Secondary Outcome
SECONDARY
The secondary outcomes assessed were height-for-age z-scores, weight-for-age z-scores, weight-for-height z-scores, and stunting, which was defined as height-for-age z-scores<−2 as calculated using the 2006 World Health Organization child growth standards.At the baseline and quarterly follow-up visits in both arms, children's length and weight were measured by the trained LHVs as per standardized protocols of World Health Organization child growth standards.Endpoint assessments were conducted by trained external evaluators holding an undergraduate degree in psychology. All external evaluators were extensively trained on the standardized protocols for measuring a child's development using the ASQ-3 and physical growth (i.e., height and weight). Inter-rater reliability of external evaluators was examined before conducting the endpoint assessment. External evaluators started the endpoint assessments after meeting the threshold of acceptable inter-rater reliability at intracluster correlation>0.80. All endpoint assessments were conducted at the public health facilities in a dedicated room. LHVs requested the mothers via a call to visit the health facility at a specified date (+7 days after a child turned 24 months). Upon visiting the health facility, the mothers were oriented about the endpoint procedure and instructed using standard narrative to not disclose any information about the type of treatment received to the endpoint evaluators.During the endpoint assessment, height was measured using a height board or stadiometer mounted at a right angle between the leveled floor and against a wall. Children were weighed alone using the LAICA baby scale, and growth charts were used to record anthropometric measurements. The ASQ-3 was administered using the interview method due to the low literacy rate of mothers. To ensure standardization of question wording, if a participant had trouble understanding a question, the question was repeated for the mother. Caregiver-rated ASQ-3 was administered instead of observation based to reduce the risk of observation bias. As per our previous experience, children are often underrated in observations because they tend to underperform during the limited time frame specified for observation by an independent observer. The novelty of observation scenarios and unfamiliarity with the independent observer further hinders the observation process. Because caregivers spend the majority of their time with children and are knowledgeable about children's functioning and developmental milestones, it was perceived as the most productive mode of evaluation for children's development.