Food Should not be Forgotten: Impacts of Combined Cash Transfer Receipt and Food Security on Child Education and Cognition in South Africa and Malawi

Lorraine Sherr; Kathryn J Roberts; Mark Tomlinson; Sarah Skeen; Helen Mebrahtu; Sarah Gordon; Stefani du Toit; Katharina Haag; Lucie D Cluver

doi:10.1007/s10461-021-03317-6

Food Should not be Forgotten: Impacts of Combined Cash Transfer Receipt and Food Security on Child Education and Cognition in South Africa and Malawi

AIDS Behav. 2021 Sep;25(9):2886-2897. doi: 10.1007/s10461-021-03317-6. Epub 2021 Jun 11.

Authors

Affiliations

¹ Institute for Global Health, University College London, London, UK. l.sherr@ucl.ac.uk.
² Institute for Global Health, University College London, London, UK.
³ Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa.
⁴ School of Nursing and Midwifery, Queens University, Belfast, UK.
⁵ Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK.
⁶ Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.

Abstract

Social protection can take many forms. Both cash transfers and food security may have important contributions to child cognitive development. This study examines the potential impact of combinations of cash transfers and food security status on child cognitive development and educational outcomes. Cross-sectional data for 796 HIV-affected children in the Child Community Care study were utilised for this analysis. Children and caregivers completed interview schedules comprised of standardised items on socio-demographics, household data, cash grant receipt and food security status, school achievement, and cognition. A series of logistic and linear regression models and marginal effects analyses were undertaken to explore the impacts of differing levels of social protection (none; either cash grant receipt or food secure status or, both in combination) on child educational and cognitive outcomes. Although all children lived in poverty-stricken households, 20% (157/796) of children did not live in a household in receipt of a cash grant and did not report food security; 32.4% (258/796) reported either component of social protection and, 47.9% (381/796) received both measures of social protection in combination. Compared to no social protection, being in receipt of either component of social protection was found to be significantly associated with being in the correct class for age, higher scores of non-verbal cognition, and higher working memory scores. Receiving both social protection measures in combination was found to be significantly associated with reduced educational risk scores, improved odds of being in the correct class for age, regular school attendance, missing less than a week of school in the previous two weeks, higher scores on measures of nonverbal cognition, higher working memory scores, and learning new things more easily. Educational and cognitive outcomes for children can be bolstered by social protection measures (cash grant receipt or food security). Benefits are enhanced when social protection is received in combination. Such findings support the notion of synergistic social protection responses for children living in environments impacted by high levels of HIV burden and deprivation.

Keywords: Cash grant; Cognition; Education; Food security; Sub-saharan africa.

MeSH terms

Child
Cognition
Cross-Sectional Studies
Food Security*
Food Supply
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Humans
Infant, Newborn
Malawi / epidemiology
South Africa / epidemiology