consistent with review study done in low- and middle-income countries that showed cash transfers with health intervention was more effective than cash alone [40]. In contrast, in this review, two studies on cash transfer with Mobile-health audio messages and cash with nutrition counseling didn\u0026rsquo;t improve undernutrition among children in humanitarian settings of Somalia. This might be due to inappropriate health and nutrition counseling in terms of time and culture that implemented with cash transfer [24, 34]. The finding of this review is consistent with study done in Bangladesh [41] that showed limited evidence of mobile nutrition counseling with cash transfer effectiveness on child nutrition. The strength of this review is that we comprehensively reviewed and considered all studies with outcome of interest to understand better the effect of cash transfers on nutrition status among children primarily and PLW in humanitarian context of Somalia. However, this review considered two studies with qualitative part that has poor quality score for doing the synthesis. Additionally, because study designs and population varied, we chose not to do a meta-analysis and therefore couldn\u0026rsquo;t synthesize the data qualitatively\u003c/p\u003e \u003cp\u003eThe implication of this systematic review is that while cash transfer programs is promising intervention which negatively impact malnutrition among children in humanitarian context of Somalia, there is limited evidence that cash transfers is significantly reduce malnutrition of children and PLW.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis review shows there is enough evidence that cash transfers alone do not prevent Somalian children from acute undernutrition. However, the qualitative findings show perceived benefits of cash transfers on children's and household nutrition. Additionally, there is little proof that cash and appropriate behavioral change communication, as well as cash with vouchers, can improve acute undernutrition in Somalia among children and pregnant/lactating women respectively. To address children's acute undernutrition in the humanitarian setting of Somalia, cash must be combined with health interventions including effective behavioral change communication. Additionally, scaling up Health and Nutrition co-responsibility cash transfer initiated by Baxnaano program in Somalia is the way forward for cash transfers in Somalia.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are within the tables, figure and supporting information files. No additional data are available\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo perceived or real conflict of interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgmen\u003c/strong\u003et\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not relevant\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eBudget\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions of authors\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition to drafting the manuscript, Ahmed Tahir Ahmed \u0026nbsp; participated in the concept, design, procedure, search, selection, title and full-text screening, and quality assessment. Additionally, the Abdikarim Mouse Duale and Abdifatah Elmi Farah \u0026nbsp;have taken part in quality evaluation, screening, and selection. All authors contributed to the final text draft as well as the concept. The final report was reviewed and approved by all authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCorresponding Author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Ahmed Tahir Ahmed\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of ethics\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;it doesn\u0026apos;t apply.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All reviewers consented for publication\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVictora CG, Christian P, Vidaletti LP, Gatica-Dom\u0026iacute;nguez G, Menon P, Black RE. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda. The Lancet. 2021 Apr 10;397(10282):1388-99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Levels and trends in child malnutrition child malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates: Key findings of the 2023 edition. World Health Organization; 2023 May 24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdeyeye SA, Ashaolu TJ, Bolaji OT, Abegunde TA, Omoyajowo AO. Africa and the Nexus of poverty, malnutrition and diseases. 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Nutrition. 2022 Nov 1;103:111760.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartin-Canavate R, Custodio E, Yusuf A, Molla D, Fasbender D, Kayitakire F. Malnutrition and morbidity trends in Somalia between 2007 and 2016: results from 291 cross-sectional surveys. BMJ open. 2020 Feb 1;10(2):e033148.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKinyoki DK, Moloney GM, Uthman OA, Kandala NB, Odundo EO, Noor AM, Berkley JA. Conflict in Somalia: impact on child undernutrition. BMJ global health. 2017 May 29;2(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonkor WE, Mbai J, Sesay F, Ali SI, Woodruff BA, Hussein SM, Mohamud KM, Muse A, Mohamed WS, Mohamoud AM, Mohamud FM. Risk factors of stunting and wasting in Somali pre-school age children: results from the 2019 Somalia micronutrient survey. 