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  • (2022) Okuba, Tolesa
    Child growth failure (CGF) is associated with high morbidity which can predispose children to impaired cognitive development. Despite decades of interventions, a high level of CGF has persisted in Ethiopia. A likely key reason for this situation is the undetermined role of water, sanitation, and hygiene (WASH) on child growth. The overarching aim of this thesis was to examine the effects of WASH on child growth in Ethiopia. Data were extensively analysed from the Ethiopia Demographic and Health Survey (EDHS) from 2000 to 2016, and a systematic review was conducted for the thesis. Logistic regression models were fitted to assess the association of access to household WASH facilities with child growth outcomes. We conducted a systematic review and meta-analysis of WASH interventions, separately, and when combined with nutrition. To estimate trends of CGF, we used adjusted margins of predicted probabilities. Socioeconomic inequalities in CGF were estimated using a concentration curve and indices. Children with access to improved household WASH facilities were 33% less likely to have stunting. Non-randomized controlled trial studies (non-RCTs) showed an effect of WASH interventions alone on height-for-age (HAZ) (Mean difference (MD)= 0.14; 95% CI: 0.08 to 0.21) while RCTs did not. WASH alone of non-RCTs and RCTs that were delivered over 18 to 60 months indicated an effect on HAZ (MD = 0.04; 95% CI: 0.01 to 0.08). RCTs showed an effect on children < 2 years (MD = 0.07; 95% CI: 0.01 to 0.13). WASH combined with nutrition showed an effect on HAZ compared with no intervention (MD = 0.13; 95% CI: 0.08 to 0.17) and on weight-for-age (WAZ) (MD = 0.09; 95% CI: 0.05 to 0.13). There was evidence of a decline in levels of CGF between 2000 and 2016 in Ethiopia. In particular, there was a greater steady decline between 2005 and 2011 compared with other periods. Access to improved household WASH facilities mainly contributed to the reduction of CGF. Between 2000 and 2016, the concentration index increased from -0.072 to -0.139 for stunting, -0.088 to -0.131 for underweight and -0.015 to -0.050 for wasting. Key socioeconomic predictors of these inequalities were identified through decomposition analyses. Socioeconomic status of the household, geographic region, antenatal care (ANC), parental education and access to household WASH facilities largely contributed to the inequalities. Access to improved household WASH facilities was strongly associated with reduced odds of stunting. WASH interventions alone improved HAZ when delivered over 18 to 60 months and in the first 1000 days of a child’s life. The effect was stronger when WASH was combined with nutrition interventions. Integrated WASH with nutrition interventions may be an effective way of improving child growth outcomes. Improving identified predictors of socioeconomic status would most likely reduce inequalities in CGF.

  • (2022) Nyholm, Melissa
    The Uluru Statement from the Heart was unanimously endorsed by 250 First Nations delegates in May 2017, culminating a year’s consultation with First Nations people around Australia (Referendum Council 2017a). The Statement calls for a First Nations Voice to Parliament, a Makarrata Commission to supervise agreement-making between governments and First Nations people and truth-telling about First Nations history. These calls for Voice, Treaty and Truth were not only made to the Australian government; the statement also seeks a response from the Australian people (Referendum Council 2017b). Aboriginal and Torres Strait Islander content was mandated in Australia’s inaugural national curriculum, announced in 2008. The national curriculum resulted from increasing global economic pressures and growing federal education influence. This thesis assesses Aboriginal and Torres Strait Islander curriculum content in the context of more recent developments in Indigenous-settler relations through the Uluru Statement: how can school curriculum contribute to self-determination, sovereignty and truth-telling? The research involved two complementary parts: analysis of selected Australian curriculum policies and conversations with First Nations educators. Poststructural analysis of the Australian goals of schooling and the Aboriginal and Torres Strait Islander cross-curriculum framework considered how curriculum policies reflect and construct Indigenous-settler relations. The second component privileged the voices of six senior First Nations educators at the forefront of integrating Indigenous knowledge and culture in school and/or tertiary curriculum and research in Indigenous Studies and other disciplines. Thematic analysis synthesises the experience and advice of these First Nations educators to provide guidance for truth-telling, self-determination and sovereignty within Aboriginal and Torres Strait Islander curriculum. The research clearly points to a need for change in Aboriginal and Torres Strait Islander curriculum development. Recommendations to support truth-telling and contribute to First Nations self-determination and sovereignty through curriculum are provided for curriculum writers and policy makers. Curriculum that tells truths about Australia’s colonised history and supports First Nations self-determination and sovereignty assists all Australian students to understand the complexities of history as well as understand and appreciate the diversity, resilience and knowledges of First Nations Peoples.