Ahmed 2019b.

Study characteristics
Methods	Study design: cRCT Study grouping: parallel group How were missing data handled? NR but based on Table 1 reporting baseline data for fewer number of participants than randomised we assume that missing data were excluded. Randomisation ratio: 1:1:1:1:1 (village‐level randomisation) Recruitment method: NR Sample size justification and outcome used: sample size calculations undertaken to assess the number of clusters (villages) and HHs needed to detect changes in both HH‐ and child‐level outcomes. Using data from an earlier study in Bangladesh (Ahmed et al. 2010), setting significance level at 0.05 and statistical power at 0.80, assuming attrition of 10% over duration of intervention, and using outcome‐specific means, SDs and intracluster correlations, a sample based on 50 clusters per treatment and 10 HHs per cluster would provide sufficient statistical power to detect an increase of: 12% in HH per capita total expenditure per month; 7% in HH per capita calorie intake per day; 16% in child HAZ; and 8% in dietary diversity of children aged 12–60 months. Sampling method: same process followed for each region – North and South: in North, 5 upazilas (subdistricts) were selected using simple random sampling from a list of upazilas where in 2010 the proportion of HHs living below Bangladesh's lower poverty line was ≥ 25%. All villages within these 5 upazilas were listed. Villages classified as urban or with < 125 HHs were dropped. Using a random number generator, each village was assigned a random number. Villages were then sorted in ascending numerical order with the first 275 retained. Given that in each region, there were 4 treatment groups and a control group, the first 50 villages were assigned to treatment group 1, the second 50 to treatment group 2, the third 50 villages to treatment group 3, the fourth 50 villages to treatment group 4 and the fifth 50 villages to the control group. The remaining 25 villages were held as a reserve. A complete village census was carried out in each of the 250 selected villages, collecting information on HH demographics, a set of poverty indicators, and whether HHs participated in safety nets and other targeted interventions. Using these data, a list was compiled of HHs that: 1. were considered poor (i.e. based on the poverty indicators collected, they were estimated to have consumption below Bangladesh's lower poverty line); 2. would have ≥ 1 child aged 0–24 months when the intervention began; and 3. were not receiving benefits from other safety net interventions. These HHs were eligible to participate in the study. Using simple random sampling, 10 eligible HHs were selected from each village. The total sample in the North included 250 clusters and 2500 HHs. An identical process was used in the South to select upazilas, villages and HHs. Study aim or objective: to devise and implement 2 × 2‐year RCTs in 2 poor rural areas of Bangladesh with both cash and food treatment groups. Building on the work of Black et al. (2013), the intervention also included 2 treatment groups that aimed to improve maternal knowledge and practices surrounding infant and young child nutrition – through BCC – thus making those treatment groups nutrition‐sensitive. We designed survey instruments to capture impacts at the child level, both for the key outcome measure of child anthropometry and for individual‐level mechanisms that plausibly underlie programme impacts. Using the RCT design, they estimated impacts of each treatment on child height‐for‐age. In the other paper, the authors assessed its implications for economic outcomes. Study period: 24 months: baseline survey was carried out in March–April 2012, the endline survey was conducted in April 2014. Unit of allocation or exposure: villages
Participants	Baseline characteristics Cash only Age: child: months (mean): North: 13.1 (SD 6.8), South: 13.8 (SD 6.1); mothers: years (mean): North: 26.5 (SD 5.8), South: 27.1 (SD 5.9) Place of residence: rural area Sex: % female: 54.6 (49.8) Ethnicity and language: NR Occupation: NR Education: schooling grades mean: North: 2.9 (SD 3.1), South: 3.5 (SD 3.3). Mean Head's years schooling: North: 1.49, South: 1.78 SES: mean HH size: North: 3.7, South: 5.25. Mean total owned land in decimals: North: 14.11, South: 17.60 Social capital: NR Nutritional status: mean food consumption per capita: North: 875.73, South: 1029.21; HAZ (mean): North: –1.86 (SD 1.54), South: –1.66 (SD 1.43); WHZ (mean) North –0.68 (SD 1.23), South –0.95 (SD 1.10) Morbidities: NR Concomitant or previous care: NR Control Age: child: months (mean): North: 13.0 (SD 6.1), South: 13.1 (SD 6.2); mothers: years (mean): North: 26.4 (SD 5.7), South: 26.7 (SD 5.9) Place of residence: rural area Sex: % female: 48.9 (50.0) Ethnicity and language: NR Occupation: NR Education: schooling grades mean: North: 3.2 (SD 3.3), South: 4.1 (SD 3.2). Mean Head's years