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Scholars and practitioners advocate evidence-based decision-making (EBDM) because facts lead to beneficial outcomes. At the same time, EBDM to reduce risks in water quality is under-studied. We examine types of decision-making by water utilities and government agencies, and the nature and origin of evidence available to them in their work on delivering safe drinking water to households. Using qualitative content analysis, we comparatively analyze water utilities and government agencies in Malawi, Ecuador, and Brazil. The results show that the water utilities perform combinations of decision-making types on water quality such as implementation, intelligence-gathering, and evaluation and choice, while government agencies perform more intelligence gathering. Sources and types of information are mainly water consumers, guidelines for water quality standards, and self-monitoring from water utilities. The analysis is useful in establishing a foundation for developing evidence-based management within water supply services, and potentially other water resources management activities.

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Objectives This study examines nighttime mother-infant sleep arrangements across the first 15 months of life, identifies maternal and infant predictors of bedsharing, and tests the relationship between breastfeeding and bedsharing. Methods We used data from 428 African-American mother-infant pairs participating in the Mothers & Others Study, a home-based intervention to prevent early development of obesity. Data were collected at 28 weeks pregnancy and 3, 6, 9, 12, and 15 months postpartum. Infant sleep variables were measured using the Brief Infant Sleep Questionnaire. A multinomial mixed-effects model tested for associations between maternal and infant explanatory variables (e.g., sociodemographic variables, maternal report of infant sleep as a problem (ISP), maternal depressive symptoms (MDS), and breastfeeding duration) and infant sleep arrangement (bedsharing, room-sharing, and separate rooms). A similar, cross-lagged model simultaneously tested cross-sectional and bidirectional associations between ISP, MDS, and bedsharing, controlling for important covariates. Results The prevalence of bedsharing increased over time with 16.7% of mothers reporting bedsharing at 1 month postpartum and 35.6% at 15 months postpartum. Maternal perception of ISP and MDS were each associated with bedsharing in both cross-sectional [(RRISP: 1.90; 95% CI: 1.21–2.99), (RRMDS: 1.62; 95% CI: 1.04–2.52)] and lagged models [(RRISP: 1.82; 95% CI: 1.11–2.99), (RRMDS: 1.66; 95% CI: 1.07–2.58)]. Lagged MDS moderated the effect of lagged maternal perception of ISP, such that among mothers who had previously perceived their infants to have a sleep problem, those with prior depressive symptoms were almost six times more likely to report bedsharing at the next visit (RR: 5.56; 95% CI: 1.31–23.65), in adjusted models. Greater length of breastfeeding duration was associated with an increased likelihood of room-sharing (RR: 1.20; 95% CI: 1.06–1.36), versus bedsharing. Conclusions Our analysis shows that infant sleep location is associated with maternal depression, perception of infant sleep, and household characteristics. More research is needed to improve our understanding of the mechanisms underlying these relationships. Funding Sources The National Institute of Child Health and Human Development.