Nutrition supplementation plus standard of care versus standard of care alone or standard of care plus unconditional cash transfer in the prevention of chronic malnutrition in Southern Angola: study protocol for the MuCCUA study, a cluster randomized controlled trial.

BACKGROUND: Chronic malnutrition is a condition associated with negative impacts on physical and cognitive development. It is multi-causal and can start very early in life, already in utero, thus it is especially challenging to find appropriate interventions to tackle it. The government of Angola is implementing a standard of care program with potential to prevent it, and the provision of cash transfers and the supplementation with small quantity lipid-based nutrients (SQ-LNS) are also promising interventions. We aimed to evaluate the impact of the standard of care program alone and of the standard of care plus a cash transfer intervention in the lineal growth of children less than 2 years old and compare it to the effectiveness of a nutrition supplementation plus standard of care program in Southern Angola. METHODS/DESIGN: The three-arm parallel cluster randomised controlled trial is set in four communes of Huila and Cunene provinces. Clusters are villages or neighbourhoods with a population around 1075 people. A total of twelve clusters were selected per arm and forty pregnant women are expected to be recruited in each cluster. Pregnant women receive the standard of care alone, or the standard of care plus unconditional cash transfer or plus nutritional supplementation during the first 1000 days, from pregnancy to the child reaching 24 months. The primary outcome is the prevalence of stunting measured as height-for-age Z-score (HAZ) < -2 in children below 2 years. Impact will be assessed at 3, 6, 12, 18 and 24 months of children's age. Secondary outcomes include mortality, morbidity, caring, hygiene and nutrition behaviours and practices, and women and children's dietary diversity. Quantitative data are also collected on women's empowerment, household food security, expenditure and relevant clinical and social events at baseline, endline and intermediate time points. DISCUSSION: The results will provide valuable information on the impact of the standard of care intervention alone as well as combined with an unconditional cash transfer intervention compared to a nutrition supplementation plus standard of care intervention, carried out during the first 1000 days, in the children´s growth up to 2 years and related outcomes in Southern Angola. TRIAL REGISTRATION: Clinical Trials NCT05571280. Registered 7 October 2022.

The catastrophic effects of groundwater intensive exploitation and Megadrought on aquifers in Central Chile: Global change impact projections in water resources based on groundwater balance modeling.

Central Chile is undergoing its most severe drought since 2010, affecting ecosystems, water supply, agriculture, and industrial uses. The government's short-term measures, such as increasing groundwater extraction (by 383 % from 1997 to 2022), are exacerbating the situation, leading to long-term hydrological deterioration. The objective of this research is to establish the main processes driving the water table depth evolution within Central Chile over the period 1979-2023. This is done by conducting groundwater balances on five major hydrological basins of Central Chile. For the Megadrought (MD) period (2010-2022), the groundwater level depths reflect not only the recharge variability but, especially, the forcing trend of groundwater withdrawals: they represent 35 % and 65 %, respectively, of the total phreatic level drawdown. This result underlines the dominant role played by groundwater withdrawals in the current delicate state of Central Chile's groundwater resources, while revealing that drought is a new complex phenomenon to deal with, in the midterm, to revert the current water resource trend in Central Chile. Our study moreover presents the impact of climate change in the basin in the framework of six different groundwater withdrawal scenarios. In the worst case (i.e., RCP8.5), the aquifer recharge decreases 18 % with respect to 1979-1997, which is the period assumed to be unaffected by the impact of MD and withdrawals. Such a reduction may be irrelevant in the dynamics of the aquifer system if the current extraction rate does not change. The estimated recovery time needed to reach aquifer conditions equal to those of the unaffected period is approximately 50 years.

Artificial recharge by means of careo channels versus natural aquifer recharge in a semi-arid, high-mountain watershed (Sierra Nevada, Spain).

The acequias de careo are ancestral water channels excavated during the early Al-Andalus period (8th-10th centuries), which are used to recharge aquifers in the watersheds of the Sierra Nevada mountain range (Southeastern Spain). The water channels are maintained by local communities, and their main function is collecting snowmelt, but also runoff from rainfall from the headwaters of river basins and distributing it throughout the upper parts of the slopes. This method of aquifer artificial recharge extends the availability of water resources in the lowlands of the river basins during the dry season when there is almost no precipitation and water demand is higher. This study investigates the contribution of the careo channels in the watershed of Bérchules concerning the total aquifer recharge during the 2014-2015 hydrological year. Several channels were gauged, and the runoff data were compared with those obtained from a semi-distributed hydrological model applied to the same hydrological basin. The natural infiltration of meteoric waters accounted for 52% of the total recharge, while the remaining 48% corresponded to water transported and infiltrated by the careo channels. In other words, the careo recharge system enhances by 92% the natural recharge to the aquifer. Our results demonstrate the importance of this ancestral and efficient channel system for recharging slope aquifers developed in hard rocks. The acequias de careo are nature-based solutions for increasing water resources availability that have contributed to a prosperous life in the Sierra Nevada. Its long history (>1200 years) suggests that the system has remarkable resilience properties, which have allowed adaptation and permance for centuries in drastically changing climatic and socioeconomic conditions. This recharge system could also be applied to -or inspire similar adaptation measures in- semi-arid mountain areas around the world where it may help in mitigating climate change effects.

