Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Electoral Politics in Zimbabwe: Authoritarianism Versus the People

The majority of Zimbabweans are now accustomed to electoral fraud as practised by the ruling Zimbabwe African National Union-Patriotic Front (ZANU-PF) led by  President Mugabe. Elections are generally not conducted in a manner that can be deemed to be free, fair and transparent. The major electoral malpractices include lack of transparency in the electoral procedures, lack of information on electoral regulations among both the electorate and the contestants, numerous amendments to the laws, most of which are aimed at disenfranchising sections of the electorate who are suspected of supporting opposition political parties, and fraudulent tallying of the votes at counting. Political violence also plays a major role in Zimbabwe’s electoral politics. The chief perpetrators of political violence are by far elements within the ruling ZANU-PF party. Human rights groups in Zimbabwe report that the majority of the victims of political violence during election times are members of opposition political parties. Apart from control of the state media for partisan political purposes, the whole electoral machinery is also effectively controlled by President Mugabe himself through direct appointments to them. Even the  law-enforcement agencies are loyal to the President and the party. These have created a grossly uneven political playing field, pose a sever security dilemma for political dissenters, and render elections a farcical exercise in democracy. La majorité des Zimbabwéens est à présent habituée aux fraudes électorales pratiquées par le parti au pouvoir, l’Union Nationale Africaine du Zimbabwe – Front Patriotique (Zimbabwe African National Union – Patriotic Front -ZANUPF) dirigé par le Président Mugabe. Les élections ne sont généralement pas menées de façon  libre, juste et transparente. Les principales pratiques électorales frauduleuses  incluent le manque de transparence au niveau des procédures électorales, le  manque d’informations relatives aux régulations électorales aussi bien pour  l’électorat que les adversaires politiques, une quantité innombrable d’amendements à la législation dont la plupart consistent à priver du droit de vote des parties  entières de l’électorat, suspectées de soutenir les partis politiques de l’opposition ;enfin, ces pratiques incluent également un décompte irrégulier des bulletins de vote. La violence politique joue également un rôle crucial dans la politique  électorale au Zimbabwe. Les principaux acteurs de cette violence sont pour la  plupart des éléments internes au ZANU-PF. Certains groupes de défense des droits de l’homme affirment que la majorité des victimes de la violence politique perpétrée durant les élections, sont des membres de partis politiques de l’opposition. Outre le contrôle des médias étatiques pour des raisons de politique partisane, l’ensemble de la machinerie électorale est également effectivement sous la mainmise du Président Mugabe lui-même, qui agit à travers un système de désignations  directes. Même les organes chargés d’appliquer la législation obéissent au  Président et au parti. Ceux-ci ont contribué à la formation d’un terrain politique extrêmement inégal, et posent un sérieux dilemme sécuritaire aux dissidents  politiques, tout en transformant les élections en une grotesque caricature de la démocratie.

Introduction and Literature review and conceptual framework

An indepth study in participatory democracy in Zimbabwe with emphasis on local governance.This study raises a number of rather controversial issues regarding development, beneficiary participation and local government in Zimbabwe. None of the people or institutions mentioned above can be blamed for any of the contents of this study. The opinions, views and conclusions contained in this study are mine alone and not of those who worked with me or supported me during this study. I certainly hope that the study will result in serious re-examination of the way development has seemed to take place in Zimbabwe since 1980, and contribute to further studies of what changes need to be made to the status quo for the benefit of the poor and needy in our country.The Ford Foundation provided financial support for the project