For the first time, in 2013, the WHO guidelines for treating children with Severe Acute Malnutrition (SAM) included guidance on how to diagnose and treat SAM in infants aged below 6 months. The treatment guidelines for infants under 6 months focused on inpatient treatment and recommended that admitted infants with SAM be supported to re-establish exclusive breastfeeding before they can be discharged. The recommendation was based mainly on programmatic reports and a few studies that had shown that lactation failure is common among infants with SAM, and that re-establishing breastfeeding among infants being treated for SAM is possible using re-lactation techniques such as supplementary suckling. However, since none of the studies followed infants up after discharge, we still do not know i) if exclusive breastfeeding was retained after discharge; ii) if retaining exclusive breastfeeding after discharge is sufficient for nutritional recovery and iii) if additional breastfeeding support offered to mothers of discharged infants would be beneficial. The proposed study is aimed at generating important information to develop a trial to establish the effectiveness of home-based breastfeeding support to mothers of infants discharged from SAM treatment on survival and growth. The main aim of the proposed study is to i) establish the breastfeeding retention rate among infants under 6 months discharged from SAM treatment within the current strategies that are without a specific post discharge breastfeeding support; and ii) establish whether among infants retaining exclusive breastfeeding, breastmilk alone is sufficient for nutritional recovery. This information will form the baseline data from where any success of any applied intervention will be measured. Hence the findings from this study will strengthen the calculations of the sample size required to show an improvement in the outcomes due to an intervention. In addition, the study will provide insight on the acceptability and sustainability of using peer breastfeeding supporters commonly used to encourage breastfeeding in preterm neonates for infants with SAM. It will also provide information on the optimal trial follow-up strategy that could be applied successfully for this group of participants. Apart from providing information for trial development, the study findings will by themselves provide data to previously identified research gap. Within the 2013 updated WHO guidelines on management of SAM in children, http://apps.who.int/iris/bitstream/10665/95584/1/9789241506328_eng.pdf (page 66) the question of how breastfeeding is most effectively established is raised. Our study intends to optimize the WHO inpatient treatment guidelines and will in the process develop a step-by-step re-lactation protocol that would be applicable for resource poor settings. Recently, using the well developed and highly recommended Child Health and Nutrition Research Initiative (CHNRI) methodology, researchers, developmental partners and other stakeholders including UN agencies identified that research into the components of a package care for outpatient care as one of the top research priorities for infants with SAM (Angood, McGrath et al. 2015). Findings from the proposed study will provide baseline information useful in designing and testing a package for outpatient care.

This research seeks to answer the question: To what extent do education and peacebuilding interventions in the two countries promote teacher agency and capacity to build peace and reduce inequalities? The proposed study is anchored within the third of the overarching questions of this call, and aimed at understanding the conditions under which education interventions focused on teachers can promote peace, and mitigate and reduce violence with a view to identifying measures and processes that can increase the effectiveness of such programmes in conflict-affected situations. The research seeks to critically evaluate a series of programme interventions aimed at improving and enhancing the peacebuilding role of teachers through a multi-scalar, mixed method study that seeks to link the everyday practices of teachers in conflict affected contexts with the local, national and global actors and factors that shape their practices and behaviour. South Africa and Rwanda have been selected because both countries have emerged peacefully out of intense and violent conflict in the 1990s and now have two decades of postconflict experience to draw from. Secondly, they have been important sites for a range of postconflict interventions in the education sector, and in particular on teacher related interventions. Thirdly, they allow for a comparison of similar interventions across two countries which have since 1994 has put in place important policy interventions to promote peace and social cohesion which warrant close scrutiny. Fourthly, both countries enable examination of the complex interrelationship between inequality and peace and social cohesion in education. The overarching aim of the study is to identify elements of education policy interventions that have enabled teachers to become active agents of peacebuilding in postconflict countries and that may inform future interventions. These objectives will be achieved through an empirically grounded evaluation of the nature, implementation, and impact of large-scale interventions that are designed to support teachers as peace-builders in schools in postconflict contexts. We will look at specifically at interventions focusing on teachers, found in both South Africa and Rwanda, including interventions related to 