Recruitments and randomization
mother-to-child HIV transmission, deformities
Two districts (woreda) that could represent the two known agro-ecological areas of the Jimma zone were selected. Accordingly, Mana from predominantly coffee-growing districts and Seka Chekorsa from grain and crop-growing districts were selected purposively for management and logistical reasons. Then, non-adjacent clusters or kebeles (the smallest administrative units) were selected from both districts to have buffer zones. Accordingly, a total of 18 clusters (kebeles) (8 from Mana and 10 from Seka chekorsa) districts were selected. Using the randomized complete block design; the clusters (kebeles) were grouped into two blocks based on their agroecological areas (mainly coffee or grain producing). Finally, from both blocks clusters were randomly assigned to the three study arms (husband, Peers, and control). Thus, Nase, Bidaru toli, Dimtu (of Seka), Doyo toil, Gudata bula, and Lemi Lelisa clusters (kebeles) were assigned to the husband group. While, Siba bake, Buyo kechema, Meti, Bore, Bebela kosa, and Haro clusters were assigned to the peer group. Likewise, Komo hare, Gepa seden, Wakito madalu, Kamise waraba, kore Lelisa, and kenteri clusters were assigned to the control group.Regarding the sample size allocation, it was proportionally to the population size of respective districts and kebeles (clusters). To make it more clear, of a total of 348 first-trimester pregnant women enrolled at baseline, this means 144 women were from the mana district and 204 women were from the Seka-chekorsa district. Finally, a total of 336 pregnant women (116 1Peers are women volunteers of any age who have given birth at least once, can read and write, and are willing to complete the nutritional intervention program as well as support and mentor pregnant women in their respective clusters. Moreover, it is common in young children’s feeding and prevention of mother-to-child HIV transmission (PTCT) programs [Eligible study participants were identified after home to a home survey of first-trimester pregnant women using the first date of their last menstrual period. Two experienced integrated emergency surgical officers (IESO) scanned the ultrasound for each enrolled woman to confirm the pregnancy and to determine the gestational age. Then, singleton first-trimester pregnant women were included in the study. Pregnancies that were identified as non-viable or had incurable deformities were excluded from the study and referred to the nearest health facilities for management.