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)

Research in Africa for Africa? Probing the Effect and Credibility of Research Done by Foreigners for Africa

Part 2: ICT4D for the Indigenous, by the Indigenous and of the IndigenousInternational audienceThis paper probes research being carried out by researchers foreign to Africa. From an assessment of decennia of research, we address the many and varied ways in which the work of foreign researchers, often from countries with unresolved colonial baggage, cast their normalising shadows over African realities. From experiences in Mozambique, Zambia and Zimbabwe, among others, through the exposit of the complex and expansive array of influences and coloniality, we paint a picture how foreign researchers benefit from enshrined and ongoing practices that dominate research scenes. These practices depreciate African research and development done by Africans, in Africa for utilisation in Africa. We propose the need to mainstream decoloniality and communiversity as to affect the primacy of African researchers researching in, on and for Africa

Environmental values, knowledge and behaviour: Contributions of an emergent literature on the role of ethnicity and migration

Amidst calls for paradigm shifts in environmental scholarship, we track an emergent literature on how environmental values, knowledge and behaviour (EVKB) change (or not) with the migration process. We focus on the role of Majority World migrants to the Minority World. Large-scale survey research into EVKB is beginning to consider both ethnicity and migration history as important variables, but tends to leave the concepts of environment and environmental behaviour unexamined. Western EVKB indicators thus tend to be universalized rather than understood as themselves culturally specific. An emergent literature attempts to improve both quantitative and qualitative research on EVKB by broadening the conceptualization of environmental behaviour to include the practices of Majority World migrants. Those studies throw new light on the process of acculturation as having disruptive or solidifying potential for sustainable practices. We summarize four implications for future research. There is a need to go beyond western logics in research design and method. Straightforward assumptions about the \u27pro\u27 in pro-environmental behaviour need to be challenged. Cases of EVKB\u27s persistence post-migration and positive influence on the broader population should be sought out and examined. The migration process provides real-time experiments in enacting alternative worlds

Using Local Capacity To Assess Carbon Stocks In Two Community Forest In South-East Cameroon

International audienc