Limitations
There are some limitations of the study. First, the health care providers and clients were not blinded to arm allocation of clusters, which could lead to bias and error. Second, the control arm was also strengthened for diagnosis and recordkeeping (same as the intervention arm) to a level higher than routine care to ensure standardized measurements across arms. This could have caused better outcomes in control as compared to actual routine care (without any intervention) due to better measurement and recordkeeping components. This would tend to reduce the effect size detected but not affect the results.