Building trans-disciplinary partnerships for exploring the impact of population displacement on nutrition interventions in rural Zimbabwe

发育迟缓影响到南部非洲近30%的儿童，并导致人的能力下降，慢性病的长期风险增加和贫困的代际循环。我们最近进行了卫生保健婴儿营养功效（SHINE）试验，该试验表明，通过改善婴幼儿喂养（IYCF），发育迟缓可以减少20%。尽管减少幅度不大，但目前的干预措施显然不足以消除发育迟缓。因此，包括津巴布韦在内的国家不太可能实现世界卫生大会关于到2025年改善孕产妇、婴儿和幼儿营养的目标。显然需要通过跨学科合作来测试新的和更广泛的方法来解决这一棘手问题的多方面决定因素。对SHINE试验数据的分析发现，尽管进行了密集的IYCF干预，但婴儿营养摄入量仍存在巨大差距。通过提高婴儿饮食的营养质量，可以在线性生长方面取得更大的收益。因此，我们最近扩大了这种伙伴关系中研究人员的学科范围，以进一步建立研究能力和能力。已经证明，通过强化IYCF干预，线性增长可以在生命的前2年得到适度改善，我们的合作伙伴关系已经扩展到包括农业专业知识在内的后续随机对照试验。与国际玉米和小麦改良中心的农业科学家和经济学家合作，这一伙伴关系的最终目标是通过将强化的“国际玉米和小麦改良年”干预措施与旨在改善农业和畜牧业做法的可持续干预措施相结合，在近期和长期内进一步缩小农村家庭面临的营养差距。像我们这样的干预措施的长期成功取决于更好地了解这些措施所处的文化和历史背景以及预期受益者对这些措施的接受程度。参与这一伙伴关系的研究人员承认这一点，他们在与其工作所在社区密切合作方面有着良好的记录。尽管如此，在知识方面仍然存在重大差距。津巴布韦与其他南部非洲国家一样，在过去几十年中遭受了相当大的人口流离失所，涉及农村-城市、区域（如博茨瓦纳、南非、赞比亚）以及海外移民（如加拿大和联合王国）。众所周知，人口流离失所对家庭的粮食安全和相关的农业生产能力产生多重影响，此外，农村家庭的家庭结构和支助系统也受到艾滋病毒/艾滋病的破坏性后果的严重影响。对于我们这样的营养干预措施来说，重要的是儿童户主和老年人户主家庭的数量增加。人们普遍承认，儿童户主家庭特别容易受到粮食不安全的影响，而由年长亲属担任户主的家庭不太可能使作物多样化，依赖种植谷类作物和其他斯台普斯更容易受到不利天气模式的影响（随着气候变化而加剧），因为他们不太能够购买杂交种子和肥料。为了支持津巴布韦等低收入中等收入国家实现世界卫生大会关于到2025年改善孕产妇、婴幼儿营养的目标，干预措施必须考虑到人口流离失所、家庭结构变化以及与性别相关的家庭动态的交叉，这些动态可能影响家庭粮食安全和农业能力。该申请旨在通过扩展和更有效地将人文和社会科学观点融入现有的伙伴关系，并通过采取更激进的跨学科和跨学科工作方法来实现这一目标。

Stunting affects nearly 30% of children in southern Africa, and leads to reduced human capacity, increased long-term risk of chronic disease and an inter-generational cycle of poverty. We recently conducted the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, which showed that stunting can be reduced by 20% through improved infant and young child feeding (IYCF). Despite this modest reduction, it is evident that current interventions are insufficient to eliminate stunting. Countries including Zimbabwe are therefore unlikely to achieve World Health Assembly targets for improving maternal, infant and young child nutrition by 2025. There is a clear need to test new and broader approaches for stunting through interdisciplinary partnerships aimed at tackling the multi-faceted determinants of this intractable problem.Analysis of SHINE trial data has identified substantial gaps in infant nutrient intake despite an intensive IYCF intervention. Greater gains in linear growth can be achieved by enhancing the nutrient quality of infant diets. We have therefore recently broadened the disciplinary scope of researchers in this partnership to further build research capacity and capability. Having shown that linear growth can be modestly improved in the first 2 years of life with an intensive IYCF intervention, our partnership has been extended to include agricultural expertise in a follow-on randomised controlled trial. Collaborating with agricultural scientists and economists from the International Maize and Wheat Improvement Centre, the ultimate goal of this partnership is to further close the nutrient gap experienced by rural households in the immediate and longer term by integrating an enhanced 'IYCF-plus' intervention with a sustainable intervention aimed at improving agriculture and animal husbandry practices.As this call identifies, the long-term success of interventions such as ours depends on better understanding the cultural and historical contexts within which they take place as well as their reception by intended beneficiaries. This is acknowledged by the researchers involved in this partnership, who have an established track-record of working closely with the communities within which their work takes place. Despite this, important gaps in knowledge remain. Zimbabwe, like other southern African countries, has been subject to considerable population displacement in the past several decades, involving rural-urban, regional (e.g. Botswana, South Africa, Zambia) as well as overseas migration (e.g. Canada and UK). Population displacement is known to have multiple influences on household food security and relatedly agricultural production capacity.In addition, the familial structure and support systems of rural households has been significantly impacted by the devastating legacies of HIV/AIDS. Of importance to nutrition interventions such as ours is the increase in the number of child-headed and elderly-headed households. It is widely acknowledged that child-headed households are especially vulnerable to food insecurity and households headed by elderly relatives are less likely to diversify crops and rely on growing cereal crops and other staples more vulnerable to adverse weather patterns (intensified with climate change) as they are less able to procure hybrid seeds and fertilizers. In order to support LMIC countries like Zimbabwe in achieving WHA targets for improving maternal, infant and young child nutrition by 2025 it is vital that interventions take account of population displacement, changing household structures and the intersection with the gender-related and household dynamics that may shape household food security and agricultural capacity. This application seeks to achieve this by extending and more effectively integrating humanities and social science perspectives into an already existing partnership and by adopting a more radical approach to inter- and trans-disciplinary working.