Gender and water security in Burkina Faso: lessons for adaptation (SEI Policy brief)

In many countries, traditional divisions of labour mean that women conduct the majority of unpaid work related to the collection, transport, and management of water supplies for drinking and other domestic uses. Women’s work on water limits time for other activities, including paid work, education or leisure, which can impact the wellbeing of the entire household. Women and girls also face different sanitation needs than men, due to social taboos and stigmas, as well as biological factors. In addition, social norms within households and communities can lead to women having less of a voice in decisions over the use of water, or the management of facilities. These gender and power relations result in differing water security for individuals, even when they live in the same household or community. This brief explores gender-differentiated water security risks in Burkina Faso, with the aim of informing the development of adaptation strategies in the water, sanitation and hygiene (WASH) sector

Empowerment in WASH Index (SEI Discussion brief)

This brief presents a new Empowerment in WASH Index (EWI) that is designed to measure empowerment in the WASH sector. The Empowerment in WASH Index (EWI) is a new survey-based tool to measure women’s empowerment and gender outcomes in the WASH sector. EWI can help to fill key gender data gaps in the sector. EWI can be used to inform better design of WASH interventions, and to monitor and evaluate WASH-related gender outcomes. We describe how the EWI tool is constructed using a series of indicators, and a case study applying the EWI in Burkina Faso

Measuring empowerment in WASH: Ghana (SEI Policy brief)

Improved monitoring tools are key to ensuring that gender and social equality outcomes receive priority attention within policy and practice related to WASH. The Empowerment in WASH Index (EWI) is a new assessment and monitoring tool that aims to close the evidence gap on the links between WASH interventions and the empowerment and wellbeing of individuals. Challenges identified by EWI go beyond infrastructure-oriented solutions and address more structural (e.g. social norms, governance systems) changes. This policy brief provides an overview and key findings of the EWI study in Asutifi North District, Ghana and presents recommendations drawn from dissemination workshops held at a District Level Learning Alliance Platform (DLLAP) at the Asutifi North District Assembly and a National Level Learning Alliance Platform in Accra

Impact of pre-harvest rainfall on the distribution of fusarium mycotoxins in wheat mill fractions

Legislative limits for Fusarium mycotoxins decrease from unprocessed wheat to processed products. A previous observational study identified a seasonal difference in the distribution of deoxynivalenol (DON) but not zearalenone (ZON) within mill fractions. Rainfall is known to influence the production of these mycotoxins in wheat, but the effects of rainfall on their distribution within mill fractions is not known. Laboratory and field experiments were conducted to determine the impact of different watering regimes on the distribution of DON and ZON in wheat mill fractions. Results indicated that repeated wetting and drying could cause movement of DON towards equilibrium across the mill fractions. Whereas, high levels of rainfall could cause a large reduction of DON in the grain, predominantly from the bran fraction, resulting in a proportional increase within white flour. ZON was detectable in fewer samples but results indicated it is less mobile within the grain. It is important for processors to be aware of the variation of mycotoxin distribution within mill fractions and the drivers of this variation to ensure limits set for grain intake result in mill products within mycotoxin legislative limits

Contextual and Cultural Influences on Parental Feeding Practices and Involvement in Child Care Centers among Hispanic Parents

Background: Parental feeding practices shape children\u27s dietary preferences and behaviors, which can influence a child\u27s weight status. Limited research exists on the precursors and contextual influences of feeding, particularly among Hispanic parents. Therefore, this study explored two areas potentially important for obesity prevention in young children: (1) precursors and contextual influences on parental feeding and (2) parental perceptions and knowledge of the child care food environment. Methods: Four focus groups (n=36) were held with Hispanic parents, predominantly mothers, of preschool children at two child care centers. Parents were asked about influences on what and how they feed their children, awareness of the child care center feeding environment, and current involvement in the child care center. Themes were coded using NVivo10 software (QSR International, Melbourne, Australia). Results: Participants\u27 childhood experiences influenced how they feed their children. Parents stated that both husbands and grandparents often indulged their children with unhealthy foods and thought this interfered with their efforts to maintain a healthy home environment. Participants reported that what their children ate while in child care sometimes influenced the home feeding environment. Conclusions: Cultural and environmental factors influence parental feeding and involvement in the child care setting. Consistent with socioecological system theory, exploring interactions between the environment and culture using a family focus framework, such as the Family Ecological Model, could provide a better understanding of these influences among Hispanic parents. Future obesity prevention interventions with Hispanic families should be culturally relevant and target the different environments where children spend their time

Climate change, water, sanitation and hygiene and resilience: a briefing paper from SWA Research and Learning Constituency