schooling: North: 1.43, South: 2.05 SES: mean HH size: North: 4.83, South: 5.30. Mean total owned land in decimals: North: 15.45, South: 27.24 Social capital: NR Nutritional status: mean food consumption per capita: North: 850.68, South: 1179.78; HAZ (mean): North: –1.78 (SD 1.44), South: –1.59 (SD 1.48); WHZ (mean): North –0.79 (SD 1.21), South: –0.88 (SD 1.27) Morbidities: NR Concomitant or previous care: NR Cash and food Age: child: months (mean): North: 13.4 (SD 6.5). South: 13.2 (SD 6.3); mothers: years (mean): North: 26.8 (SD 5.9), South: 26.2 (SD 5.6) Place of residence: rural area Sex: % female: 47.6 (50.0) Ethnicity and language: NR Occupation: NR Education: schooling grades mean: North: 2.7 (SD 3.2), South: 3.8 (SD 3.1). Mean Head's years schooling: North: 1.28, South: 1.97 SES: mean HH size: North: 4.80, South: 5.06. Mean total owned land in decimals: North: 12.44, South: 27.17 Social capital: NR Nutritional status: mean food consumption per capita: North: 808.54, South: 1164.27; HAZ (mean): North: –1.75 (SD 1.39), South: –1.64 (SD 1.42); WHZ (mean): North: –0.85 (SD 1.21), South: –0.84 (SD 1.19) Morbidities: NR Concomitant or previous care: NR Food only Age: child: months (mean): North: 13.4 (SD 6.1), South: 12.5 (SD 6.4); mothers: years (mean): North: 26.8 (SD 5.9), South: 26.9 (SD 6.0) Place of residence: rural area Sex: % female: 47.5 (50.0) Ethnicity and language: NR Occupation: NR Education: schooling grades (mother) mean: North: 2.9 (SD 3.1), South 3.4 (SD 3.1). Head's years of schooling (mean): North: 1.23, South: 1.83 SES: mean HH size: North: 4.68, South: 5.22 Social capital: NR Nutritional status: HAZ (mean): North: –1.85 (SD 1.50), South: –1.58 (SD 1.61); WHZ (mean): North: –0.85 (SD 1.21), South: –0.84 (SD 1.19) Morbidities: NR Concomitant or previous care: NR Food and BCC Age: child: months (mean): North: N/A, South: 13.2 (SD 6.5); mothers: years (mean): North: N/A, South: 26.1 (SD 5.4) Place of residence: rural areas Sex: % female: 47.6 (50.0) Ethnicity and language: NR Occupation: NR Education: schooling grades (mother) (mean): North: N/A, South: 3.7 (SD 3.1). Head's years schooling (mean): North: N/A, South: 2.26 SES: HH size (mean): North: N/A, South: 5.20 Social capital: NR Nutritional status: HAZ (mean): North: N/A, South: –1.67 (SD 1.42); WHZ (mean): North: N/A, South: –0.80 (SD 1.19) Morbidities: NR Concomitant or previous care: NR Overall Age: child: months (mean): North: 13.2 (SD 6.4), South: 13.2 (SD 6.3); mothers: years (mean): North: 26.7 (SD 5.9), South: 26.6 (SD 5.8) Place of residence: rural area Sex: % female: 49.2 (50.0) Ethnicity and language: NR Occupation: NR Education: schooling grades (mother) (mean): North: 2.9 (SD 3.2), South: 3.7 (SD 3.2). Mean Head's years schooling: NR SES: NR Social capital: NR Nutritional status: HAZ (mean): North: –1.78 (SD 1.44), South: –1.63 (SD 1.47); WHZ (mean): North: –0.76 (SD 1.22), South: –0.86 (SD 1.20) Morbidities: NR Concomitant or previous care: NR Inclusion criteria: subdistrict eligibility: proportion of HHs living below Bangladesh's lower poverty line ≥ 25%." Village eligibility: rural; HH eligibility: list compiled of 1. HHs that: were considered poor (i.e. based on the poverty indicators collected, they were estimated to have consumption below Bangladesh's lower poverty line); 2. would have ≥ 1 child aged 0–24 months when the intervention began and 3. were not receiving benefits from other safety net interventions. Target beneficiary was mother of an 'index child' aged 0–24 months in March 2012, residing in a poor rural HH. Exclusion criteria: village level: villages classified as urban or villages with fewer than 125 HHs were dropped. Pretreatment: outcome and control variables similar across the North and South and similar across treatment groups. Attrition per relevant group: only overall: 4992 HHs interviewed at baseline, 2498 in North and 2494 in South. In North, 2410 HHs were re‐interviewed at endline, an attrition rate of 3.5%. 78 HHs were not surveyed at endline because they had migrated, another 10 dropped out of study, refused to be interviewed or could not be found. In South, 2438 HHs re‐interviewed at endline, an attrition rate of 2.2%. 49 HHs were not surveyed at endline because they had migrated, another 7 dropped out of study, refused to be interviewed or could not be found. Using probit regressions, there was no evidence that attrition was related to treatment status or HH demographic, occupational or asset characteristics (Ahmed et al. 2016). Description of subgroups measured and reported: NR Total number completed and analysed per relevant group: total number of HHs interviewed in North was 2410 and in South was 2438 at endline. For the outcomes related to children (due to restrictions related to age at baseline, biological children): this led to an estimation sample of 4399 children; 2218 in North and 2181 in South. Note that sample sizes differed per outcome as can be seen in the legends of the tables. Numbers per group NR. Total number enrolled per relevant group: interviewed 4992 HHs at baseline, 2498 in North and 2494 in South. Table 1 presented number of mothers/children per group at baseline, but total was 2275 for North and 2288 for South. North: cash only group: 458; food only group: 454; cash and food group: 458; cash and BCC group: 455; control: 450. South: cash only group: 454; food only group: 462; cash and food group: 446; cash and BCC group: 462; control group: 464 Total number randomised per relevant group: North included 250 clusters and 2500 HHs. Similar in South.
