DISCUSSION
diarrhoea, stunting
SECONDARY
Ultimately, the comprehensive package of community‐level interventions in this study failed to reduce stunting in project areas in rural Indonesia, even for the cohort with most project exposure, although the literature suggests that such a package has strong potential to do so. The comprehensive nature of the package of interventions included in the project is an important strength of this study. Among the 10 evidence‐based nutrition interventions that Bhutta et al. (In a subsequent synthesis about the experience of countries that have successfully reduced child stunting at scale, Bhutta et al. (The study had additional strengths. At $120 million, the project was expansive and represented a concerted and well‐resourced effort to reduce stunting. It reached more than 5,000 villages, trained more than 17,000 providers in IYCF and trained almost 7,000 providers in CLTS across 11 of Indonesia's 34 provinces (at the time). We were able to conduct a rigorous randomized controlled trial, albeit not with multiple intervention arms that would have allowed us to parse out the effects of different interventions. The study was also large—it included more than 780 villages and 9,000 households at endline—and spanned a range of geographies across three provinces. The study team was able to devote resources to careful anthropometric measurement, including ensuring inter‐rater reliability through extensive training and high‐quality measurement tools.The lack of impacts on stunting demonstrates that implementing a multifaceted stunting project at scale in a synchronized manner over a relatively short period can be challenging in practice. For example, the expectation was that For sanitation, the implementer experienced delays and did not meet triggering or ODF targets. Further, there may have been weaknesses in CLTS training content and/or provider capacity to implement it, given the small share of villages that became ODF compared to those that were triggered. It was unlikely that child diarrhoea would decline when open defecation rates remained so high; substantially more intensive interventions might have been required to achieve that (Null et al., The study identified positive impacts on some secondary, more proximal outcomes related to maternal and child nutrition, including the percentage of mothers consuming the recommended number of IFA pills during pregnancy, exclusive breastfeeding and meal frequency. While the study design did not enable us to disentangle the impact of specific interventions, it is plausible that they were the result of a combination of improved training for community health workers and Our findings stress that successfully implementing an integrated package of interventions to reduce child stunting—the approach emphasized by the literature—may be challenging in practice, especially in a typical programme timeframe. Project design needs to consider implementation reality along with best practice—for example, by potentially piloting implementation of multifaceted interventions to be confident that such synchronous implementation is feasible. Alternatively, project components could be phased in more gradually over a longer timeframe, which would require funders to support longer implementation timelines. Overall, even if best practice advocates for interdependent component implementation to reduce child stunting, such advocacy is unlikely to lead to the desired outcomes unless the practicalities of implementation are fully considered.