REVIEW The impact of conditional cash transfers on child health in low- and middle-income countries: a systematic review Ebenezer Owusu-Addo • Ruth Cross Received: 15 January 2014 / Revised: 19 April 2014 / Accepted: 12 May 2014 / Published online: 5 June 2014 Ó Swiss School of Public Health 2014 Abstract Objectives The review aimed to assess the effectiveness of conditional cash transfers (CCTs) in improving child health in low- and middle-income countries. Methods Seven electronic databases were searched for papers: MEDLINE, EMBASE, PubMed, PsychINFO, BIOSIS Previews, Academic Search Complete, and CSA Sociological Abstracts. The included studies comprised of randomised controlled trials and controlled before-and- after studies evaluating the impact of CCTs on child health. Due to the substantial heterogeneity of the studies, a nar- rative synthesis was conducted on the extracted data. Results Sixteen studies predominantly from Latin American countries met the inclusion criteria. The out- comes reported by the studies in relation to CCTs’ effectiveness in improving child health were reduction in morbidity risk, improvement in nutritional outcomes, health services utilisation, and immunisation coverage. Conclusions The review suggests that to a large extent, CCTs are effective in improving child health by addressing child health determinants such as access to health care, child and maternal nutrition, morbidity risk, immunisation coverage, and household poverty in developing countries particularly middle-income countries. Of importance to both policy and practice, it appears that CCTs require effective functioning of health care systems to effectively promote child health. Keywords Conditional cash transfers Á Child health Á Low- and middle-income countries Á Programme theory Á Systematic review Introduction Child health remains a major public health concern in developing countries in contemporary times (UNICEF 2009). In 2008, the median level of child mortality stood at 109 deaths per 1,000 live births in developing countries as compared with 5 per 1,000 in developed countries (World Health Organisation 2010). Aside being a key indicator of economic development, child health has a close association with educational attainments, future health outcomes, and employment opportunities (Case et al. 2005; Marmot Review Report 2010). Child health has thus attracted the attention of the international community as a number of vertical programmes (health programmes which focus on a specific demographic population, disease, or health issue, e.g. vitamin A supplementation, exclusive breastfeeding, and immunisation) are currently being implemented to help improve child health in line with the Millennium Devel- opment Goal (MDG) 4 (Ellis and Allen 2006). It is undeniable that vertical programmes that are dis- ease-focused and largely reflect the biomedical approach to child health promotion continue to make significant con- tributions to child health in terms of reducing childhood mortality in developing countries (Claeson and Waldman 2000). However, there is a growing consensus that a more holistic approach is to employ horizontal programmes that Electronic supplementary material The online version of this article (doi:10.1007/s00038-014-0570-x) contains supplementary material, which is available to authorized users. E. Owusu-Addo (&) Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana e-mail: eowusuaddo@yahoo.co.uk R. Cross Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, UK Int J Public Health (2014) 59:609–618 DOI 10.1007/s00038-014-0570-x 123