Interventions	Intervention characteristics Cash only Food access intervention category: increase buying power Intervention type: UCTs Description: monthly payment of BDT 1500 (approximately USD 19) per HH, which was about 25% of the mean monthly HH consumption expenditures of poor rural HHs in Bangladesh as of 2012. Mothers who were randomly selected to be in cash treatment groups received monthly payments via mobile money. Duration of intervention period: 24 months, May 2012 to April 2014 Frequency: monthly transfers; on second week of each month Number of study contacts: 3: baseline (2012), midline (2013), endline (2014) Providers: programme designed and evaluated by IFPRI and implemented by the United Nations' WFP. WFP managed the procurement and delivery of transfers, as well as the nutrition BCC training, and routinely monitored the programme. An NGO contracted by WFP, the ESDO, was responsible for the field implementation of project activities, including distributing the monthly food and cash transfers, and delivering the nutrition BCC (Ahmed 2019 b) Delivery: delivered using a mobile phone cash transfer system, in which women collected cash from designated distribution sites using mobile verification of identity. To facilitate payments to cash recipients and maintain comparability across groups, a basic mobile phone was provided to target mother in all treatment and control groups. Both quantitative and qualitative data collected throughout the intervention indicated that implementation fidelity was high. Co‐interventions: NR Resource requirements: NR Economic indicators: USD 19 per month per HH Control: no intervention Cash and food Food access intervention category: increase buying power and food availability Intervention type: cash (UCT) and food transfers Description: cash and food transfers provided half of each of 'Cash only' and 'Food only' (i.e. BDT 750, 15 kg of rice, 1 kg of mosoor pulse and 1 L of micronutrient‐fortified cooking oil. Duration of intervention period: 24 months, May 2012 to April 2014. Frequency: monthly transfers; on second week of each month Number of study contacts: 3: baseline (2012), midline (2013), endline (2014) Providers: designed and evaluated by IFPRI and implemented by the United Nations' WFP. WFP managed the procurement and delivery of transfers, as well as the nutrition BCC training, and routinely monitored the programme. An NGO contracted by WFP, the ESDO, was responsible for the field implementation of project activities, including distributing the monthly food and cash transfers and delivering the nutrition BCC (Ahmed 2019 b). Delivery: cash delivered using a mobile phone cash transfer system, in which women collected cash from designated distribution sites using mobile verification of identity. Food transfers handed to beneficiaries at designated FDPs. Both quantitative and qualitative data collected throughout the intervention indicates that implementation fidelity was high. Co‐interventions: NR Resource requirements: NR Economic indicators: USD 19 per month per HH Cash and BCC Food access intervention category: improve buying power Intervention type: cash transfers and BCC ('soft' condition for cash transfer) Description: monthly payment of BDT 1500 (about USD 19) per HH + suite of intensive nutrition BCC activities. BCC component that was included in the fourth treatment group in each region consisted of a suite of intensive nutrition BCC activities ('Cash and BCC'). The core activity was a weekly, 1‐hour group session in each village with a trained CNW. These sessions covered a defined series of 6 topics: 1. importance of nutrition and diet diversity for health; 2. how handwashing and hygiene improve health; 3. diet diversity and micronutrients; 4. breastfeeding; 5. complementary foods for children aged 6–24 months; and 6. maternal nutrition. Several methods were used to deliver this information including presentations, question and answer, interactive call and answer songs and chants, practical demonstrations, and role playing. 