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)

Factors associated with acute pesticide poisoning among farmers in Northwestern Jamaica

The safe production and marketing of food is a major step towards food security. However, many farmers put themselves at risk from pesticide poisoning during the production process. The unsafe use of pesticides is a major problem, especially in Caribbean Common Market (CARICOM) countries where the most persistent and hazardous pesticides are used by farmers with limited training. Excessive and improper use of pesticides is one of the major causes of chemical poisoning in the CARICOM area. In Jamaica, high levels of pesticide residues have been detected in surface water and aquatic life but the extent of acute pesticide poisoning among farmers has not been determined. We conducted a population survey using an interviewer-administered questionnaire among farmers in three parishes of northwestern Jamaica to determine the occurrence of pesticide poisoning and to identify factors associated with pesticide poisoning. Approximately 16% of the 359 farmers who participated reported incidents of pesticide poisoning within the last two years. Age 40-49 years (compared with 20-39 years), shorter distance from home to the farm, 20-29 years of farming experience (compared with ≤20 years), using hand-held sprayers and never wearing masks/respirator when handling pesticides were significantly associated with pesticide poisoning. Factors that were protective against pesticide poisoning included, always reading the instructions on the pesticide bag before use, using special tools for mixing and applying pesticides, and farm owned/run by a family. The majority (60%) of farmers who reported pesticide poisoning never sought medical attention for poisoning. Approximately one in six Jamaican farmers experienced symptoms of acute pesticide poisoning but the majority did not seek medical attention. The factors found to be associated with pesticide poisoning in this study indicate that implementation of specific intervention strategies and education of farmers can lead to safe handling and use of pesticides and reduction of acute pesticide poisoning among farmers

The Effects of Prolonged Water-Only Fasting and Refeeding on Markers of Cardiometabolic Risk

(1) Background: Cardiometabolic disease, including insulin resistance, hyperlipidemia, and hypertension, are major contributors to adverse health outcomes. Fasting has gained interest as a nonpharmacological therapeutic adjunct for these disorders. (2) Methods: We conducted a prospective, single-center study on the effects of prolonged water-only fasting followed by an exclusively whole-plant-food refeeding diet on accepted measures of cardiovascular risk and metabolic health. Participants were recruited from patients who had voluntarily elected to complete a water-only fast in order to improve their overall health according to an established protocol at an independent, residential medical center. Median fasting and refeed lengths were 17 and 8 days, respectively. The primary endpoint was to describe the mean glucose tolerance as indicated by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) scores at baseline, end-of-fast (EOF), and end-of-refeed (EOR) visits. Secondary endpoints were to describe the mean weight, body mass index (BMI), abdominal circumference (AC), systolic blood pressure (SBP), diastolic blood pressure (DBP), lipid panel, and high-sensitivity C-reactive protein (hsCRP) at the same time points. (3) Results: The study enrolled 48 overweight/obese non-diabetic participants, of which 26 completed the full study protocol. At the EOF visit, the median SBP, AC, low-density lipoprotein (LDL), and hsCRP were decreased and triglycerides (TG) and HOMA-IR scores were increased. Conclusion: Prolonged water-only fasting and whole-plant-food refeeding holds potential as a clinical therapy for cardiometabolic disease but increased TG and HOMA-IR values after refeeding necessitate further inquiry

PESTICIDE USE AND HUMAN HEALTH IN NORTHWESTERN JAMAICA

A number of studies have detected high levels of pesticide residues in surface water and aquatic life in Jamaica and acute pesticide poisoning is believed to be widespread there. Despite efforts by the Jamaican government to create awareness of the dangers of pesticides and adopt safe a pesticide disposal method, many farmers still display poor pesticide handling and disposal practices. The objectives of this study were to 1) describe pesticide use by farmers in northwestern Jamaica including inappropriate methods in pesticides handling and disposal, and 2) determine whether farmers’ perception of the mode of bodily entry of pesticides affects their method of disposal. Farmers in Westmoreland, St. James and Hanover were surveyed using an investigator-administered instrument. Although 96% of farmers had some form of formal education, 75% had received no training in the use of pesticides. Only about 15% thought that crop yields and quality could be maintained without the use of pesticides. Only 29% believed that pesticide use posed a health risk, while 91% thought that pesticide use was an environmental hazard. Less than 45% of farmers used safety gear (gloves, masks, goggles) in handling pesticides although 65% always used special clothing. A fair proportion of farmers burn, bury or dump unused pesticide or empty pesticide containers in the bushes. Farmers’ disposal methods were influenced by their perception of the ways that pesticides enter the human body. Thus, a large percentage of farmers in these parishes use pesticides inappropriately and are exposed to pesticides in handling. Disposal of unused pesticides and empty pesticide containers pollute the environment and most likely expose others. Measures should be taken to educate farmers, to provide protective gear at an affordable price, and to implement a clear and consistent method for collection of unused pesticide and empty pesticide containers