The association between the Human Development Bonus and chronic child malnutrition in Ecuador was analyzed
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Chronic child malnutrition remains a persistent problem in Ecuador and disproportionately affects households facing economic, territorial, and housing deprivation. This study aimed to analyze the adjusted association between reported receipt of the Human Development Bonus or pension and chronic malnutrition among children under five. Microdata from the second round of the National Survey on Child Malnutrition were analyzed using a cross-sectional observational design. Height-for-age Z-scores were recalculated according to World Health Organization standards, a housing index was constructed through principal component analysis, and inverse probability weighting with regression adjustment was applied. Children living in recipient households had a 3.97-percentage-point higher adjusted probability of chronic malnutrition and a height-for-age Z-score 0.1365 standard deviations lower than comparable children in non-recipient households. These findings reflect the program’s concentration among households experiencing persistent structural vulnerabilities and do not demonstrate an adverse causal effect of the transfer. Cash transfers should therefore be complemented by maternal and child health, nutrition, water, sanitation, and territorial development interventions.
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Ahmed, A., Hoddinott, J., & Roy, S. (2025). Food transfers, cash transfers, behavior change communication and child nutrition: Evidence from Bangladesh. The World Bank Economic Review, 39(2), 439–472. https://doi.org/10.1093/wber/lhae023 DOI: https://doi.org/10.1093/wber/lhae023
Alkire, S., & Foster, J. (2011). Counting and multidimensional poverty measurement. Journal of Public Economics, 95(7–8), 476–487. https://doi.org/10.1016/j.jpubeco.2010.11.006 DOI: https://doi.org/10.1016/j.jpubeco.2010.11.006
Arias-Macias, B. C., Mosquera-Arevalo, A. P., & Alava-Rosado, M. X. (2026). Devolución del IVA y calidad de vida de adultos mayores y personas con discapacidad bajo un enfoque comparativo. Journal of Economic and Social Science Research, 6(2), 69–86. https://doi.org/10.55813/gaea/jessr/v6/n2/241 DOI: https://doi.org/10.55813/gaea/jessr/v6/n2/241
Attanasio, O., Battistin, E., Fitzsimons, E., Mesnard, A., & Vera-Hernández, M. (2005). How effective are conditional cash transfers? Evidence from Colombia (IFS Briefing Note No. 54). Institute for Fiscal Studies. https://doi.org/10.1920/bn.ifs.2005.0054 DOI: https://doi.org/10.1920/bn.ifs.2005.0054
Attanasio, O., Gómez, L. C., Heredia, P., & Vera-Hernández, M. (2005). The short-term impact of a conditional cash subsidy on child health and nutrition in Colombia (Report Summary: Familias 03). Institute for Fiscal Studies. https://ifs.org.uk/sites/default/files/output_url_files/rs_fam03.pdf
Austin, P. C. (2011). An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research, 46(3), 399–424. https://doi.org/10.1080/00273171.2011.568786 DOI: https://doi.org/10.1080/00273171.2011.568786
Bastagli, F., Hagen-Zanker, J., Harman, L., Barca, V., Sturge, G., & Schmidt, T. (2019). The impact of cash transfers: A review of the evidence from low- and middle-income countries. Journal of Social Policy, 48(3), 569–594. https://doi.org/10.1017/S0047279418000715 DOI: https://doi.org/10.1017/S0047279418000715
Becker, G. S. (2009). Human capital: A theoretical and empirical analysis, with special reference to education (3.ª ed.). University of Chicago Press. https://books.google.com.ec/books?id=nowHzq2QoYsC
Black, M. M., Walker, S. P., Fernald, L. C. H., Andersen, C. T., DiGirolamo, A. M., Lu, C., McCoy, D. C., Fink, G., Shawar, Y. R., Shiffman, J., Devercelli, A. E., Wodon, Q. T., Vargas-Barón, E., & Grantham-McGregor, S. (2017). Early childhood development coming of age: Science through the life course. The Lancet, 389(10064), 77–90. https://doi.org/10.1016/S0140-6736(16)31389-7 DOI: https://doi.org/10.1016/S0140-6736(16)31389-7
Cavalcanti, D. M., Ordoñez, J. A., Aransiola, T., Almeida, C., Perdomo Díaz, J. F., Zuluaga Mayorga, D., Zamudio Sosa, A., Tasca, R., Campello, T., De Souza, L. E., Hessel, P., Chivardi, C., Moncayo, A. L., & Rasella, D. (2023). Evaluation and forecasting analysis of the association of conditional cash transfer with child mortality in Latin America, 2000–2030. JAMA Network Open, 6(7), Artículo e2323489. https://doi.org/10.1001/jamanetworkopen.2023.23489 DOI: https://doi.org/10.1001/jamanetworkopen.2023.23489