1 of these sessions, with only beneficiaries participating, occurred on the day of the transfer distribution. For the remaining group, BCC training each month, other HH members – particularly mothers‐in‐law, husbands, and other pregnant or lactating women – were invited to attend along with beneficiaries, with the intention of creating a supportive HH atmosphere and behaviour change at the HH level. CNWs also made home visits to beneficiaries twice a month to follow‐up on topics discussed during group sessions and to discuss specific concerns that mothers had. Duration of intervention period: 24 months, May 2012 to April 2014 Frequency: monthly transfers; on second week of each month; BCC: main activity was weekly Number of study contacts: 3: baseline (2012), midline (2013), endline (2014) Providers: designed and evaluated by the IFPRI and implemented by the United Nations' WFP. WFP managed the procurement and delivery of transfers, as well as the nutrition BCC training, and routinely monitored the programme. An NGO contracted by WFP, the ESDO, was responsible for the field implementation of project activities, including distributing the monthly food and cash transfers, and delivering the nutrition BCC (Ahmed 2019 b) Delivery: cash delivered using a mobile phone cash transfer system, in which women collected cash from designated distribution sites using mobile verification of identity. While attendance at these BCC sessions was a condition for receipt of transfers, this was a 'soft' condition. When a mother missed a session, the CNW followed up with a home visit to ascertain why the session had been missed, and there were no cases where a beneficiary was dropped from the study for failing to attend sessions. In addition, CNWs staff conducted community meetings and met with influential members (village leaders, imams, elders) of the villages in which the BCC took place to explain the purposes of the nutrition training and to provide them with the information being conveyed to study participants. CNWs received training prior to the start of the intervention. In localities where the same payment point was used for both the cash group and the cash + BCC group, cash beneficiaries were paid in the morning while cash + BCC beneficiaries were paid in the afternoon to minimise the likelihood of information from the BCC activities spilling over to the cash treatment group. Both quantitative and qualitative data collected throughout the intervention indicated that implementation fidelity was high. Co‐interventions: NR Resource requirements: NR Economic indicators: USD 19 per month + BCC activities cost approximately USD 50 per year per beneficiary Food only Food access intervention category: N/A Intervention type: food provision Description: consisted of a monthly food ration of 30 kg of rice, 2 kg of mosoor pulse (a type of lentil), and 2 L of micronutrient‐fortified cooking oil. This ration was designed to provide a nutritious basket of foods familiar to beneficiaries. The quantities were chosen so that the value of the food ration was equal to the value of the cash provided in treatment groups that provided cash. Duration of intervention period: 24 months, from May 2012 to April 2014. Frequency: monthly Number of study contacts: 3: baseline (2012), midline (2013), endline (2014) Providers: an NGO contracted by WFP, the ESDO, was responsible for the field implementation of project activities, including distributing the monthly food and cash transfers, and delivering the nutrition BCC (Ahmed 2019 b) Delivery: food transfers were handed to beneficiaries at designated FDPs. Co‐interventions: NR Resource requirements: NR Economic indicators: USD 19 per month per HH Food and BCC Food access intervention category: N/A Intervention type: food provision and BCC Description: food treatment group consisted of a monthly food ration of 30 kg of rice, 2 kg of mosoor pulse (a type of lentil), and 2 L of micronutrient‐fortified cooking oil. This ration was designed to provide a nutritious basket of foods familiar to beneficiaries. The quantities were chosen so that the value of the food ration was equal to the value of the cash provided in treatment groups that provided cash. The BCC intervention involved 3 complementary activities: 1. weekly group BCC trainings – some with beneficiaries only (i.e. the target women in the Food+BCC or Cash+BCC groups) and some that invited other family members to attend along with beneficiaries, 2. twice‐a‐month visits by CNWs to the beneficiaries' homes, and 3 monthly group meetings between programme staff and influential community leaders. BCC session attendance conditional for cash transfer, but 'soft condition' (no beneficiaries dropped for failing to attend sessions). About 9–15 beneficiaries were part of each group. The group training took place no further than 2 km from beneficiaries' homes and lasted approximately 1 hour, on average. Duration of intervention period: 24 months, from May 2012 to April 2014. Frequency: monthly (food), weekly (BCC) Number of study contacts: 3: baseline (2012), midline (2013), endline (2014) Providers: an NGO contracted by WFP, the ESDO, was responsible for the field implementation of project activities, including distributing the monthly food and cash transfers, and delivering the nutrition BCC (Ahmed 2019 b) Delivery: food transfers were handed to beneficiaries at designated FDPs. BCC: CNW Co‐interventions: NR Resource requirements: NR Economic indicators: USD 19 per month + BCC activities cost approximately USD 50 per year per beneficiary
