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. 2020 Jul 28;2020(7):CD011504. doi: 10.1002/14651858.CD011504.pub2

Kusuma 2017b.

Study characteristics
Methods Study design: cRCT
Study grouping: parallel group
How were missing data handled? No missing data reported
Randomisation ratio: 1:1:1.
Recruitment method: NR
Sample size justification and outcome used: NR
Sampling method: first, within each province, the 20% richest districts were excluded for both programmes (based on school transition rates, malnutrition and poverty). Districts who participated in the Kecamatan Development Project (a governmental poverty programme that developed infrastructure and capacity) were eligible for Generasi, from which 20 were selected and stratified by province. In NTT, East Java, and West Java selection was random, in Gorontalo and North Sulawesi all eligible districts were selected. Within the selected districts, subdistricts were not eligible if they had participated in the UPP or where < 30% of the villages (desa) and urban precincts (kelurahan) were considered as rural by the national statistics office. The final screening yielded 300 PNPM Generasi eligible subdistricts, which were randomly assigned to incentivised treatment (hereafter referred to as treatment I), non‐incentivised treatment (hereafter treatment II) and the control group. The remaining districts were considered for PKH. The subdistricts that were deemed as 'supply‐side ready' were then randomly assigned to the PKH treatment and control groups.
Study aim or objective: Kusuma 2016: to provide evidence on the effects of HH cash transfers (PKH) and community cash transfers (Generasi) on determinants of maternal mortality. Kusuma 2017: to provide evidence on the impact of HH cash transfers (PKH) and community cash transfers (Generasi) on children's food consumption.
Study period: from June–August 2007 to October 2009 to January 2010
Unit of allocation or exposure: subdistricts
Participants Baseline characteristics
Intervention: NR
Control
  • Age: mother, mean, years: 33.47; children aged < 5 years, mean, n: 1.33; child, age, mean, months: 30.06

  • Place of residence: rural subdistricts

  • Sex: child, female, proportion: 0.44

  • Education: mother's education (1 = ≥ 6 years): 0.85

  • SES: HH size, mean: 5.1; per capita HH expenditure: IDR 7.19; latrine in house, mean: 0.61; house had electricity, mean: 0.64; wood and cooking fuel, mean: 0.74

  • Nutritional status: children's food consumption (previous week), mean: grain, roots, tubers: 0.97; milk: 0.49; meat: 0.44; fish: 0.8; eggs: 0.69; fruit, vegetables: 0.94


Overall: NR
Inclusion criteria: very poor HHs (UCT database) with pregnant/lactating women, children aged 0–15 years in rural villages.
Exclusion criteria: NR
Pretreatment: no baseline differences reported.
Attrition per relevant group: 2 independent cross‐sectional samples analysed. Overall attrition: 98/4262 (2.3%).
Description of subgroups measured and reported: NR
Total number completed and analysed per relevant group: 1481 children, 1472 HHs in total (2 cross‐sectional samples; 1 for baseline and 1 at follow‐up).
Total number enrolled per relevant group: Kusuma 2017 used subsets of data from HHs that participated in PKH and Generasi and reported on food consumption for children aged 24–36 months: 4262 HHs. Kusuma 2016 used subsets of data from HHs that participated in Generasi and had married women aged 16–49 who had had pregnancies or deliveries within the past 24 months in 2007 and 2009: 4262 women at baseline
Total number randomised per relevant group: 300 subdistricts (Intervention group (Versi A – with rewards): 100 subdistricts; intervention group (Versi B – without rewards): 100 subdistricts; control group: 100 subdistricts). Results for Generasi Versi A and B are presented together.
Interventions Intervention characteristics
  • Food access intervention category: increase buying power

  • Intervention type: community conditional grant programme

  • Description: mean payment of USD 8500 (2007) and USD 18,200 (2009) to each village. Only for health and education use. 2 types: Versi A: performance incentive and Versi B: no incentive. Conditionalities for PKH and Generasi. Health: 1. 4 antenatal visits, 2. iron tablets during pregnancy, 3. assisted delivery, 4. 2 postnatal visits, 5. complete childhood immunisations, 6. adequate monthly weight increases for infants, 7. monthly weighing for children aged < 3 years and biannually for children aged < 5 years and 8. vitamin A twice a year for children aged < 5 years. Education: 9. primary school enrolment of children aged 6–12 years, 10. minimum attendance rate of 85% for primary school‐aged children, 11. junior secondary school enrolment of children aged 13–15 years and 12. minimum attendance rate of 85% for junior secondary school‐aged children.

  • Duration of intervention period: 2 years

  • Frequency: annually

  • Number of study contacts: baseline survey (June–August 2007); follow‐up survey (October–December 2009)

  • Providers: government of Indonesia

  • Delivery: block grant payments to villages. Trained facilitators advised village management team on allocation of funds. 41% of villages implemented financial incentives for health worker outreach, which might contribute to health knowledge; 79% of villages implemented SFP, which might contribute to nutritional intake; 96% villages implemented financial assistance for mothers. However, the potential impact might be hampered because many activities were toward Posyandu e 33% and 37% villages provided transport and financial incentive for posyandu cadres and only 2% and 4% villages did for midwives.


Control: no intervention
Outcomes Anthropometry: underweight (WAZ < –2SD); severe underweight (WAZ < –3SD); wasting (WHZ < –2SD); severe wasting (WHZ < –3SD); stunting (HAZ < -2SD); severe stunting (HAZ < –3SD)
Identification Sponsorship source: research fellowship from the Harvard Kennedy School Indonesia Program.
Country: Indonesia
Setting: urban very poor HHs (PKH) and rural very poor HHs (Generasi) in West Java, East Java, North Sulawesi, Gorontalo, and East Nusa Tenggara provinces
Author's name: Dian Kusuma
Email: dkusuma@mail.harvard.edu
Declarations of interest: none declared.
Study or programme name and acronym: Program Keluarga Harapan (PKH) and Generasi.
Type of record: journal articles
Notes The Generasi programme is reported in the same papers that report PKH programme, a CCT to HHs programme.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (Selection bias) Unclear risk Study authors referred to randomisation of subdistricts but did not describe how randomisation sequence was generated.
Allocation concealment (Selection bias) Unclear risk Allocation concealment NR.
Baseline characteristics similar (Selection bias) Low risk No important differences reported in terms of maternal, HH and subdistrict characteristics between groups at baseline.
Baseline outcome measurements similar (Selection bias) Unclear risk Food consumption in children was similar at baseline; however, important growth outcomes were NR at baseline.
Blinding of participants and personnel (Performance bias) Low risk Blinding of participants and personnel in these types of studies was not possible, but lack of blinding was unlikely to influence intervention received.
Blinding of outcome assessment (Detection bias) Low risk Unclear whether outcome assessors were blinded. However, key anthropometric outcomes were objective and thus less susceptible to lack of blinding.
Protection against contamination (Performance bias) Low risk Randomisation was at subdistrict level which reduces spillover effect risk.
Incomplete outcome data (Attrition bias) Low risk 2 independent cross‐sectional surveys conducted. Response rate was high.
Selective outcome reporting (Reporting bias) Unclear risk Study protocol N/A.
Other bias Unclear risk Misclassification of exposure: low risk. Measurement bias: unclear risk. Incorrect analysis: low risk. analyses adjust for clustering. Recruitment bias: low risk. HHs randomly selected after subdistrict randomisation.