Menu
Menu
Menu
Menu
Background: Child cash transfers are increasingly recognised for their potential to reduce poverty and improve health outcomes. South Africa’s child support grant (CSG) constitutes the largest cash transfer in the continent. No studies have been conducted to look at factors associated with successful receipt of the CSG. This paper reports findings on factors associated with CSG receipt in three settings in South Africa (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal). Methods. This study used longitudinal data from a community-based cluster-randomized trial (PROMISE EBF) promoting exclusive breastfeeding by peer-counsellors in South Africa (ClinicalTrials.gov: NCT00397150). 1148 mother-infant pairs were enrolled in the study and data on the CSG were collected at infant age 6, 12, 24 weeks and 18-24 months. A stratified cox proportional hazards regression model was fitted to the data to investigate factors associated with CSG receipt. Results: Uptake of the CSG amongst eligible children at a median age of 22 months was 62% in Paarl, 64% in Rietvlei and 60% in Umlazi. Possessing a birth certificate was found to be the strongest predictor of CSG receipt (HR 3.1, 95% CI: 2.4 -4.1). Other factors also found to be independently associated with CSG receipt were an HIV-positive mother (HR 1.2, 95% CI: 1.0-1.4) and a household income below R1100 (HR1.7, 95% CI: 1.1 -2.6). Conclusion: Receipt of the CSG was sub optimal amongst eligible children showing administrative requirements such as possessing a birth certificate to be a serious barrier to access. In the spirit of promoting and protecting children’s rights, more efforts are needed to improve and ease access to this cash transfer program. © 2012 Zembe-Mkabile et al.; licensee BioMed Central Ltd.
This study used data from a community-based cluster-randomized trial promoting exclusive breastfeeding by peer-counsellors in three South African sites between 2006 and 2008. A total of 34 clusters from three separate areas in South Africa were chosen: Paarl in the Western Cape Province (peri-urban), Umlazi (urban) and Rietvlei (rural) in KwaZulu-Natal Province. Infant mortality rate (IMR) and antenatal HIV prevalence at the time of the study were 40/1000 and 10% in Paarl, 60/1000 and 42% in Umlazi and 99/1000 and 34% in Rietvlei. Full trial study methods are described elsewhere [19]. In the intervention arm women received 5 visits from peer supporters to promote exclusive breastfeeding and in the control arm women received the same number of visits from peer supporters but they were counselled on how to apply for the child support grant. The visits took place antenatally, and at 1 week, 4 weeks, 7 weeks and 10 weeks after birth. The trial found no effect of peer support visits on uptake of the child support grant at six months of age. Results of CSG receipt by arm were 54% in the infant feeding arm and 46% in CSG arm, but these results were not significant (Relative risk 1.0, 95% CI: 0.9 -1.2), therefore this paper analysed the study as a longitudinal cohort adjusting for study arm and clustering. A total of 1276 mother-infant pairs were recruited. Among these, 128 were excluded due to relocation or being lost-to-follow-up, twin delivery, death of infant or mother before 3 weeks after birth. Thus, 1148 mother-infant pairs remained in the analysis. The mother-infant pairs were scheduled to be interviewed at recruitment (antenatally) for socio-demographic information and at 3, 6, 12 and 24 weeks after birth for data regarding CSG uptake, with a final follow up visit amongst a sub sample of 741 children at a median age of 22 months (range 9–36 months) to assess final grant receipt. Detailed information on CSG application and receipt was only collected at the final follow-up interview to allow enough time for families to have gone through the grant process. Contact was made with mothers for the final follow up visit through home visits by data collectors. Where possible, mothers were first called on their cell phones to determine a suitable time for the visit. A structured paper based questionnaire was administered at the recruitment, 3, 6, 12 and 24 week data collection points by a trained data collector. Items in the questionnaire included socio demographics, infant feeding practices, grant application and receipt. At the final follow up interview data collectors captured the data using questionnaires loaded onto cell phones purchased for the study with built in range checks and skip logic. The questionnaires were automatically transferred to a central server once each one was completed. Items in this final questionnaire included timing of CSG application, barriers to CSG access, use of the CSG, anthropometry, and infant health. Data collectors were not involved in the implementation of the intervention. Data collected on paper were double entered using EpiData (http://www.epidata.dk) and merged with the data collected from the final interview on the cell phones. CSG receipt was defined as a mother reporting receipt of the grant at any of weeks 12, 24 or the final data collection point (median age 22 months). Possession of a birth certificate was defined as the mother reporting possessing a birth certificate for her child at any of weeks 6, 12 or 24. A survival analysis approach was used to model time to receipt of a CSG on a set of determinants. A stratified Cox proportional hazards model was fitted and hazard ratio estimates were obtained, with equal coefficients across strata (sites) but with a baseline hazard unique to each strata. The Breslow method was used for handling tied successes due to the limited number of data collection points. An epidemiological approach was undertaken in selecting variables for the model including demographic and socio-economic factors relevant to the South African context. In case of collinearity, one of the variables, such as Identity Document (ID) was collinear with Birth Certificate, and was subsequently dropped from the model. The models were adjusted for arm and clustering to account for the community randomised trial design. Possible interaction terms which included maternal education and arm; maternal education and birth certificate; birth certificate and arm were inserted into the model but none were found significant to include in the model. A socioeconomic wealth index was constructed with the use of multiple correspondence analysis based on ownership of assets including mobile phone and television, and house characteristics including water source, roof material and toilet type. This method is analogous to principal component analysis, and better suited for categorical data [20]. The infants’ households were grouped into quintiles on the basis of socioeconomic rank. Data analysis was done with SAS version 9.2 and STATA/IC 12.0. Ethics approval for the cluster randomised controlled trial was received from the Ethics Committee of the Medical Research Council South Africa. Signed or thumb-printed informed consent was obtained from each mother prior to study participation. Additional ethics approval was granted in a subsequent application to the Medical Research Council Ethics Committee for the additional data collection point when the children were at median age of 22 months. An information sheet explaining the purpose of the additional interview was read to each participant and each participant who agreed to participate signed a consent form. This study is registered with ClinicalTrials.gov, number {“type”:”clinical-trial”,”attrs”:{“text”:”NCT00397150″,”term_id”:”NCT00397150″}}NCT00397150.
N/A