1) Teacher training 2) Teacher recruitment, deployment and management 3) Teacher performance and practices 4) Curriculum and textbook reform. Research will include a political economy analysis of the context of these interventions in each country in order to critically embed the research in the local context, and will draw upon a realist evaluation approach (Pawson, 2005) which seeks to understand the underpinning programme theory of each of the interventions, as well as the challenges and outcomes. Research will also include a global mapping of peacebuilding interventions aimed at teachers, interviews and focus groups with key stakeholders in each country, and detailed classroom observations in three key sites in each country. The research is linked to, and supported by, a UNICEF 4 year $160 million Education, Peacebuilding and Advocacy Programme (2012-2016), which will ensure its relevance, influence and impact in practitioner, policy and academic domains. It will feed into debates related to the role of education in peacebuilding with the opportunity to both improve the quality of UNICEF 's and international agencies' peacebuilding and education programmes and to influence a broader United Nations debate on education's place in postconflict peacebuilding interventions. The research team comprises an internationally diverse and interdisciplinary team of experts from the UK, South Africa, and Rwanda with expertise in teacher education, peacebuilding and conflict studies. The research team will work closely with UNICEF in order to maximise, local, national and global impact and build knowledge and capacity in this important field

In every country in the world, especially poor countries, people experience ill-health because of what they eat. Not eating enough nutritious foods, and eating too many unhealthy foods means young children do not grow properly, women do not get enough vitamins and minerals, and many more people are affected by overweight and diseases like diabetes. This is often called "malnutrition" and is especially serious for young children, including babies, many of whom are not properly breastfed or receive inadequate nutrients when they are under the age of five. One country with a major malnutrition problem is South Africa. Most people in South Africa live in cities, where life is difficult for poor people. These people have long travel times to work and live in tiny houses. This makes it really difficult for them to store and prepare nutritious foods at home. As a result, they often rely on food that they can eat straight away or does not spoil, like fatty fried food and sugary snacks and drinks. Because they have so little money and time, they often feed babies watery, starchy foods without enough nutrients. Where they live and work, this food is readily available and cheap. In fact, the whole system of things that bring food into their neighbourhoods makes it easier and cheaper to create an environment around them that's full of the wrong types of food. This system is known as a "food system." This all means, too, that the many efforts the government has made in South Africa to help people eat better have not really reached their potential, efforts such as the extra money they give to poor families for their children, or programmes designed to help them feed their toddlers better. While South Africa has its own specific context, this is also the case in many other countries around the world. In our project, we want to change this. We want to see a whole system of actions that will actually work for people who live in cities. This means ensuring that existing actions to help them are better aligned with and supported by that food system, as well as designing new actions within the system that recognise the challenges in peoples' lives. We are going to provide evidence to know what this system of actions would look like. We will do this in a way that is not done very much: to actually start by listening to the people in urban settings who experience the problems we are talking about. We will talk to families who have children under the age of 5, as this is the group the evidence says needs most support, along with their mothers and other women who might have babies quite soon. We will walk with them around their neighbourhoods and find out what influences the foods they eat, and what could change that. We will talk to them about the ways the government already tries to help them and whether they know about them, or are able to respond to them. And together with them, we will design a system of actions that would actually work for them and their children. We will also talk to the government about what they can do, especially about changes further back into the entire food system, as well as in urban planning. And we will bring into a broader conversation all the people who have influenced what these people eat. Together we will work to design a system that supports children and their mothers eating foods that support their health and development. We will do this in two communities in the fourth largest province in South Africa: the Western Cape. We have chosen that place because the local government is already committed to improving food systems to address poor nutrition in their communities, and have asked us to help them identify what could effect real change. Although we will conduct this study in South Africa, it will be relevant to the region and the whole world. So we will produce reports and other materials that help other people in other cities create a more effective response to poor diets in their communities.

