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

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.

As indicated throughout case for support this proposal seeks to develop radical transdisciplinary approaches to the challenge of stunting which affects nearly 30% of children living in southern Africa. We will do this by (1) identifying inter- and trans-disciplinary partners (2) building equitable and sustainable partnerships (3) building capacity and capability through participatory research (4) developing future intervention strategies.

To achieve those 4 objectives we will be building upon, and extending an existing network in Southern Africa; by working collaboratively with our partners we will be able to realise and co-develop our impact goals: (1) improve child survival, health and potential by finding new ways of tackling undernutrition and especially stunting to help reach the Sustainable Development Goals (SDG 1,2,3,8 and 10) (2) create a network of researchers, policy makers and practitioners working on child stunting and food cultures (3) facilitate knowledge exchange and south-south and south-north learning (see case for support)

Those 3 key areas of impact throughout the project will be developed by inclusive practices, regular communication and workshops with relevant stakeholders. It is expected that early, and regular, engagement and communication will enable a reflexive and proactive approach to pathways to impact. Dialogue with, and between, all non-academic users will be facilitated through project activities where participants will be invited to contribute to better and shared understandings of effective transdisciplinary approaches to child stunting. Non-academic users will be integral to refining partnership building through inception meetings on co-creating the knowledge and practices.

In order to close the nutrition gap experienced by rural households in the immediate and longer term in countries such as Zimbabwe and others on the DAC list, we believe wide-ranging inter- and transdisciplinary approaches are necessary. Such approaches would have direct and indirect impact, including wider societal impact and benefits related to our contribution to the further development of research-related capability and capacity in this area across Southern Africa.
We anticipate that the interventions we devise would ultimately be best delivered as a single comprehensive and integrated nutrition programme, and will have a strong impact in building knowledge exchange and south-south and south-north learning.