DuGoff, E. H., Schuler, M., & Stuart, E. A. (2014). Generalizing observational study results: Applying propensity score methods to complex surveys. Health Services Research, 49(1), 284–303. https://doi.org/10.1111/1475-6773.12090 DOI: https://doi.org/10.1111/1475-6773.12090
Falcão, I. R., Tedde, J. G. G., Paixão, E., Cerqueira-Silva, T., Rocha, A. dos S., Fiaccone, R. L., Silva, N. J., Silva, J. F. de M. e, Ichihara, M. Y., Pescarini, J. M., Ribeiro-Silva, R. de C., & Barreto, M. L. (2025). Brazil’s Bolsa Família conditional cash transfer and child malnutrition: A nationwide birth cohort study. BMJ Global Health, 10(7), Artículo e018431. https://doi.org/10.1136/bmjgh-2024-018431 DOI: https://doi.org/10.1136/bmjgh-2024-018431
Fernald, L. C. H., Gertler, P. J., & Neufeld, L. M. (2008). Role of cash in conditional cash transfer programmes for child health, growth, and development: An analysis of Mexico’s Oportunidades. The Lancet, 371(9615), 828–837. https://doi.org/10.1016/S0140-6736(08)60382-7 DOI: https://doi.org/10.1016/S0140-6736(08)60382-7
Fiszbein, A., & Schady, N. (2009). Conditional cash transfers: Reducing present and future poverty. World Bank. https://doi.org/10.1596/978-0-8213-7352-1 DOI: https://doi.org/10.1596/978-0-8213-7352-1
Heckman, J. J. (2006). Skill formation and the economics of investing in disadvantaged children. Science, 312(5782), 1900–1902. https://doi.org/10.1126/science.1128898 DOI: https://doi.org/10.1126/science.1128898
Heckman, J. J., & Mosso, S. (2014). The economics of human development and social mobility. Annual Review of Economics, 6, 689–733. https://doi.org/10.1146/annurev-economics-080213-040753 DOI: https://doi.org/10.1146/annurev-economics-080213-040753
Instituto Nacional de Estadística y Censos. (2024). Encuesta Nacional sobre Desnutrición Infantil—ENDI: Principales resultados. Segunda ronda 2023–2024. https://www.ecuadorencifras.gob.ec/documentos/web-inec/ENDI/R2/Presentacion_publicacion_ENDI_R2.pdf
Landin Basterra, E., Gentilini, U., Medeiros Cavalcanti, D., Ferreira da Silva, A., Oliveira Ferreira de Sales, L., Silva, N. J., & Rasella, D. (2025). Impact of social protection on child malnutrition and mortality across 46 LMICs: A longitudinal study over two decades with insights from the COVID-19 pandemic. eClinicalMedicine, 87, Artículo 103414. https://doi.org/10.1016/j.eclinm.2025.103414 DOI: https://doi.org/10.1016/j.eclinm.2025.103414
León, M., & Younger, S. D. (2007). Transfer payments, mothers’ income and child health in Ecuador. The Journal of Development Studies, 43(6), 1126–1143. https://doi.org/10.1080/00220380701466708 DOI: https://doi.org/10.1080/00220380701466708
Little, M. T., Roelen, K., Lange, B. C. L., Steinert, J. I., Yakubovich, A. R., Cluver, L., & Humphreys, D. K. (2021). Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low- and middle-income countries. PLOS Medicine, 18(9), Artículo e1003698. https://doi.org/10.1371/journal.pmed.1003698 DOI: https://doi.org/10.1371/journal.pmed.1003698
Manley, J., Alderman, H., & Gentilini, U. (2022). More evidence on cash transfers and child nutritional outcomes: A systematic review and meta-analysis. BMJ Global Health, 7(4), Artículo e008233. https://doi.org/10.1136/bmjgh-2021-008233 DOI: https://doi.org/10.1136/bmjgh-2021-008233
Ministerio de Inclusión Económica y Social. (2019). Metodología de cálculo de umbrales sobre la métrica del Registro Social 2018. https://www.desarrollohumano.gob.ec/wp-content/uploads/downloads/2019/09/Documento-final-umbrales-RS2018-MIES.pdf
Moreno, L. (2017). Assessing the effect of conditional cash transfers in children chronic stunting: The Human Development Bonus in Ecuador. Analítika: Revista de Análisis Estadístico, 13(1), 83–131. https://www.ecuadorencifras.gob.ec/documentos/web-inec/Revistas/Analitika/Anexos_pdf/Analit_13/3.pdf
Ngamasana, E. L., & Moxie, J. (2024). Cash transfer, maternal and child health outcomes: A scoping review in sub-Saharan Africa. Global Health Action, 17(1), Artículo 2309726. https://doi.org/10.1080/16549716.2024.2309726 DOI: https://doi.org/10.1080/16549716.2024.2309726
