Strengths and Limitations
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Strengths of this study include the cluster randomized trial design, which involved a randomized and masked intervention, standardized and rigorous data collection procedures, and a low likelihood of misclassification of exposure, outcome, or other variables. In addition, the large sample size enabled examination of effect modification on mortality, which is a relatively rare event even in high-mortality settings. This study also included a population-based sample, which ensures generalizability to similar settings within the range of eligible community size. However, the study also has some limitations. MORDOR did not include communities smaller than 200 or larger than 2000 people; thus, results may not generalize beyond this range. We also used Euclidean distance to the nearest primary health center in this study as a proxy for access to a health center, whereas other methods, such as friction surfaces, may reflect travel times more accurately.