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)

Food Web Connectivity in a Mangrove–Seagrass–Patch Reef (MSP) Seascape: Lessons from a Tropical Back-Reef in Puerto Rico

Alterations to the functions and connectivity of mangrove–seagrass–patch reef (MSP) seascapes have the potential to impact the survival, foraging activities, and movement of reef-dependent invertebrates (e.g., crabs and shrimp) and fishes. In the current study, we examined carbon flow in the Guánica Biosphere Reserve in southwestern Puerto Rico using pigment analysis of particulate organic matter and stable isotope analysis of carbon (δ13C) and nitrogen (δ15N) in flora and fauna. Several lines of evidence pointed to N2 fixers (cyanobacteria) being important for fueling primary productivity in this oligotrophic ecosystem including low (−1) chlorophyll, prevalence of cyanobacteria based on pigment signatures, and the isotope signatures of seagrass and red mangrove leaf tissue (enriched δ15N values) and consumers (depleted δ15N values). Food web mixing models based on stable isotopes (δ13C and δ15N) revealed that multiple producers (phytoplankton, benthic microalgae, seagrasses, etc.) contributed organic matter to the consumers (zooplankton, invertebrates, and fishes) in the MSP seascape at the center of the reserve. Contribution estimates for common benthic invertebrates (crabs and shrimp) were taxon-specific, and the highest input was generally linked to particulate organic matter (POM) and benthic microalgae (BMA)/seagrass producer categories, although meaningful mangrove contribution was observed for some taxa. Similarly, contribution estimates for fishes were highest for POM and BMA/seagrass, with the latter producer category being more important for species known to migrate from mangroves or patch reefs to seagrass beds at night (bluestriped grunt, French grunt, and white grunt). Although all fish investigated were observed in mangrove prop-root habitats, input of organic matter from mangroves to these consumers was typically limited for most of the species examined. Understanding these complex seascapes contributes to our understanding of the ecology of these vital ecosystems

The Impact of Labor Market Entry Conditions on Initial Job Assignment, Human Capital Accumulation, and Wages

We estimate the effects of labor market entry conditions on wages for male individuals first entering the Austrian labor market between 1978 and 2000. We find a large negativ effect of unfavorable entry conditions on starting wages as well as a sizeable negative long-run effect. Specifically, we estimate that a one percentage point increase in the initial local unemployment rate is associated with an approximate shortfall in lifetime earnings of 6.5%. We also show that bad entry conditions are associated with lower quality of a worker's first job and that initial wage shortfalls associated with bad entry conditions only partially evaporate upon involuntary job change. These and additional findings support the view that initial job assignment, in combination with accumulation of occupation or industry-specific human capital while on this first job, plays a key role in generating the observed wage persistencies