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Social Science \u0026amp; Medicine. 2016 Jun 1;159:92\u0026thinsp;\u0026minus;\u0026thinsp;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEscher NA, Andrade GC, Ghosh-Jerath S, Millett C, Seferidi P. The effect of nutrition-specific and nutrition-sensitive interventions on the double burden of malnutrition in low-income and middle-income countries: a systematic review. The Lancet Global Health. 2024 Mar 1;12(3):e419-32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManley J, Alderman H, Gentilini U. More evidence on cash transfers and child nutritional outcomes: a systematic review and meta-analysis. BMJ global health. 2022 Apr 1;7(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManley J, Balarajan Y, Malm S, Harman L, Owens J, Murthy S, Stewart D, Winder-Rossi NE, Khurshid A. Cash transfers and child nutritional outcomes: a systematic review and meta-analysis. BMJ global health. 2020 Dec 1;5(12):e003621.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartins AP, Canella DS, Baraldi LG, Monteiro CA. Cash transfer in Brazil and nutritional outcomes: a systematic review. Revista de saude publica. 2013;47:1159-71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalhara KS, Silvestri DM, Tyler Winders W, Selvam A, Kivlehan SM, Becker TK, Levine AC, Global Emergency Medicine Literature Review Group (GEMLR). Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: a systematic review. Tropical Medicine \u0026amp; International Health. 2017 Dec;22(12):1464-92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOumer A, Yigezu M, Getachew MS, Mekonnen BA. Effects of productive safety net program on children\u0026rsquo;s nutritional outcomes in Ethiopia: a systematic review without meta-analysis. BMC nutrition. 2025 Feb 13;11(1):40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDas A, Sethi N. Cash transfers and human capital outcomes of children in LMICs: A systematic review using PRISMA. Heliyon. 2023 Apr 1;9(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli MK, Flacking R, Sulaiman M, Osman F. Effects of nutrition counselling and unconditional cash transfer on child growth and family food security in internally displaced person camps in Somalia\u0026mdash;a quasi-experimental study. International journal of environmental research and public health. 2022 Oct 18;19(20):13441.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrijalva-Eternod CS, Jelle M, Haghparast-Bidgoli H, Colbourn T, Golden K, King S, Cox CL, Morrison J, Skordis-Worrall J, Fottrell E, Seal AJ. A cash-based intervention and the risk of acute malnutrition in children aged 6\u0026ndash;59 months living in internally displaced persons camps in Mogadishu, Somalia: A non-randomised cluster trial. PLoS medicine. 2018 Oct 29;15(10):e1002684.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoocy S, Busingye M, Lyles E, Colantouni E, Aidam B, Ebulu G, Savage K. Cash and voucher assistance and children's nutrition status in Somalia. Maternal \u0026amp; child nutrition. 2020 Jul;16(3):e12966.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFang T, Tran A, Oranga B, Kopper R, Kang Y. Associations between a cash voucher intervention, food consumption, and coping strategies in Somali food-insecure populations. Agriculture \u0026amp; Food Security. 2024 Feb 7;13(1):8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. 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Cash-based assistance and the nutrition status of pregnant and lactating women in the Somalia food crisis: A comparison of two transfer modalities. PloS one. 2020 Apr 23;15(4):e0230989.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuriithi N. Influence Of Cash Transfer Programmes On Health And Nutrition Outcomes Among Households: A Case Of Middle Shebelle Region In Southern Somalia. 2018\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrijalva-Eternod CS, Jelle M, Mohamed H, Waller K, Osman Hussein B, Barasa E, Solomon A, Mehjabeen S, Copas A, Fottrell E, Seal AJ. Evaluation of conditional cash transfers and mHealth audio messaging in reduction of risk factors for childhood malnutrition in internally displaced persons camps in Somalia: A 2\u0026times; 2 factorial cluster-randomised controlled trial. PLoS medicine. 2023 Feb 27;20(2):e1004180.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBliznashka L, Nwabuikwu O, Diatta AD, Ray S, Iruhiriye E, Gelli A. Review of the shock responsive safety net for human capital project\u0026ndash;Somalia. 2024\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell JW, Clark VL. Designing and conducting mixed methods research. Sage publications; 2017 Aug 31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKureishy, S., Abdullahi, F. A., Qureshi, A., \u0026amp; Hassan, Y. I. (2024, July). \u003cem\u003eBaxnaano: Integrating social protection, health, and nutrition in Somalia. Field Exchange\u003c/em\u003e, (73), 29\u0026ndash;31. Emergency Nutrition Network. https://www.ennonline.net/fex/73/baxnaano\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed Z, Ataullahjan A, Gaffey MF, Osman M, Umutoni C, Bhutta ZA, Dalmar AA. Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study. Conflict and Health. 2020 May 27;14(1):35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSegura-P\u0026eacute;rez S, Grajeda R, P\u0026eacute;rez-Escamilla R. Conditional cash transfer programs and the health and nutrition of Latin American children. Revista Panamericana de Salud P\u0026uacute;blica. 