Effects of productive safety net program on children's nutritional outcomes in Ethiopia: a systematic review without meta-analysis.

Background: Productive Safety Net Program (PSNP) is a livelihood intervention to improve food insecurity among the poor and has been implemented in Ethiopia. However, there is inconsistent evidence on the impacts of PSNP on improving the nutritional status of vulnerable segments (children). The current review was to synthesize evidence on the effects of PSNP on the nutritional status of children in Ethiopia.

Methods: A comprehensive search for Google, Google Scholar, PubMed, and other relevant repositories, coupled with a manual search (till March 15, 2024), was done using a combination of relevant key words. Hence, the search was conducted on "productive safety net," "Ethiopia," "nutritional status," and "undernutrition." An updated systematic review without meta-analysis guideline was used to select relevant literature. Data were extracted using MS Excel format by two reviewers and cross-checked. The extracted data were grouped, and summarized in narrative summaries, descriptions, and quantitative summaries whenever applicable. The risk of bias was assessed, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess the strength of the evidence.

Results: A total of nine studies (n = 14,114) were included in this review, and the studies assessed the risk of undernutrition among PSNP members and non-PSNP members, in the form of pre- and post-design, survey, and cohort studies. The program has the potential to improve income, food security, dietary diversity, and reduce the occurrence of acute malnutrition, with a limited effect on stunting reduction. Moreover, food aid or cash transfer plus food aid was found to be superior compared to cash transfer mode in improving child nutrition than cash transfer alone, which could be frustrated by food inflation, subjects' knowledge and attitude about child feeding. Overall, evidence from survey studies reporting the comparative risk of undernutrition could limit the conclusiveness of the causation which could be confounded.

Conclusion: PSNP could improve wasting with limited evidence on stunting reduction, where the causal pathway could be frustrated by the purchasing power of cash vouchers, household income expenditure patterns, and subjects' knowledge and attitude limiting its impact. Well-designed implementation research could further help. A comprehensive review, considering more recent evidence, could help.

Clinical trial registration: Not applicable.