Limitations
diarrhoea, infection
INFECTION, HAND INFECTION
The main strengths of this study are the randomised design, the nested substudy with seasonal pre‐intervention baselines and the use of PIPs to understand the plausibility of programme effects. Several important limitations are also apparent. First, the measurement of intermediate outcomes on the PIPs, including WASH‐related knowledge and practices and child morbidity symptoms, involves subjective assessments that suffer from well‐documented measurement errors and a lack of validity testing. One reason for the higher prevalences of diarrhoea reported in the SELEVER groups could be that mothers in these groups are more aware of the definition of diarrhoea and thus report it more. However, the results from the anthropometry indicators, as well as the results of the SELEVER trial published elsewhere, are largely consistent with the null results that we report. The analysis of infection biomarkers that is currently underway as part of the SELEVER trial will provide more objective evidence on the complex biological processes linking animal husbandry, livestock‐related pathogen exposure and infection in young children. Another important limitation arises from the potential effects of the COVID‐19‐related lockdown that took place midway during the endline survey. However, the results from lean season analysis that pre‐dates the COVID‐related crises are largely consistent with the overall trial results. An additional limitation arises from the low level of intervention uptake in the study population, highlighting that these results reflect the low implementation fidelity rather than the potential effectiveness of livestock–WASH–gender interventions.