The dose-response association between LEAP 1000 and birthweight – no clear mechanisms: a structural equation modeling approach
Date
2023
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Pregnancy and Childbirth
Abstract
Background Birthweight is an important indicator of maternal and fetal health globally. The multifactorial origins
of birthweight suggest holistic programs that target biological and social risk factors have great potential to improve
birthweight. In this study, we examine the dose-response association of exposure to an unconditional cash transfer
program before delivery with birthweight and explore the potential mediators of the association.
Methods Data for this study come from the Livelihood Empowerment Against Poverty (LEAP) 1000 impact
evaluation conducted between 2015 and 2017 among a panel sample of 2,331 pregnant and lactating women living
in rural households of Northern Ghana. The LEAP 1000 program provided bi-monthly cash transfers and premium fee
waivers to enroll in the National Health Insurance Scheme (NHIS). We used adjusted and unadjusted linear and logistic
regression models to estimate the associations of months of LEAP 1000 exposure before delivery with birthweight
and low birthweight, respectively. We used covariate-adjusted structural equation models (SEM) to examine
mediation of the LEAP 1000 dose-response association with birthweight by household food insecurity and maternal level (agency, NHIS enrollment, and antenatal care) factors.
Results Our study included a sample of 1,439 infants with complete information on birthweight and date of birth.
Nine percent of infants (N=129) were exposed to LEAP 1000 before delivery. A 1-month increase in exposure to LEAP
1000 before delivery was associated with a 9-gram increase in birthweight and 7% reduced odds of low birthweight,
on average, in adjusted models. We found no mediation effect by household food insecurity, NHIS enrollment,
women’s agency, or antenatal care visits.
Conclusions LEAP 1000 cash transfer exposure before delivery was positively associated with birthweight, though
we did not find any mediation by household- or maternal-level factors. The results of our mediation analyses may
serve to inform program operations and improve targeting and programming to optimize health and well-being
among this population.
Description
Research Article
Keywords
LEAP 1000, Birthweight, Ghana, Antenatal care