Olney, D. K., Gelli, A., Kumar, N., Alderman, H., Go, A., & Raza, A. (2022). Social assistance programme impacts on women’s and children’s diets and nutritional status. Maternal & Child Nutrition, 18(4), Artículo e13378. https://doi.org/10.1111/mcn.13378 DOI: https://doi.org/10.1111/mcn.13378
Parikh, P., Semba, R., Manary, M., Swaminathan, S., Udomkesmalee, E., Bos, R., Poh, B. K., Rojroongwasinkul, N., Geurts, J., Sekartini, R., & Nga, T. T. (2022). Animal source foods, rich in essential amino acids, are important for linear growth and development of young children in low- and middle-income countries. Maternal & Child Nutrition, 18(1), Artículo e13264. https://doi.org/10.1111/mcn.13264 DOI: https://doi.org/10.1111/mcn.13264
Paxson, C., & Schady, N. (2007). Cognitive development among young children in Ecuador: The roles of wealth, health, and parenting. Journal of Human Resources, 42(1), 49–84. https://doi.org/10.3368/jhr.XLII.1.49 DOI: https://doi.org/10.3368/jhr.XLII.1.49
Ranganathan, M., & Lagarde, M. (2012). Promoting healthy behaviours and improving health outcomes in low- and middle-income countries: A review of the impact of conditional cash transfer programmes. Preventive Medicine, 55, S95–S105. https://doi.org/10.1016/j.ypmed.2011.11.015 DOI: https://doi.org/10.1016/j.ypmed.2011.11.015
Rawlings, L. B., & Rubio, G. M. (2005). Evaluating the impact of conditional cash transfer programs. The World Bank Research Observer, 20(1), 29–55. https://doi.org/10.1093/wbro/lki001 DOI: https://doi.org/10.1093/wbro/lki001
Richterman, A., Bùi, T.-M. N., Bair, E. F., Jerome, G., Millien, C., Suffrin, J. C. D., Behrman, J. R., & Thirumurthy, H. (2025). The effects of government-led cash transfer programmes on behavioural and health determinants of mortality: A difference-in-differences study. The Lancet, 406(10520), 2656–2666. https://doi.org/10.1016/S0140-6736(25)01437-0 DOI: https://doi.org/10.1016/S0140-6736(25)01437-0
Rivadeneira, M. F., Moncayo, A. L., Cóndor, J. D., Tello, B., Buitrón, J., Astudillo, F., Caicedo-Gallardo, J. D., Estrella-Proaño, A., Naranjo-Estrella, A., & Torres, A. L. (2022). High prevalence of chronic malnutrition in indigenous children under 5 years of age in Chimborazo-Ecuador: Multicausal analysis of its determinants. BMC Public Health, 22, Artículo 1977. https://doi.org/10.1186/s12889-022-14327-x DOI: https://doi.org/10.1186/s12889-022-14327-x
Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55. https://doi.org/10.1093/biomet/70.1.41 DOI: https://doi.org/10.1093/biomet/70.1.41
Ruel, M. T., & Alderman, H. (2013). Nutrition-sensitive interventions and programmes: How can they help to accelerate progress in improving maternal and child nutrition? The Lancet, 382(9891), 536–551. https://doi.org/10.1016/S0140-6736(13)60843-0 DOI: https://doi.org/10.1016/S0140-6736(13)60843-0
Rukiko, M. D., Mwakalobo, A. B. S., & Mmasa, J. J. (2023). The impact of conditional cash transfer program on stunting in under five year’s poor children. Public Health in Practice, 6, Artículo 100437. https://doi.org/10.1016/j.puhip.2023.100437 DOI: https://doi.org/10.1016/j.puhip.2023.100437
Toaquiza Mesías, V. A., & Vargas Sánchez, A. C. (2025). Determinantes de la desnutrición crónica infantil en niños menores de tres años: Una revisión sistemática de la literatura. Revista Multidisciplinar Ciencia y Descubrimiento, 3(4). https://doi.org/10.63816/r2jt1r96 DOI: https://doi.org/10.63816/r2jt1r96
Vallejo-Rosero, C. A., López-Contreras, J. del R., Tabarquino-Muñoz, R. A., & Gaviria-Moreno, G. E. (2024). Estrategias de inclusión en la economía del conocimiento para mejorar la calidad de vida de poblaciones vulnerables. Journal of Economic and Social Science Research, 4(3), 13–31. https://doi.org/10.55813/gaea/jessr/v4/n3/118 DOI: https://doi.org/10.55813/gaea/jessr/v4/n3/118
Victora, C. G., Christian, P., Vidaletti, L. P., Gatica-Domínguez, G., Menon, P., & Black, R. E. (2021). Revisiting maternal and child undernutrition in low-income and middle-income countries: Variable progress towards an unfinished agenda. The Lancet, 397(10282), 1388–1399. https://doi.org/10.1016/S0140-6736(21)00394-9 DOI: https://doi.org/10.1016/S0140-6736(21)00394-9
World Health Organization. (2006). WHO child growth standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. https://www.who.int/publications/i/item/924154693X