Limited evidence is available on the associations of high-quality protein and energy intake, serum transthyretin (TTR), serum amino acids and serum insulin-like growth factor-1 (IGF-1) with linear growth of young children. Data collected during the baseline of a randomized control trial involving rural Ethiopian children aged 6–35 months (n = 873) were analyzed to evaluate the associations among height/length-for-age z-scores, dietary intakes, and these biomarkers (i.e., serum level of TTR, IGF-1, tryptophan and lysine, and inflammation). The prevalence of stunting was higher for children >23 months (38%) than ≤23 months (25%). The prevalence of inflammation was 35% and of intestinal parasites 48%. Three-quarters of the children were energy deficient, and stunted children had lower daily energy intake that non-stunted children (p < 0.05). Intakes of tryptophan, protein, and energy, and serum levels of tryptophan and IGF-1 were positively correlated with the linear growth of children. Controlling for inflammation, intestinal parasites, and sociodemographic characteristics, daily tryptophan (b = 0.01, p = 0.001), protein (b = 0.01, p = 0.01) and energy (b = 0.0003, p = 0.04) intakes and serum TTR (b = 2.58, p = 0.04) and IGF-1 (b = 0.01, p = 0.003) were positively associated with linear growth of children. Linear growth failure in Ethiopian children is likely associated with low quality protein intake and inadequate energy intake. Nutrition programs that emphasize improved protein quantity and quality and energy intake may enhance the linear growth of young children and need to be further investigated in longitudinal and interventional studies.

National drinking water assessments for Bangladesh do not reflect local variability, or temporal differences. This paper reports on the findings of an interdisciplinary investigation of drinking water insecurity in a rural coastal south-western Bangladesh. Drinking water quality is assessed by comparison of locally measured concentrations to national levels and water quality criteria; resident's access to potable water and their perceptions are based on local social surveys. Residents in the study area use groundwater far less than the national average; salinity and local rainwater scarcity necessitates the use of multiple water sources throughout the year. Groundwater concentrations of arsenic and specific conductivity (SpC) were greater than surface water (pond) concentrations; there was no statistically significant seasonal difference in mean concentrations in groundwater, but there was for ponds, with arsenic higher in the dry season. Average arsenic concentrations in local water drinking were 2-4 times times the national average. All of the local groundwater samples exceeded the Bangladesh guidance for SpC, although the majority of residents surveyed did not perceive their water as having a 'bad' or 'salty' taste.

A rapidly growing literature documents that the quality of service delivery in many developing countries -particularly in health and education -is poor (Chaudhury et al. 2006, Das and Hammer 2014, Das, Holla, et al. 2016, Mohanan et al. 2015. Among the

Background: Linear growth failure is the most common form of undernutrition. Childhood stunting impairs human development and health and productivity in adulthood. Ethiopia has a high prevalence of stunting, with diets reliant on staple crops with low nutrient content. Maize is the most highly produced crop in Ethiopia. Unfortunately, conventional maize has poor protein quality due to a poor balance of essential amino acids. Quality protein maize (QPM) varieties are biofortified with these essential amino acids and, in controlled trials, improve child growth. However, evidence on the impact of QPM adoption and consumption on protein status and linear growth of children under natural circumstances is not yet available. Methods/design: A randomized controlled trial was carried out to evaluate the impact of a) nutrition-focused adoption encouragement and provision of QPM seed in small seed packs, and b) a consumption encouragement intervention primarily targeting female caregivers and encouraging earmarking and integration of QPM into diets for infants and young children. The trial (n = 1611) had three randomly assigned arms: a control group; a first intervention group receiving adoption encouragement only; and a second intervention group receiving both adoption and consumption encouragement. The primary outcomes of this study are QPM consumption, protein status, and linear growth of children, assessed using questionnaires, biological specimen collection, and anthropometry over one cycle of agricultural production and post-harvest consumption. Secondary outcomes include child stunting, acute malnutrition, underweight, total intake of utilizable protein, and caregivers' cooking and child feeding practices. Discussion: This study addresses important behavioral barriers between the development of a biofortified crop, QPM, and its impact on children's nutrition and health in a natural setting. The randomized controlled trial design, collection of data in multiple domains along hypothesized impact pathways, and assessment of nutritional status using both biomarkers and anthropometry allow greater understanding on mechanisms of impact. This trial is the first such study to be conducted with a biofortified staple crop in a natural setting and supports the Government of Ethiopia's current targets for nutrition and agriculture.

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