Open Access
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
Florence Majo
,
Cynthia M Chasokela
,
Amee R. Manges
,
Jean H. Humphrey
,
Andrew D. Jones
,
Amee Manges
,
Goldberg Mangwadu
,
John A. Maluccio
,
Mduduzi N N Mbuya
,
Lawrence H. Moulton
,
Robert Ntozini
,
Andrew J. Prendergast
,
Rebecca J. Stoltzfus
,
James M. Tielsch
,
Cynthia Chasokela
,
Ancikaria Chigumira
,
William Heylar
,
Preston Hwena
,
George Kembo
,
Florence D Majo
,
Batsirai Mutasa
,
Kuda Mutasa
,
Philippa Rambanepasi
,
Virginia Sauramba
,
Naume V. Tavengwa
,
Franne Van Der Keilen
,
Chipo Zambezi
,
Dzivaidzo Chidhanguro
,
Dorcas Chigodora
,
Joseph F Chipanga
,
Grace Gerema
,
Tawanda Magara
,
Mandava Mandava
,
Tafadzwa Mavhudzi
,
Clever Mazhanga
,
Grace Muzaradope
,
Marian T Mwapaura
,
Simon Phiri
,
Alice Tengende
,
Cynthia Banda
,
Bernard Chasekwa
,
Leah Chidamba
,
Theodore Chidawanyika
,
Elisha Chikwindi
,
Lovemore K Chingaona
,
Courage K Chiorera
,
Adlight Dandadzi
,
Margaret Govha
,
Hlanai Gumbo
,
Karen T Gwanzura
,
Sarudzai Kasaru
,
Rachel Makasi
,
Alois M Matsika
,
Diana Maunze
,
Exevia Mazarura
,
Eddington Mpofu
,
Johnson Mushonga
,
Tafadzwa E Mushore
,
Tracey Muzira
,
Netsai Nembaware
,
Sibongile Nkiwane
,
Penias Nyamwino
,
Sandra D Rukobo
,
Thompson Runodamoto
,
Shepherd Seremwe
,
Pururudzai Simango
,
Joice Tome
,
Blessing Tsenesa
,
Umali Amadu
,
Beauty Bangira
,
Daniel Chiveza
,
Priscilla Hove
,
Horaiti A Jombe
,
Didymus Kujenga
,
Lenin Madhuyu
,
Prince M Makoni
,
Naume Maramba
,
Betty Maregere
,
Ellen Marumani
,
Elisha Masakadze
,
Phathisiwe Mazula
,
Caroline Munyanyi
,
Grace Musanhu
,
Raymond C Mushanawani
,
Sibongile Mutsando
,
Felicia Nazare
,
Moses Nyarambi
,
Wellington Nzuda
,
Trylife Sigauke
,
Monica Solomon
,
Tendai Tavengwa
,
Farisai Biri
,
Misheck Chafanza
,
Cloud Chaitezvi
,
Tsundukani Chauke
,
Collen Chidzomba
,
Tawanda Dadirai
,
Clemence Fundira
,
Athanasios C Gambiza
,
Tatenda Godzongere
,
Maria Kuona
,
Tariro Mafuratidze
,
Idah Mapurisa
,
Tsitsi Mashedze
,
Nokuthula Moyo
,
Charles Musariri
,
Matambudzo Mushambadope
,
Tawanda R Mutsonziwa
,
Augustine Muzondo
,
Rudo Mwareka
,
Juleika Nyamupfukudza
,
Baven Saidi
,
Tambudzai Sakuhwehwe
,
Gerald Sikalima
,
Jenneth Tembe
,
Tapiwanashe E Chekera
,
Owen Chihombe
,
Muchaneta Chikombingo
,
Tichaona Chirinda
,
Admire Chivizhe
,
Ratidzai Hove
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Rudo Kufa
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Tatenda F Machikopa
,
Wilbert Mandaza
,
Liberty Mandongwe
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Farirai Manhiyo
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Emmanuel Manyaga
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Peter Mapuranga
,
Farai S Matimba
,
Patience Matonhodze
,
Sarah Mhuri
,
Joice Mike
,
Bekezela Ncube
,
Walter T S Nderecha
,
Munyaradzi Noah
,
Charles Nyamadzawo
,
Jonathan Penda
,
Asinje Saidi
,
Sarudzai Shonhayi
,
Clemence Simon
,
Monica Tichagwa
,
Rachael Chamakono
,
Annie Chauke
,
Andrew F Gatsi
,
Blessing Hwena
,
Hillary Jawi
,
Benjamin Kaisa
,
Sithembile Kamutanho
,
Tapiwa Kaswa
,
Paradhi Kayeruza
,
Juliet Lunga
,
Nomatter Magogo
,
Daniel Manyeruke
,
Patricia Mazani
,
Fungai Mhuriyengwe
,
Farisai Mlambo
,
Stephen Moyo
,
Tawanda Mpofu
,
Mishelle Mugava
,
Yvonne Mukungwa
,
Fungai Muroyiwa
,
Eddington Mushonga
,
Selestino Nyekete
,
Tendai Rinashe
,
Kundai Sibanda
,
Milton Chemhuru
,
Vimbai F Chikwavaire
,
Charity Chikwiriro
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Anderson Chimusoro
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Jotam Chinyama
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Gerald Gwinji
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Nokuthula Hoko Sibanda
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Rutendo Kandawasvika
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Tendai Madzimure
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Brian Maponga
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Mary Muchekeza
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Monica Muti
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Urayai Bhoroma
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Elizabeth Chafota
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Tavengwa Champion
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Stella Chazuza
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Beauty Chikwira
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Chengeto Chingozho
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Albert Furidzirai
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Andrew Gandanga
