30 research outputs found

    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.

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    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)

    Evaluating Public Transit Modal Shift Dynamics In Response to Bikesharing: A Tale of Two U.S. Cities

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    Public bikesharing—the shared use of a bicycle fleet—has recently emerged in major North American cities. Bikesharing has been found to decrease driving and increase bicycling. But shifts in public transit have been mixed. The authors evaluate survey data from two U.S. cities to explore who is shifting toward and away from public transit as a result of bikesharing. The authors explore this question by mapping geocoded home and work locations of respondents within Washington DC and Minneapolis. Respondents were mapped by their modal shift toward or away from bus and rail transit. The results show that in Washington DC, those shifting toward bus and rail transit live on the urban periphery, whereas those living in the urban core tend to use public transit less. In Minneapolis, the shift toward rail extends to the urban core, while the modal shift for bus transit is more dispersed. The authors analyze socio-demographics associated with modal shift through cross-tabulations and four ordinal regression models. Common attributes associated with shifting toward public transit include increased age, being male, living in lower density areas, and longer commute distances. The authors conclude with a discussion of the final results in the context of bikesharing’s impacts on other cities throughout North America.&nbsp

    Smartphone App Evolution and Early Understanding from a Multimodal App User Survey

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    Travelers are increasingly turning to smartphone applications for an array of transportation functions. Four types of transportation apps have emerged: 1) mobility apps; 2) connected vehicle apps; 3) smart parking apps; and 4) courier network service (CNS) apps. This chapter discusses the history and trends leading to the growth and development of transportation apps and summarizes key characteristics of 83 transportation apps identified through an Internet search cataloging transportation apps with more than 10,000 downloads each. Seventy-one percent of the 83 apps identified incorporated a real-time data function (e.g., traffic conditions, roadway incidents, parking availability, and public transit wait times). Additionally, the chapter reports on findings from a survey, conducted in spring 2016, of 130 app users who downloaded the RideScout mobility aggregator app (which ceased operations in August 2016). The survey, was asked questions about their use of mobility aggregators more generally, sought to understand how multimodal information apps shift travel behavior. The findings showed that most users of such apps would walk, drive alone, and carpool during a typical month. Fifty percent of respondents drove alone once or more per day. Twenty-five percent owned one vehicle, and 75% owned two or more vehicles. Thirty-nine percent of respondents reported that they drove less or much less due to the apps. Findings from the survey suggest that multi-modal app users do change their travel behavior in response to information provided, and they may contribute to a reduction in vehicle use

    Public Bikesharing and Modal Shift Behavior: A Comparative Study of Early Bikesharing Systems in North America

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    Public bikesharing—the shared use of a bicycle fleet by the public—is an innovative mobility strategy that has recently emerged in major North American cities. Bikesharing systems typically position bicycles throughout an urban environment, among a network of docking stations, for immediate access. This paper discusses the modal shift that results from individuals participating in four public bikesharing systems in North America. The authors conducted an online survey (n =10,661 total sample), between November 2011 and January 2012, with members of four major bikesharing organizations (located in Montreal, Toronto, the Twin Cities, and Washington D.C.) and collected information regarding travel-behavior changes, focusing on modal shift, as well as public bikesharing perceptions. The survey probed member perceptions about bikesharing and found that a majority in the surveyed cities felt that bikesharing was an enhancement to public transportation and improved transit connectivity. With respect to modal shift, the results suggest that bikesharing generally draws from all travel modes. Three of the four largest cities in the study exhibited declines in bus and rail usage as a result of bikesharing. For example, 50% of respondents in Montreal reported reducing rail use, while 44% and 48% reported similar shifts in Toronto and Washington D.C., respectively. However, within those same cities, 27% to 40% of respondents reported using public transit in conjunction with bikesharing to make trips previously completed by automobile. In the Twin Cities, the dynamic was different, as 15% of respondents reported increasing rail usage versus only 3% who noted a decrease in rail use. In all cities, bikesharing resulted in a considerable decline in personal driving and taxi use, suggesting that public bikesharing is reducing urban transportation emissions, while at the same time freeing capacity of bus and rail networks within large cities
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