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Background The prevalence of acute malnutrition is often high in emergency-affected populations and is associated with elevated mortality risk and long-term health consequences. Increasingly, cash transfer programmes (CTP) are used instead of direct food aid as a nutritional intervention, but there is sparse evidence on their nutritional impact. We aim to understand whether CTP reduces acute malnutrition and its known risk factors. Methods/design A non-randomised, cluster-controlled trial will assess the impact of an unconditional cash transfer of US$84 per month for 5 months, a single non-food items kit, and free piped water on the risk of acute malnutrition in children, aged 6–59 months. The study will take place in camps for internally displaced persons (IDP) in peri-urban Mogadishu, Somalia. A cluster will consist of one IDP camp and 10 camps will be allocated to receive the intervention based on vulnerability targeting criteria. The control camps will then be selected from the same geographical area. Needs assessment data indicates small differences in vulnerability between camps. In each trial arm, 120 households will be randomly sampled and two detailed household surveys will be implemented at baseline and 3 months after the initiation of the cash transfer. The survey questionnaire will cover risk factors for malnutrition including household expenditure, assets, food security, diet diversity, coping strategies, morbidity, WASH, and access to health care. A community surveillance system will collect monthly mid-upper arm circumference measurements from all children aged 6–59 months in the study clusters to assess the incidence of acute malnutrition over the duration of the intervention. Process evaluation data will be compiled from routine quantitative programme data and primary qualitative data collected using key informant interviews and focus group discussions. The UK Department for International Development will provide funding for this study. The European Civil Protection and Humanitarian Aid Operations will fund the intervention. Concern Worldwide will implement the intervention as part of their humanitarian programming. Discussion This non-randomised cluster controlled trial will provide needed evidence on the role of unconditional CTP in reducing the risk of acute malnutrition among IDP in this context. Trial registration ISRCTN29521514 . Registered 19 January 2016.

Background Somalia has been affected by conflict since 1991, with children aged, Carlos S Grijalva-Eternod and colleagues present results for acute malnutrition, dietary diversity, and other nutrition-related outcomes from their non-randomised trial of a CBI for displaced families with young children., Author summary Why was this study done? Interventions that include the provision of cash have become ubiquitous within most humanitarian responses to crisis. The transfer of cash often aims to prevent children becoming acutely malnourished, but it is still unknown whether it works as a preventive intervention in different settings. Somalia has been affected by conflict since 1991, periodically forcing large-scale displacement and increasing mortality. Somalia has one of the highest levels of acute malnutrition observed in children aged less than 5 years. Evidence is needed to understand whether, in Somalia, a humanitarian intervention involving cash transfers would reduce the risk of children becoming malnourished and/or improve conditions that are often associated with malnutrition. What did the researchers do and find? We studied the changes in the risk of children aged 6–59 months becoming undernourished and the changes in the children’s dietary diversity following a cash-based humanitarian intervention in a population of internally displaced persons living in camps in peri-urban Mogadishu, Somalia. We compared the occurrence of acute malnutrition in all children aged 6–59 months living in the 10 camps that received the intervention with 10 camps that did not receive the intervention. We also compared the children’s dietary diversity in a sample of 240 households. Diet diversity appeared to improve in children from households receiving the cash-based humanitarian intervention. An apparent improvement in diet and food security was also observed in their mothers or primary carers and in their households. However, despite this apparent improvement in food security and diet diversity, we did not observe an associated reduction in the risk of children becoming acutely malnourished in camps receiving the cash-based humanitarian intervention. What do these findings mean? Humanitarian interventions involving cash transfers have consistently been shown to improve beneficiaries’ food security and diet. However, malnutrition has many causes, and this study provides evidence that these interventions are not always effective in preventing children becoming acutely malnourished. The study limitations include the fact that the intervention was allocated to camps based on vulnerability. This renders the negative finding for reducing malnutrition more difficult to interpret. In addition, we could not collect more information on undernutrition to better understand other potential changes, and the overall occurrence of acute malnutrition in the children was lower than we anticipated. It is unclear why this humanitarian intervention did not appear to reduce the risk of malnutrition in children. Future work is necessary to understand whether modifications to this intervention, such as adding specific nutritious foods or social and behaviour change communication, could positively affect its ability to prevent children from becoming acutely malnourished.