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Chipo Gukuta
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Beauty Macheche
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Norman Sibindi
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Mercy Sitotombe
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Pearson Siwawa
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Pretty Taruvinga
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Antony Tavagwisa
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Stella Timothy
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Job Ziyambe
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James A Church
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Dadirai Fundira
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Ethan Gough
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Rukundo A Kambarami
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PETER MORGAN
,
Gretel H. Pelto
,
Corinne Sheffner Rogers
,
Roslyn Thelingwani
,
Paul Turner
,
Lindiwe Zungu
,
Tariro Makadzange
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Hilda A. Mujuru
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Chandiwana Nyachowe
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Rugare Chakadai
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Gabriel Chanyau
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Mary G Makamure
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Humphrey Chiwariro
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Tambudzai Mtetwa
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Jeffrey Chikunya
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Lisbern Maguwu
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Simon Nyadundu
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Tshebukani Moyo
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Beauty Chayima
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Lucy Mvindi
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Pauline Rwenhamo
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Shamiso Muzvarwandoga
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Rumbidzai Chimukangara
,
Handrea Njovo
,
Talent Makoni
Publication type: Journal Article
Publication date: 2019-01-01
scimago Q1
wos Q1
SJR: 5.870
CiteScore: 31.8
Impact factor: 18.0
ISSN: 2214109X, 2572116X
PubMed ID:
30554749
General Medicine
Abstract
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.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.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.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.Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.
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14
|
Publishers
|
10
20
30
40
50
60
70
|
|
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Elsevier
68 publications, 18.99%
|
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|
Springer Nature
45 publications, 12.57%
|
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Cold Spring Harbor Laboratory
34 publications, 9.5%
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Wiley
30 publications, 8.38%
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American Society for Nutrition
21 publications, 5.87%
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Oxford University Press
21 publications, 5.87%
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|
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BMJ
20 publications, 5.59%
|
|
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Public Library of Science (PLoS)
18 publications, 5.03%
|
|
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MDPI
16 publications, 4.47%
|
|
|
American Chemical Society (ACS)
11 publications, 3.07%
|
|
|
American Society of Tropical Medicine and Hygiene
9 publications, 2.51%
|
|
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IWA Publishing
8 publications, 2.23%
|
|
|
SAGE
8 publications, 2.23%
|
|
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Cambridge University Press
8 publications, 2.23%
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|
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Taylor & Francis
8 publications, 2.23%
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|
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F1000 Research
5 publications, 1.4%
|
|
|
Ovid Technologies (Wolters Kluwer Health)
5 publications, 1.4%
|
|
|
Environmental Health Perspectives
4 publications, 1.12%
|
|
|
Annual Reviews
3 publications, 0.84%
|
|
|
Canadian Science Publishing
1 publication, 0.28%
|
|
|
Mary Ann Liebert
1 publication, 0.28%
|
|
|
Frontiers Media S.A.