Isotopic content in high mountain karst aquifers as a proxy for climate change impact in Mediterranean zones: The Port del Comte karst aquifer (SE Pyrenees, Catalonia, Spain).

The objective of this work is to characterize the impact of climate change in the karst aquifer of the Port del Comte Massif (PCM). Six regional climate models (RCMs) from CLYM'PY Project are used to analyse the magnitude and trends of changes on precipitation and temperature (RCP4.5 and RCP8.5 scenarios) and how these changes propagate through the hydrogeological system as groundwater resources availability and the associated water isotopic content. The study uses the RCMs climate change forcings as input data to a combination of (1) a semi-distributed hydrological model for simulating the hydrodynamical response of the aquifer, and (2) a lumped parameter model for simulating the isotopic content in groundwater at the outlet of the aquifer. A mean decrease of 2.6% and 1.9% in yearly precipitation and a mean increase of 1.9 and 3.1 °C in average temperature is expected in PCM at the end of the 21st century in the RCP4.5 and RCP8.5 scenarios, respectively. This climate signal entering the hydrogeological system results in a mean decrease in recharge of 3.9% and 0.5% from rainfall and of 59.3% and 76.1% from snowmelt, and a decrease of 7.6% and 4.5% in total system discharge, but also generates an isotopic enrichment in groundwater discharge (δ18OGW) of 0.50‰ and 0.84‰, respectively. Moreover, from a long-term (2010-2100) perspective, the mean trend in δ18OGW is 0.7‰/100 yr and 1.2‰/100 yr for RCP4.5 and RCP8.5, respectively, resulting in easily measurable annual lapse rates with the current analytical methods.

Evaluation of natural background levels of high mountain karst aquifers in complex hydrogeological settings. A Gaussian mixture model approach in the Port del Comte (SE, Pyrenees) case study.

The hydrogeological processes driving the hydrochemical composition of groundwater in the alpine pristine aquifer system of the Port del Comte Massif (PCM) are characterized through the multivariate statistical techniques Principal Component Analysis (PCA) and Gaussian Mixture Models (GMM) in the framework of Compositional Data (CoDa) analysis. Also, the groundwater Natural Background Levels (NBLs) for NO3 and SO4 and Cl are evaluated, which are specially important for indicating the occurrence of groundwater contamination derived from the anthropic activities conducted in the PCM. The different hydrogeochemical facies found in the aquifer system of the PCM comprises low mineralized Ca-HCO3 water for the main Eocene karst aquifer, and Ca-SO4 and highly mineralized NaCl water types in the minor aquifers discharging from the PCM. The NBL values of SO4, Cl and NO3 obtained for the main karst aquifer are 14.33, 4.06 and 6.55 mg/L, respectively. These values are 35, 3 and 1.2 times lower than the respective official NBLs values that were determined by the water administration to be compared with in the case of conducting a pollution assessment characterization in the main karst aquifer. Official overestimation of NBLs can put important groundwater resources in the PCM at risk.

Snowmelt as a determinant factor in the hydrogeological behaviour of high mountain karst aquifers: The Garcés karst system, Central Pyrenees (Spain).

Time series of environmental tracers (groundwater stable isotope composition, electrical conductivity and temperature) and concentration breakthrough curves of artificial tracers (uranine, eosine, amino-G and naphtionate) have been analyzed to characterize fast preferential and slow matrix in-transit recharge flows in the Paleocene-Eocene limestone aquifer of the Ordesa and Monte Perdido National Park, an alpine karst system drained by a water table cave, a rare hydrological feature in high mountain karst systems with similar characteristics. Snowmelt favors the areal recharge of the system. This process is reflected in the large proportion of groundwater flowing through the connected porosity structure of the karst aquifer, which amounts the 75% of the total system water discharge. From the perspective of water resources recovery, the water capacity of the fissured-porous zone (matrix) represents 99% of the total karst system storage. The volume associated to the karst conduits is very small. The estimated mean travel times are 9 days for conduits and 475 days for connected porosity. These short travel times reveal high vulnerability of the karst system to pollutants in broad sense and a great impact of climate change on the associated water resources.