Outcomes	Dietary diversity: FCS; percentage with low FCS (FCS < 35) Adequacy of dietary intake: percentage with per capita daily caloric intake < 2122 calories (food poverty) Anthropometry: WHZ; HAZ Morbidity: % of children with the following symptoms in the previous 2 weeks: fever, cough or cold, diarrhoea
Identification	Sponsorship source: funding support provided by the German Ministry for Economic Cooperation and Development, the UK's DfID, PIM, the Swiss Agency for Development and Cooperation, the United Nations Development Programme, and the USAID. Country: Bangladesh Setting: 1. rural areas of the northwest region (the 'North'), where poverty and food insecurity rates were high but where food markets functioned well; and 2. rural areas of the southern region (the 'South'), where food markets existed but were less accessible. Comments: ClinicalTrials.gov (study ID: NCT02237144) Authors' names: Akhter Ahmed. Contact author: John Hoddinott Institution: NR Email: jfh246@cornell.edu Address: NR Declarations of interest: NR Study or programme name and acronym: Transfer Modality Research Initiative (TMRI) Type of record: report
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (Selection bias)	Unclear risk	Quote: "Using a random number generator, each village was assigned a random number." Comment: this was to sort the villages in ascending numerical order. They dis not report how the random sequence for allocation into each trial group was generated.
Allocation concealment (Selection bias)	Low risk	Allocation concealment was NR; however, this was carried out at village level.
Baseline characteristics similar (Selection bias)	Low risk	Outcome and control variables were similar across the North and South and similar across treatment groups.
Baseline outcome measurements similar (Selection bias)	Low risk	Outcome and control variables were similar across the North and South and similar across treatment groups.
Blinding of participants and personnel (Performance bias)	Low risk	Blinding was not possible but it was unlikely to have influenced the intervention delivered.
Blinding of outcome assessment (Detection bias)	Low risk	Core outcomes were anthropometric measures objectively reported, which lack of blinding is unlikely to influence.
Protection against contamination (Performance bias)	Low risk	Allocation was by village and it was unlikely that contamination occurred. Authors reported that in some localities the "… same payment point was used for both the cash group and the cash plus BCC arm,…" and that "… cash beneficiaries were paid in the morning while cash plus BCC beneficiaries were paid in the afternoon to minimize the likelihood of information from the BCC activities spilling over to the cash treatment arm." Comment: according to authors, the implementation fidelity was high, therefore, contamination was likely avoided.
Incomplete outcome data (Attrition bias)	Low risk	Overall attrition was low; 3.5% in North and 2.3% in South, but attrition per treatment group was NR. Reasons for HHs not being surveyed at endline in the North included "… they had migrated, another 10 dropped out of study, refused to be interviewed, or could not be found." and in the South: "49 households were not surveyed at endline because they had migrated, another seven dropped out of study, refused to be interviewed, or could not be found." Authors reported that "Using probit regressions, we found no evidence that attrition was related to treatment status or household demographic, occupational or asset characteristics (Ahmed et al. 2016)."
Selective outcome reporting (Reporting bias)	Unclear risk	No protocol accessed.
Other bias	Low risk	Judgement comment: misclassification bias of exposure: low risk. Exposure determined by researchers. Measurement bias: low risk. Incorrect analysis: low risk. Study accounted for the cluster design. We noted that 1 might be concerned that BCC could lead to social desirability bias affecting the IYCDDS responses – i.e. after 2 years of nutrition training, mothers might respond to questions about child feeding by over‐reporting foods commonly discussed during the group training sessions. The fact that there are differences between what mothers in the North described and what mothers in the South described – e.g. that mothers receiving BCC in the South did not report feeding their children dairy products more frequently than those in the control group – despite their receiving identical BCC gave us some confidence in these results.