Health Services/Policy
A randomized study of cash transfers on biomarkers of inflammation and infection among the ultra-poor Rebecca Stebbins* Rebecca Stebbins Audrey Pereira Allison E. Aiello Sudhanshu Handa
The immune system is highly sensitive to stressors, with economic hardship being a significant source of stress, particularly for individuals living in resource-limited settings. In this study, we examine the effects of a government cash transfer program, and its impact of alleviating economic stress, on immune function and infectious disease biomarkers in Malawi. Using data on 1,788 youth participants (mean age = 24 years) and 2,118 adult caregiver participants (mean age = 59 years) in the Malawi Social Cash Transfer Project (SCTP), we described the distribution of C-reactive protein (CRP), cytomegalovirus (CMV), and herpes simplex virus (HSV)-1 in a low resource setting and tested whether these biomarker levels were associated with a randomized cash transfer treatment. The Malawi SCTP is an unconditional poverty-targeted cash transfer program administered by the Ministry of Gender, Community Development and Social Welfare, reaching approximately 10% of the population. The transfer size varies by household size and averages approximately US$8 per month per household (18% of pre-program consumption). Households were randomized to begin receiving cash transfers either in 2013 (treatment group) or 2016 (delayed-entry control group). Biomarkers were measured from dried blood spot samples collected in 2021-2022. We found that over 99% of all participants were seropositive to both CMV and HSV-1. Average CRP levels were high at 296.8 (SD 286.72) pg/mL for adults and 252.6 (SD 279.0) pg/mL for youth. While levels CRP (pg/mL), CMV IgG, and HSV IgG levels were roughly 4% higher among participants in the cash transfer treatment group versus the control group, respectively, but the associations were not statistically significant. These findings highlight the extreme viral and immune burden experienced by this population, which in turn explains why the three additional years of cash support had no impact.