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Groundwater provides a vital source of drinking water for rural communities in many parts of Africa, particularly in the dry season when there are few safe alternative sources. This paper summarises results from a study (n = 428) assessing dry season water quality, both microbiological and inorganic chemistry, in handpump equipped boreholes (HPBs) across the Ethiopia Highlands (n = 142), Malawi (n = 162) and Uganda (n = 124) using a stratified, randomised sampling design. This study seeks to examine general water quality by randomly sampling rural groundwater supplies across larger areas with different geology and climate. The majority, 72%, of HPBs surveyed provide good quality dry season drinking water as defined by WHO drinking water quality criteria. Within this overall picture, the most notable constraints were from thermotolerant coliforms (TTCs), which exceeded the WHO drinking water guideline of zero colony forming units (cfu/100 ml) in 21% of sites (range 0-626 cfu/100 ml). TTC contamination was found to have a significant and positive correlation with annual average rainfall (ρ = 0.2, p = 0.00003). Across all three countries, WHO health based chemical drinking water quality values were exceeded at 9% of sites and were found for manganese (4%), fluoride (2.6%) and nitrate (2.5%); arsenic concentrations were below the guideline value of 10 µg l −1 (range < 0.5-7 µg l −1 ). The high percentage of Mn exceedances (14% ± 5.2% >400 µg l −1 ) found in drinking water sources in Uganda challenges the decision by WHO not to formalise a health-based guideline for Mn. While the overall level of microbiological contamination from HPBs is low, results from this study strongly suggest that at a national and regional level, microbiological contamination rather than chemical contamination will provide a greater barrier to achieving targets set for improved drinking water quality under the UN-SDG 6. Efforts should be made to ensure that boreholes are properly sited and constructed effectively to reduce pathogen contamination.

Selenium (Se) is essential for human health, however, data on population Se status and agriculturenutrition-health linkages are limited in sub-Saharan Africa (SSA). The scoping review aims to identify linkages between Se in soils/crops, dietary Se intakes, and livestock and human Se status in SSA. Online databases, organisational websites and grey literature were used to identify articles. Articles were screened at title, abstract and full text levels using eligibility criteria. The search yielded 166 articles from which 112 were excluded during abstract screening and 54 full text articles were assessed for eligibility. The scoping review included 34 primary studies published between 1984 and 2021. The studies covered Se concentrations in soils (n = 7), crops (n = 9), animal tissues (n = 2), livestock (n = 3), and human Se status (n = 15). The evidence showed that soil/crop Se concentrations affected Se concentration in dietary sources, dietary Se intake and biomarkers of Se status. Soil types are a primary driver of human Se status and crop Se concentration correlates positively with biomarkers of Se dietary status. Although data sets of Se concentrations exist across the food system in SSA, there is limited evidence on linkages across the agriculture-nutrition nexus. Extensive research on Se linkages across the food chain is warranted.

Background Folate is essential for the synthesis and integrity of DNA, normal cell formation and body growth. Folate deficiency among women of reproductive age (WRA) increases the risk of poor birth outcomes including neural tube defect (NTD) affected pregnancies. Folate status is largely dependent on dietary intakes. Objectives To explore the spatial distribution of biomarkers of folate status and their association with farming systems among non-pregnant WRA in Ethiopia. Methods Serum and red blood cell (RBC) folate concentration data were derived from the Ethiopia National Micronutrient Survey of 2015. The spatial dependencies of folate concentration of WRA was investigated and its relationship with the dominant local farming system was explored. Results The median serum folate and RBC folate concentrations were 12.3 nmol L–1 and 567.3 nmol L–1, respectively. The national prevalence of folate deficiency using homocysteine concentration as metabolic indicator based on serum and RBC folate concentration was 11.6% and 5.7%, respectively. The majority of women (77.9%) had low RBC folate concentrations consistent with increased risk of NTD affected pregnancies. Folate nutrition was spatially dependent at distances of up to 300 km. A marked variability in folate concentration was observed between farming systems where greater RBC folate concentration (median 1,036 nmol L–1) was found among women from Lake Tana fish-based system while the lowest RBC folate concentration (median 386.7 nmol L–1) was observed in highlands or sorghum-chat mixed system. Conclusion The majority (78%) of WRA in Ethiopia had low folate status potentially increasing the risk of NTD affected pregnancies. These findings may help national and subnational nutrition intervention strategies to target the most affected areas in the country.

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BackgroundMicronutrient deficiencies including selenium (Se) are widespread in Malawi and potentially underlie a substantial disease burden, particularly among poorer and marginalised populations. Concentrations of Se in staple cereal crops can be increased through application of Se fertilisers – a process known as agronomic (agro-) biofortification – and this may contribute to alleviating deficiencies. The Addressing Hidden Hunger with Agronomy (AHHA) trial aims to establish the efficacy of this approach for improving Se status in rural Malawi.MethodsA double-blind, randomised, controlled trial will be conducted in a rural community in Kasungu District, Central Region, Malawi. The hypothesis is that consumption of maize flour agro-biofortified with Se will increase serum Se concentration. We will recruit 180 women of reproductive age (WRA; 20–45 years) and 180 school-aged children (SAC; 5–10 years) randomised in a 1:1 ratio to receive either maize flour enriched through agro-biofortification with Se or a control flour not enriched with Se. Households will receive flour (330 g [i]capita[/i]-1 day-1) for 12 weeks. The primary outcome is Se concentration in serum (µg L-1). Serum will be extracted from venous blood samples drawn at baseline (prior to flour distribution) and end-line. Selenium concentration will be measured using Inductively Coupled Plasma Mass Spectrometry (ICPMS).DiscussionFindings will be communicated to policy stakeholders and participating communities and reported in peer-reviewed journals. This work was supported by the Bill & Melinda Gates Foundation, Grant Number OPP1181048

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