Table 1

Intervention components

ComponentDescription of the intervention components delivered in the group and combined intervention arms
Nutrition Contents: This component was adapted from the WASH-Benefits intervention.6 The nutrition component included specific recommendations for each trimester of pregnancy, recommendations for lactation and recommendations for the complementary feeding period.
 Supplements: Nutritional supplements were distributed to participants depending on age and child nutritional status as indicated by mid-upper arm circumference (MUAC).

  •  Pregnant women and caregivers of children under 6 months of age were given multiple micronutrients

  •  Children with a MUAC 11.5–12.49 cm were given small-quantity lipid-based supplements (SonaMoni)

  •  Children over 6 months with a MUAC 12.5 cm and greater were given multiple micronutrient powder (Pushtikona)

  •  Children over 6 months with a MUAC under 11.5 cm were referred to a health facility (control arm children were also referred)

WASHThis component was adapted from the WASH-Benefits intervention and included activities to coach participants to identify changes they could make in their own environments.6 Soapy water bottles were provided to all households.
LeadThis component included teaching participants about the harms of lead and encouraging changes in their household to reduce lead exposure from previously identified lead sources: turmeric and lead-soldered cans.10 36
Mental healthThis component was adapted from the thinking healthy programme.37 Through field piloting the strategies were simplified, integrated with other intervention material and incorporated behavioural activation.18
Targeted households

  •  Participants with a MUAC under 12.5 were considered at risk: 17 at-risk participants who did not have access to their own hygienic latrine at baseline received WASH infrastructure (a child potty, a handwashing station and a dual pit latrine).

  •  Pregnant women received foot measurement sticks: participants who gave birth to a child who had a foot length <7 cm received a visit from the CHW who confirmed the foot length and provided (1) a session to teach the mother to provide Kangaroo Mother Care (KMC) to the baby; and (2) gave the mother a KMC kit that included three KMC pouches, one hat and one pair of socks.

Toys and booksAll participants in sessions received low-cost picture books and toys made out of recycled materials for children over 6 months of age

  • WASH, water, sanitation and hygiene.