Hydrogeochemical, isotopic and geophysical characterization of saline lake systems in semiarid regions: The Salada de Chiprana Lake, Northeastern Spain.

Most of the athalassic saline and hypersaline lakes are located in arid and semiarid regions where water availability drives the hydrological dynamics of the lake itself and the associated ecosystems. This is the case of the Salada de Chiprana Lake, in the Ebro River basin (Spain). It is the only athalassic permanent hypersaline lake in Western Europe, and where rare and endangered bacterial mats exist. This work presents a robust hydrogeological conceptual model for the lake system. The model evaluates the contribution of groundwater discharge to the whole water budget and explains the hydrological behaviour of the lake system. The lake behaves as a flow-through system rather than a closed basin. About 40% of total water outflow from the lake occurs as groundwater, whereas evaporation accounts for the remaining 60%. The surface water inflows are variable, but the groundwater contribution seems almost constant, amounting to 13% of the average total water inflow and contributing 1.9% of salt income. The high water salinity of the lake is controlled by evaporation, by saline water inflows from irrigation return flows, and the by groundwater outflows. The role of groundwater should be taken into account when drafting the water and land planning, once the conditions for the conservation of the algal mats are defined. A major contribution of this study is the water balance in the Salada de Chiprana Lake, which is consistent with a robust hydrogeological conceptual model defined upon scarce hydrogeological, hydrochemical and isotopic data in the local context as conditioned by the regional behaviour. The water balance is a key tool to help to correctly manage this unique athalassic saline lake, and the approach used here can be extrapolated to other similar ecosystems around the world.

Groundwater dynamics in a hydrologically-modified alpine watershed from an ancient managed recharge system (Sierra Nevada National Park, Southern Spain): Insights from hydrogeochemical and isotopic information.

In many of the alpine watersheds of Sierra Nevada (Southern Spain) exists an ancient network of dug canals that collect, transport and facilitate the recharge the snowmelt in the underlying aquifer during the spring season. This practice, known as careos, in the lower part of the watersheds supply drinking water as spring discharge during the dry season. To study how this managed recharge technique modifies the natural response of these basins this work focuses on characterizing the hydrological behavior of one of the sites, the Berchules watershed. The mechanisms for mineralization of groundwater are based on geochemical processes such as evapo-concentration in the soil layer and silicate mineral weathering due to dissolved CO2 originated from both soil biogenic processes and the atmosphere. Groundwater presents a main hydrogeochemical calcium­magnesium-bicarbonate type facies, which is associated to groundwater flowing through the upper weathered silicates and quickly drained through springs located in the uplands and in the intermediate altitude catchment zone. Additionally, in the lower part of the basin some springs discharge mineralized groundwater with a sodium-calcium-bicarbonate composition associated to regional groundwater flow. In natural conditions, this hydrogeological system behaves as a sloping aquifer, occurring recharge between 1400 and 2500 m a.s.l. The springs discharge groundwater with an isotopic content and temperature in coherence with the local rainfall isotopic and thermal atmospheric altitudinal lines. Nevertheless, once the careo recharge begins the affected springs reveal the fingerprint of the concentrated recharge system by blurring the fingerprint of both the isotopic and thermal altitudinal dependence in the springs discharge. This validates the previous conceptual model and supports average recharge values of 141 ±â€¯140 mm/yr and total average water resources of 181 ±â€¯111 mm/yr which include a 40% increase in the study period due to the effect of the acequias de careo.

Competências e dificuldades dos pais no cuidar o recém-nascido e o apoio recebido pelos enfermeiros / Parents' skills and difficulties in caring for the newborn and the support received by nurses