Between 1990 and 2014, sub-Saharan Africa saw a 23% increase in the number of children experiencing stunting, with around 58 million children under 5 affected. Many of these children also experienced wasting, and the co-occurrence of these anthropometric deficits ("multiple malnutrition", MM) entail heightened morbidity risks. At household and community level, MM can refer to the co-existence of under- and over-nutrition, a pattern observed across many low and middle income countries (LMICs), and which the 2015 and 2016 Global Nutrition Reports have noted to be "the new normal". This project focuses on MM in young children in one of the world's poorest regions, the countries of West and Central Africa (WCA). Utilising data from existing household surveys from the 24 countries of WCA, the project will conduct quantitative analyses on anthropometric and demographic data and variables to explore the prevalence and patterning of MM. It will bring together individual and household level data from the surveys (DHS, MICS), and combine this information with macro-level indicators, of national governance, of public expenditure on health and nutrition, and of food prices, to examine the underlying, intermediate and basic causes of MM, as set out in UNICEF's conceptual framework on (mal)nutrition. Malnutrition is associated with raised mortality risks, particularly in children; analysis of longitudinal survey data has shown that children experiencing multiple anthropometric deficits are 12.3 times more likely to die. Such children are likely to benefit most from nutrition and other child survival interventions (McDonald et al., 2013), as long as they can be indentified - which is not currently happening. Despite this, and the efforts and resources (national and international) which go to early child development programs in LMICs, a UNICEF/WHO/World Bank review of child malnutrition revealed that data on the prevalence and patterning of MM in young children are severely lacking, with no regional or global estimates of the number of children concurrently stunted and wasted. This knowledge gap is a real and ongoing problem for national governments and international agencies like UNICEF and the FAO. The analysis of existing household surveys, using advanced quantitative methods, will provide policy-relevant evidence on the determinants of MM for policy makers. We will also show how patterns of MM have changed over time, and identify key geographic and socio-demographic factors associated with MM. The project focuses on children under 5 years of age, since this is a crucial period of physical development, and also because anthropometric data (heights, weights) on this age group are most reliable and routinely collected in national surveys. The WCA region has some of the world's poorest countries, many with high rates of child malnutrition. These countries also face on-going challenges of food security not least with respect to unstable food production in the context of increasing desertification, political and economic instability, and violent conflict (e.g. in northern Nigeria, Niger and Mali). WCA has excellent coverage in terms of the number of countries with existing survey data, all of which contain detailed, comparable data with which to investigate drivers of disparities in MM. Importatnly, the evidence generated by this project will aid assessment of progress towards the first three Sustainable Development Goals (SDG) - of ending poverty, hunger and reducing child mortality.

WHAT IS THE PROBLEM? Caesarean section is considered a life-saving procedure for pregnant women and their babies. Yet, in low- and middle-income countries, mothers who give birth by caesarean section are 100 times more likely to die than those having the procedure in high-income countries. In these settings, caesarean sections also contribute to life-long health problems that affect the women's quality of life and their ability to safely have more children. Their babies are also at high risk of dying during or soon after caesarean section. The three main reasons for poor outcomes after caesarean section in low- and middle-income countries are: 1. Inappropriate caesarean sections (e.g. performed 'too many, too soon' or 'too little, too late') 2. Unsafe practices in performing the procedure 3. Substandard care in labour (e.g. not culminating in vaginal birth which leads to complicated caesarean sections in advanced labour). Many issues contribute to the above problems such as lack of knowledge and skills to undertake safe caesarean section (and to achieve safe vaginal births - both normal and by using instruments). In addition, attitudes towards caesarean section and use of vacuum or forceps, marginalisation of midwives, dysfunctional teamwork, a culture of blame and medico-legal concerns, influence of family members and communities in decision-making, poor communication skills between women and healthcare providers and amongst clinicians, and inability to determine why caesarean sections are performed worsen the problem. WHAT IS NEEDED? There is no single solution to the above complex problems. We need to both improve the safety of caesarean sections and ensure they are only done when needed. To do this, we will co-develop evidence-based interventions that are acceptable, equitable, sustainable and which can be adapted or scaled-up cost-effectively across settings, by collaborating with women and their support networks, healthcare providers, policymakers and other relevant stakeholders. WHAT IS OUR AIM? We propose a 5-year Programme that aims to improve mother and baby outcomes following caesarean sections in low- and middle-income countries. The Programme (C-Safe) plans to (ii) ensure caesarean sections are done for the right reasons (C-Why), (ii) improve their safety (C-Op), and (iii) promote safe and respectful care in labour resulting in vaginal births, including safe delivery with instruments (C-Non). The C-Safe intervention will be implemented using a comprehensive training Programme, empowerment of local opinion leaders (C-Safe Champions) and mothers, team-based working, and learning through audit and feedback, in four hospitals each in India and Tanzania (30,000 births). WHAT WILL WE DO? The C-Safe Programme involves four work packages that will (i) identify and bring together evidence on the effects of interventions and outcomes, (ii) rank the interventions and outcomes according to their importance to key local professionals, local maternity care users, and community members, (iii) develop the interventions with regional healthcare providers, women and policymakers on what is considered to be beneficial, acceptable, relevant, accessible and feasible and (iv) test whether the C-Safe strategy changes practices and increases uptake of the intervention by healthcare providers, as well as the number of women receiving it. We will also assess costs and views of healthcare providers, women, their family and community members on being part of it. Building academic and training capacity and capability, and involving women and their communities in all aspects of the study, are core features. WHO ARE THE TEAM MEMBERS? The team includes doctors, , midwives, experts in study design, patient and public involvement groups, trainers, policymakers. They are supported by members of the World Health Organization, UNICEF, Jhpiego, Professional associations, ELLY Charity.