1 publication, 0.28%
|
|
|
U.S. Agency for International Development
1 publication, 0.28%
|
|
|
eLife Sciences Publications
1 publication, 0.28%
|
|
|
Japan Society of Civil Engineers
1 publication, 0.28%
|
|
|
Proceedings of the National Academy of Sciences (PNAS)
1 publication, 0.28%
|
|
|
APESB (Associacao de Apoio a Pesquisa em Saude Bucal)
1 publication, 0.28%
|
|
|
Massachusetts Medical Society
1 publication, 0.28%
|
|
|
Institute of Electrical and Electronics Engineers (IEEE)
1 publication, 0.28%
|
|
|
10
20
30
40
50
60
70
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- We do not take into account publications without a DOI.
- Statistics recalculated weekly.
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Metrics
359
Total citations:
359
Citations from 2024:
69
(19.27%)
Cite this
GOST |
RIS |
BibTex |
MLA
Cite this
GOST
Copy
Majo F. et al. 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 // The Lancet Global Health. 2019. Vol. 7. No. 1. p. e132-e147.
GOST all authors (up to 50)
Copy
Majo F. et al. 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 // The Lancet Global Health. 2019. Vol. 7. No. 1. p. e132-e147.
Cite this
RIS
Cite this
BibTex (up to 50 authors)
Copy
@article{2019_Majo,
author = {Florence Majo and Cynthia M Chasokela and Amee R. Manges and Jean H. Humphrey and Andrew D. Jones and Amee Manges and Goldberg Mangwadu and John A. Maluccio and Mduduzi N N Mbuya and Lawrence H. Moulton and Robert Ntozini and Andrew J. Prendergast and Rebecca J. Stoltzfus and James M. Tielsch and Cynthia Chasokela and Ancikaria Chigumira and William Heylar and Preston Hwena and George Kembo and Florence D Majo and Batsirai Mutasa and Kuda Mutasa and Philippa Rambanepasi and Virginia Sauramba and Naume V. Tavengwa and Franne Van Der Keilen and Chipo Zambezi and Dzivaidzo Chidhanguro and Dorcas Chigodora and Joseph F Chipanga and Grace Gerema and Tawanda Magara and Mandava Mandava and Tafadzwa Mavhudzi and Clever Mazhanga and Grace Muzaradope and Marian T Mwapaura and Simon Phiri and Alice Tengende and Cynthia Banda and Bernard Chasekwa and Leah Chidamba and Theodore Chidawanyika and Elisha Chikwindi and Lovemore K Chingaona and Courage K Chiorera and Adlight Dandadzi and Margaret Govha and Hlanai Gumbo and Karen T Gwanzura and others},
title = {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},
journal = {The Lancet Global Health},
year = {2019},
volume = {7},
publisher = {Elsevier},
month = {jan},
url = {https://doi.org/10.1016/S2214-109X(18)30374-7},
number = {1},
pages = {e132--e147},
doi = {10.1016/S2214-109X(18)30374-7}
}
Cite this
MLA
Copy
Majo, Florence, et al. “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.” The Lancet Global Health, vol. 7, no. 1, Jan. 2019, pp. e132-e147. https://doi.org/10.1016/S2214-109X(18)30374-7.