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(OR10-06-26) Effectiveness of Vouchers and Cash Transfers for the Treatment of Moderate Wasting Among Under-Five Children: A Non-inferiority, Cluster-Randomized Controlled Trial

Sunday, July 26, 2026
11:30 AM - 11:42 AM ET
Location: Maryland Ballroom C
Disclosure(s):
Seifu H. Gebreyesus, P.hD.: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: The study aims to evaluate whether vouchers or cash transfers can serve as effective alternatives to Supplementary Nutrition Foods (SNF) in the treatment of moderate acute malnutrition (MAM) among children aged 6–59 months.

Methods: A three-arm, non-inferiority, cluster-randomized controlled trial was conducted among 3327 children across 102 health posts in Ethiopia, with randomization (1:1:1) to SNF (control), food vouchers, or cash transfers. Children in the SNF arm received age-appropriate doses of SNF. In the voucher arm, children received food vouchers, nutritionally equivalent to the standard regimen (SNF), redeemable at approved local vendors for a predefined food basket. Children in the cash arm received cash transfers, calculated to match the value of the voucher basket. The primary outcomes were nutritional recovery and average daily weight gain, with non-inferiority margins of 10% and 1.2 g/kg/day, respectively. Both Intention-to-treat and per-protocol analyses were performed.

Results: A total of 3,296 were included in the analysis: 1,117 in the SNF arm, 1,051 in the voucher arm, and 1,128 in the cash arm. Voucher was non-inferior to SNF for nutritional recovery, both in PP (risk difference (RD): −5.7%; 95% CI −8.6 to −2.9) and ITT (RD: −6.5%; 95% CI −9.6 to −3.4). Similar patterns were observed for average daily weight gain with a mean difference (MD) of −0.09 g/kg/day (95% CI −0.35 to 0.18) in PP and −0.08 g/kg/day (95% CI −0.34 to 0.17) in ITT. For cash transfers, recovery was non-inferior to SNF in ITT analyses (−6.7%, 95% CI −9.7 to −3.7), but inferior in PP analyses (−9.2%, 95% CI −12.1 to −6.3). For average daily weight gain, cash transfers remained non-inferior in both ITT [−0.27 g/kg/day (95% CI −0.47 to −0.07)] and PP [−0.27 g/kg/day (95% CI −0.48 to −0.07)] analyses.

Conclusions: Vouchers were non-inferior in effectiveness compared to SNF, whereas cash supported weight gain but was less effective for nutritional recovery. Our findings suggest that vouchers could be used as an effective alternative for managing MAM in children.

Funding Sources: The World Food Programme, Ethiopia country office