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)

A review of children’s participation in disaster risk reduction

Children are often excluded from disaster risk reduction (DRR) activities, yet they are one of the most vulnerable groups to disasters. As a result, they experience physical, psychological and educational vulnerabilities. There is lack of research on children’s participation in DRR and their potential value in strengthening community resilience has been largely overlooked. Therefore, this article highlights the existing research and knowledge gap in children’s participation in DRR. It highlights the existing research and knowledge gap by reviewing literature on the concept of children’s participation in DRR. The article analyses the different ways in which children’s participation in DRR has been conceptualised, and how this has influenced the way children are involved in DRR. The study will then explore the obstacles to involving children and their potential contribution in DRR

The effectiveness of community-based rehabilitation as a strategy for improving quality of life and disaster resilience for children with disability in rural Zimbabwe

The study aimed to investigate the effectiveness of the community-based rehabilitation (CBR) project in Ward 20 of Chipinge in Zimbabwe and ascertain the positive district changes in the quality of life and disaster resilience of children with disability. Effectiveness involved examining the role of the parents of children with disabilities and the general community in the CBR programme, the extent to which children living with disabilities (CWDs) have been empowered to live quality life and access basic social services and evaluate whether local resources and capacities were being utilised. Data were collected through key informant interviews, document analysis and focus group discussions. The CBR model borrows heavily from rights-based approaches to development. Its practical application is problematic because of difficulties in defining issues such as participation and the ability of developing and poor communities to generate resources for these programmes. The study found that factors that hinder the effectives of CBR programmes included continuous dependence on donor funding, lack of political will by government and local authorities to commit financial resources towards CBR implementation and unreliable referral systems for access of services for children with disability. Gaps identified include establishing appropriate context-specific strategies that suit developing countries. The government and local authorities should prioritise resource allocation for marginalised groups such as people with disabilities. Civil society should not be the major and only source of funding for CBR. Extensive consultations should be made to adapt the CBR model to the socio-economic context of developing countries. The referral system for access to services for CWDs should be strengthened

Disaster risk reduction legislations: Is there a move from events to processes?

Disaster research and scholarship is now advocating a shift from focusing on the hazard event to processes that generate vulnerability and loss of resilience to disasters. Disaster legislations are among prominent instruments that can highlight the tensions as well as challenges that are being encountered towards this change in focus. Using textual analysis, this paper presents a study that investigated whether five post-2002 disaster legislations have shifted emphasis from the hazard to the vulnerability and resilience paradigms. The five examples illustrate that while there is a slight change, at least in rhetoric, from response to a prevention focus, disaster legislations largely promote a centralised institutional framework, with inadequate resource commitments and limited participation from vulnerable communities. Consequently, while generalisations simply cannot be made without a wider analysis of many more examples from different countries, the five disaster legislations appear to re-emphasise the response focus with less attention on the processes that reduce vulnerability and enhance resilience. The conclusion is that while the rhetoric has changed, the disaster legislations have not significantly moved from the hazard to vulnerability and resilience focus suggesting that reduction of losses and damages to disasters remains a big challenge