Water and sanitation are basic human needs and essential for functional societies but are threatened by climate change. The Covid-19 pandemic has highlighted societal risks, uncertainties and inequalities, while also highlighting the critical role of access to safe water and sanitation services to ensure recovery and resilience. However, climate change is a threat to the delivery of sustainable water and sanitation services. The water cycle is a primary way that climate change impacts society. According to the IPCC AR6 2021 report, “continued global warming is projected to further intensify the global water cycle, including its variability, global monsoon precipitation and the severity of wet and dry events.” These changes are already affecting water and sanitation services, such as disrupted water supply, and sewers and pit latrines overflowing, requiring increased attention to strengthen their climate resilience. This brief was prepared by the SWA Research and Learning constituency in support of the 2022 Sector Ministers’ Meeting (SMM) ‘Building Forward Better for Recovery and Resilience.’ It seeks to make available the latest research evidence on climate change, resilience and water, sanitation and hygiene for the preparatory processes leading up to the SMM and to support evidence-based follow-up action

Effectiveness of conditional cash transfers (Afya credits incentive) to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya: a cluster-randomised trial

OBJECTIVES: Given high maternal and child mortality rates, we assessed the impact of conditional cash transfers (CCTs) to retain women in the continuum of care (antenatal care (ANC), delivery at facility, postnatal care (PNC) and child immunisation). DESIGN: We conducted an unblinded 1:1 cluster-randomised controlled trial. SETTING: 48 health facilities in Siaya County, Kenya were randomised. The trial ran from May 2017 to December 2019. PARTICIPANTS: 2922 women were recruited to the control and 2522 to the intervention arm. INTERVENTIONS: An electronic system recorded attendance and triggered payments to the participant's mobile for the intervention arm (US$4.5), and phone credit for the control arm (US$0.5). Eligibility criteria were resident in the catchment area and access to a mobile phone. PRIMARY OUTCOMES: Primary outcomes were any ANC, delivery, any PNC between 4 and 12 months after delivery, childhood immunisation and referral attendance to other facilities for ANC or PNC. Given problems with the electronic system, primary outcomes were obtained from maternal clinic books if participants brought them to data extraction meetings (1257 (50%) of intervention and 1053 (36%) control arm participants). Attendance at referrals to other facilities is not reported because of limited data. RESULTS: We found a significantly higher proportion of appointments attended for ANC (67% vs 60%, adjusted OR (aOR) 1.90; 95% CI 1.36 to 2.66) and child immunisation (88% vs 85%; aOR 1.74; 95% CI 1.10 to 2.77) in intervention than control arm. No intervention effect was seen considering delivery at the facility (90% vs 92%; aOR 0.58; 95% CI 0.25 to 1.33) and any PNC attendance (82% vs 81%; aOR 1.25; 95% CI 0.74 to 2.10) separately. The pooled OR across all attendance types was 1.64 (1.28 to 2.10). CONCLUSIONS: Demand-side financing incentives, such as CCTs, can improve attendance for appointments. However, attention needs to be paid to the technology, the barriers that remain for delivery at facility and PNC visits and encouraging women to attend ANC visits within the recommended WHO timeframe. TRIAL REGISTRATION: NCT03021070

Cost-effectiveness of conditional cash transfers to retain women in the continuum of care during pregnancy, birth and the postnatal period: protocol for an economic evaluation of the Afya trial in Kenya

Introduction A wealth of evidence from a range of country settings indicates that antenatal care, facility delivery and postnatal care can reduce maternal and child mortality and morbidity in high-burden settings. However, the utilisation of these services by pregnant women, particularly in low/middle-income country settings, is well below that recommended by the WHO. The Afya trial aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased utilisation of these services in rural Kenya and thus retain women in the continuum of care during pregnancy, birth and the postnatal period. This protocol describes the planned economic evaluation of the Afya trial. Methods and analysis The economic evaluation will be conducted from the provider perspective as a within-trial analysis to evaluate the incremental costs and health outcomes of the cash transfer programme compared with the status quo. Incremental cost-effectiveness ratios will be presented along with a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Sensitivity analyses will be undertaken to explore uncertainty and to ensure that results are robust. A fiscal space assessment will explore the affordability of the intervention. In addition, an analysis of equity impact of the intervention will be conducted. Ethics and dissemination The study has received ethics approval from the Maseno University Ethics Review Committee, REF MSU/DRPI/MUERC/00294/16. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference. Trial registration number NCT0302107

PROTOCOL: What is the impact of complex WASH interventions on gender and social equality outcomes in low‐ and middle‐income countries? A mixed‐method systematic review protocol

Correspondenc