2016;40:124\u0026thinsp;\u0026minus;\u0026thinsp;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLittle MT, Roelen K, Lange BC, Steinert JI, Yakubovich AR, Cluver L, Humphreys DK. Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low-and middle-income countries. PLoS medicine. 2021 Sep 28;18(9):e1003698.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuda TM, Alam A, Tahsina T, Hasan MM, Khan J, Rahman MM, Siddique AB, Arifeen SE, Dibley MJ. Mobile-based nutrition counseling and unconditional cash transfers for improving maternal and child nutrition in Bangladesh: pilot study. JMIR Mhealth Uhealth. 2018 Jul 18; 6 (7): e156. 10.2196/mhealth. 8832 [Internet].\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cash transfer, Nutrition, Somalia, Humanitarian setting","lastPublishedDoi":"10.21203/rs.3.rs-8273214/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8273214/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAcute malnutrition is sustained problem in Somalia despite interventions. This is mainly due to many factors including protracted conflicts. The aim of this systemic review was to understand better the effect of cash transfer on child and pregnant and lactating women (PLW) nutrition outcome in Somalia as there wasn\u0026rsquo;t any pooled study done so far.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines was used to conduct this systematic review of all studies including qualitative studies conducted on Cash transfer and nutrition outcome among children and PLW in humanitarian settings of Somalia. Wasting was the outcome of interest since humanitarian context was focused. However, stunting and underweight were also considered as primary outcome. In addition to manual searches, key phrases were searched in several databases, including PubMed/Medline, Science Direct, and Google Scholar. Two reviewers worked separately to choose, extract, and analyze data quality.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eNine papers in total\u0026mdash;two qualitative and the remaining randomized/nonrandomized trials\u0026mdash;were included in this review; however, because study designs varied, we chose not to do a meta-analysis. According to qualitative research, cash transfers help beneficiaries' families and children nutrition better. Furthermore, two controlled trial studies on pregnant/lactating women and children found that cash with voucher and cash with behavioral change communication significantly (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) reduce acute malnutrition in PLW and children, respectively. Many of included studies, however, concluded that, in the humanitarian context of Somalia, cash alone, cash plus cash, cash with voucher or nutrition counseling do not significantly (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) reduce acute malnutrition in children.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis review concludes that although there is limited evidence that cash transfer programs combined with appropriate behavioral change communication, as well as cash or vouchers, can reduce acute undernutrition in Somalia among children and pregnant/lactating women respectively, cash transfers alone do not significantly impact under-five child undernutrition in Somalia. However, the qualitative findings show perceived benefits of cash transfers on children's and household nutrition. To address children's acute undernutrition in the humanitarian setting of Somalia, cash must be combined with other health interventions including effective behavioral change communication. Additionally, scaling up Health and Nutrition co-responsibility cash transfer initiated by Baxnaano program in Somalia is the way forward.\u003c/p\u003e","manuscriptTitle":"The impact of Cash transfer on Children’s Nutrition outcome in Humanitarian context of Somalia, Systematic review.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 13:10:40","doi":"10.21203/rs.3.rs-8273214/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T22:26:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-09T04:09:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325054351478382025834843224567700843285","date":"2026-04-09T03:45:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T17:42:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305509437702688450999775539601278323551","date":"2026-03-04T16:44:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T09:04:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37887070680408282232007644009716038099","date":"2026-03-03T07:30:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-02T06:42:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-20T15:51:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-03T23:55:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-03T23:54:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2025-12-03T18:46:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d8cb603e-f80c-4e42-921c-a43b3f795cda","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T07:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 13:10:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8273214","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8273214","identity":"rs-8273214","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}