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Objective:To investigate if food security mediated the impact of a nutrition-sensitive agroecology intervention on women’s depressive symptoms.Design:We used annual longitudinal data (four time points) from a cluster-randomised effectiveness trial of a participatory nutrition-sensitive agroecology intervention, the Singida Nutrition and Agroecology Project. Structural equation modelling estimation of total, natural direct and natural indirect effects was used to investigate food security’s role in the intervention’s impact on women’s risk of probable depression (Center for Epidemiologic Studies Depression Scale > 17) across 3 years.Setting:Rural Singida, Tanzania.Participants:548 food insecure, married, smallholder women farmers with children < 1 year old at baseline.Results:At baseline, one-third of the women in each group had probable depression (Control: 32·0 %, Intervention: 31·9 %, P difference = 0·97). The intervention lowered the odds of probable depression by 43 % (OR = 0·57, 95 % CI: 0·43, 0·70). Differences in food insecurity explained approximately 10 percentage points of the effects of the intervention on odds of probable depression (OR = 0·90, 95 % CI: 0·83, 0·95).Conclusions:This is the first evidence of the strong, positive effect that lowering food insecurity has on reducing women’s depressive symptoms. Nutrition-sensitive agricultural interventions can have broader impacts than previously demonstrated, i.e. improvements in mental health; changes in food security play an important causal role in this pathway. As such, these data suggest participatory nutrition-sensitive agroecology interventions have the potential to be an accessible method of improving women’s well-being in farming communities.

Introduction Recent legislation requires public and charter schools in California to test drinking water for lead. Our objective was to describe 1) results from this testing program in the context of other available water safety data and 2) factors related to schools and water utilities associated with access to safe drinking water in schools. Methods Our study focused on a random sample of 240 California public and charter schools. We used multivariable logistic regression, accounting for clustering of tested water sources in schools, to examine school-level factors associated with failure to meet lead-testing deadlines and any history of water utility noncompliance. Results Of the 240 schools, the majority (n = 174) tested drinking water for lead. Of the schools tested, 3% (n = 6) had at least 1 sample that exceeded 15 parts per billion (ppb) (California action level) and 16% (n = 28) exceeded 5 ppb (bottled water standard). Suburban schools had lower odds of being served by noncompliant water systems (OR = 0.17; CI, 0.05-0.64; P = .009) than city schools. Compared with city schools, rural schools had the highest odds of not participating in the water testing program for lead (OR = 3.43; CI, 1.46-8.05; P = .005). Hallways and common spaces and food services areas were the most frequent school locations tested; one-third of all locations sampled could not be identified. Conclusion In our study, geography influenced access to safe drinking water in schools, including both water utility safety standards and school lead-testing practices. Considerations for improving the implementation of state lead-testing programs include establishing priority locations for sampling, precisely labeling samples, and developing well-defined testing and reporting protocols.

OBJECTIVES: Childhood vaccines and biannual vitamin A delivery by health systems are key to child health; suboptimal administration may be a result of inadequate coverage or access to health systems. There have been national programs set in Ethiopia, such as the health sector development program, to improve child health. Therefore, we sought to describe trends in infant vaccines and vitamin A in urban and rural settings in Ethiopia. We hypothesized there would be an increase over time in infants (1) receiving all basic vaccines and (2) vitamin A in the past 6 months. We also hypothesized (3) coverage would be higher in urban settings. METHODS: We used four nationally representative Demographic and Health Surveys (DHS) from Ethiopia between 2000 and 2016. The analysis comprised 11,621 infants 6–23 months old. Logistic regression models using a forward-stepwise approach were created to test these 3 hypotheses, controlling for wealth, age, sex of infant, and mother's highest education level. Interaction terms were fitted between survey year and education level, setting and education level, and setting and wealth index quintile, and tested using the Wald test. RESULTS: (1) The percentage of infants having received all basic vaccines increased from 11.1% in 2000 to 31.0% in 2016; the odds of having received these vaccines increased over time also. (2) This is not true for vitamin A, where there was no pattern in the odds of having received vitamin A between survey years. (3) Rural infants were 40% less likely to have received all basic vaccines, compared to urban infants (adjusted odds ratio (AOR): 0.60; 95% CI: 0.43, 0.83), and there was no evidence of an association between setting and receiving vitamin A (AOR: 0.81; 95% CI: 0.61, 1.09). There was strong evidence for interaction between setting and mother's highest education level, setting and wealth index quintile, and survey year and education level (all P