Enquadramento: O nascimento de um filho é um acontecimento, geralmente, desejado e marcante na vida dos pais e da família. Há integração de um novo elemento e novos papéis que exigem dos pais competências que têm que ser desenvolvidas e apoiadas. O enfermeiro especialista de saúde materna tem competências específicas no cuidar a mulher, inserida na família e comunidade, funcionando como recurso de apoio no processo de transição para parentalidade. Objetivos: Descrever as competências e principais dificuldades dos pais no cuidar o recém-nascido; relacionar as características dos pais e do recém-nascido com as competências dos pais no cuidar o recém-nascido; analisar o apoio e o contributo do enfermeiro na aquisição de competências no cuidar o recém-nascido. Método: Estudo descritivo-correlacional, em que foi aplicada a Escala de Autoperceção Materna das Competências Cuidativas Neonatais (EAPMCCN) a uma amostra de 102 pais e relativamente ao período neonatal. Resultados: Os pais auto-percecionaram as suas competências cuidativas como elevadas, em que os níveis mais elevados corresponderam às competências cognitivo-motoras. As principais dificuldades dos pais no cuidar o recém-nascido foram no âmbito da amamentação e no sono do bebé. Existiram diferenças estatisticamente significativas na autoperceção de competências cuidativas dos pais em função do número de filhos, da idade dos pais, de ser ou não profissional de saúde, da escolaridade, do peso do recém-nascido, da forma como o recém-nascido foi alimentado e de tererem ou não realizado o curso de preparação para o parto e parentalidade. Não existiram diferenças estatisticamente significativas entre a autoperceção de competências cuidativas no cuidar o recém-nascido e o contributo do enfermeiro. Os pais expressaram a necessidade de maior apoio e disponibilidade do enfermeiro, especialmente após o parto, no internamento e após a alta da maternidade. Conclusão: Existem competências que têm que ser apoiadas pelo enfermeiro que deve ter uma prática mais interventiva e individualizada, direccionada para as principais necessidades e dificuldades dos pais no cuidar o recém-nascido.

Correlation of the seasonal isotopic amplitude of precipitation with annual evaporation and altitude in alpine regions.

The time series of stable water isotope composition relative to IAEA-GNIP meteorological stations located in alpine zones are analyzed in order to study how the amplitude of the seasonal isotopic composition of precipitation (Aδ) varies along a vertical transect. A clear relationship between Aδ and local evaporation is obtained, with slopes of -0.87 ‰/100mm/yr and -7.3 ‰/100mm/yr for Aδ(18)O and Aδ(2)H, respectively. When all sampling points of the vertical transect receive the same moisture sources, then a linear relationship between Aδ and elevation is obtained, with vertical gradients of 0.16 ‰/100mm/yr and 1.46 ‰/100mm/yr forAδ(18)O and Aδ(2)H, respectively.

Isotopic and hydrogeochemical characterization of high-altitude karst aquifers in complex geological settings. The Ordesa and Monte Perdido National Park (Northern Spain) case study.

The Ordesa and Monte Perdido National Park, located in the Southern Pyrenees, constitutes the highest karst system in Western Europe. No previous studies regarding its geochemical and isotopic groundwater characterization are available in this area. This work presents the results of field and sampling campaigns carried out between July 2007 and September 2013. The groundwater presents high calcium bicarbonate contents due to the occurrence of upper Cretaceous and lower Paleocene-Eocene carbonate materials in the studied area. Other relevant processes include dissolution of anhydrite and/or gypsum and incongruent dissolution of Mg-limestone and dolomite. The water stable isotopes (δ(18)O, δ(2)H) show that the oceanic fronts from the Atlantic Ocean are responsible for the high levels of precipitation. In autumn, winter, and spring, a deuterium excess is found in the recharge water, which could be related to local atmospheric transport of low-altitude snow sublimation vapour and its later condensation on the snow surface at higher altitude, where recharge is mostly produced. The recharge zones are mainly between 2500m and 3200ma.s.l. The tritium content of the water suggests short groundwater transit times. The isotopic composition of dissolved sulphate points to the existence of regional fluxes mixed with local discharge in some of the springs. This work highlights the major role played by the altitude difference between the recharge and discharge zones in controlling the chemistry and the vertical variability of the isotopic composition in high-altitude karst aquifers.

Seawater injection barrier recharge with advanced reclaimed water at Llobregat delta aquifer (Spain).

The main aquifer of the Llobregat delta (Barcelona, Spain) has been affected by seawater intrusion since the 1960s. The Catalan Water Agency (ACA) has sponsored the construction of a positive hydraulic barrier in order to stop the progress of seawater intrusion advance due to the intensive aquifer development. The hydraulic barrier consists of 15 wells into which highly treated reclaimed water from the waste water treatment plant of the Baix Llobregat is injected. Water is subjected, prior to the distribution to the injection wells, to secondary and tertiary treatments, and later to ultrafiltration, UV disinfection without chlorination, and salinity reduction through reverse osmosis. A preliminary pilot phase of the project was started in late 2007, with highly positive results, and the second phase started in mid 2010. Hydrogeological and hydrochemical monitoring data indicate an efficient performance and aquifer improvement. The evaluation of such efficiency and operational costs has been analyzed and discussed.