The SHINE Trial (WASH)

Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) Trial: Implementation Science and Operations Research in Zimbabwe

Early childhood undernutrition causes about one-third of all under-5-mortality, and leads to long-term cognitive deficits and lower adult economic productivity, perpetuating the problem into future generations.  Poor diet is an important cause of stunting and anemia, two major syndromes common in malnourished children.  However, the best diet interventions do not entirely prevent stunting or anemia.

SHINE Mother & Village Health WorkerThe SHINE Trial, ongoing in two rural districts of Zimbabwe, will measure the independent and combined effects of improved sanitation and hygiene (WASH) and improved infant diet on stunting and anemia among children 0-18 months old.  We will also test the hypothesis that a major cause of child undernutrition is Environmental Enteric Dysfunction (EED), a subclinical condition of the small bowel characterized by reduced surface area and increased permeability. SHINE is being conducted in an area of high HIV prevalence, and HIV status is measured in all the SHINE mothers and babies.  The district health team and a revitalized Village Health Worker network deliver SHINE interventions.

The goal of this project is to conduct a trial that informs and improves child health and nutrition programs in Zimbabwe and globally, and results in reduced stunting and anemia among children 0-18 months old. SHINE is led by the ZVITAMBO Institute for Maternal and Child Health Research in Harare, Zimbabwe.

Research Team: Rebecca Stoltzfus, Dadirai Fundira, Rukundo Kambarami Benedict

Funding: Funded by the Bill & Melinda Gates Foundation and the UK Department for International Development (DFID), with additional contributions from Wellcome Trust, National Institutes of Health, and the Swiss Development Cooperation.

Publications:

Kambarami RA, Mbuya MN, Pelletier D, Fundira D. Tevengwa NV, Stoltzfus RJ. Factors Associated with Community Health Worker Performance Differ by Task in a Multi-Tasked Setting in Rural Zimbabwe. Global Health: Science and Practice. 2016 June: 238-250.

Matare, CR, Mbuya, MN, Pelto, G, Dickin KL, Stoltzfus RJ (2015). Assessing Maternal Capabilities in the SHINE Trial: Highlighting a Hidden Link in the Causal Pathway to Child Health. Clin Infect Dis; 61 (Suppl 7).