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Infants need to receive care in environments that limit their exposure to pathogens. Inadequate water, sanitation, and hygiene (WASH) environments and suboptimal infection prevention and control practices in healthcare settings contribute to the burden of healthcare-associated infections, which are particularly high in low-income settings. Specific research is needed to understand infant feeding preparation in healthcare settings, a task involving multiple behaviors that can introduce pathogens and negatively impact health. To understand feeding preparation practices and potential risks, and to inform strategies for improvement, we assessed facility WASH environments and observed infant feeding preparation practices across 12 facilities in India, Malawi, and Tanzania serving newborn infants. Research was embedded within the Low Birthweight Infant Feeding Exploration (LIFE) observational cohort study, which documented feeding practices and growth patterns to inform feeding interventions. We assessed WASH-related environments and feeding policies of all 12 facilities involved in the LIFE study. Additionally, we used a guidance-informed tool to carry out 27 feeding preparation observations across 9 facilities, enabling assessment of 270 total behaviors. All facilities had ‘improved’ water and sanitation services. Only 50% had written procedures for preparing expressed breastmilk; 50% had written procedures for cleaning, drying, and storage of infant feeding implements; and 33% had written procedures for preparing infant formula. Among 270 behaviors assessed across the 27 feeding preparation observations, 46 (17.0%) practices were carried out sub-optimally, including preparers not handwashing prior to preparation, and cleaning, drying, and storing of feeding implements in ways that do not effectively prevent contamination. While further research is needed to improve assessment tools and to identify specific microbial risks of the suboptimal behaviors identified, the evidence generated is sufficient to justify investment in developing guidance and programing to strengthen infant feeding preparation practices to ensure optimal newborn health.

These are the compilation of the data collection tools used for the process and final qualitative evaluation for the Key informant interviews, In-depth Interviews, and staff survey of a PD/Hearth qualitative research project. It also includes the codebook used to analyze the dataset on NVivo version 12.0 for the Program Impact Pathway Analysis.

We demonstrated how the special synergy between a noble metal single site and neighboring oxygen vacancies provides an "ensemble reaction pool" for high hydrogen generation efficiency and carbon dioxide (CO2) selectivity of a tandem reaction: methanol steam reforming. Specifically, the hydrogen generation rate over single site Ru1/CeO2 catalyst is up to 9360 mol H2 per mol Ru per hour (579 mLH2gRu-1s-1) with 99.5% CO2 selectivity. Reaction mechanism study showed that the integration of metal single site and O vacancies facilitated the tandem reaction, which consisted of methanol dehydrogenation, water dissociation, and the subsequent water gas shift (WGS) reaction. In addition, the strength of CO adsorption and the reaction activation energy difference between methanol dehydrogenation and WGS reaction play an important role in determining the activity and CO2 selectivity. Our study paves the way for the further rational design of single site catalysts at the atomic scale. Furthermore, the development of such highly efficient and selective hydrogen evolution systems promises to deliver highly desirable economic and ecological benefits.

Additional file 1: Table S1. Percentage of sampled households with hemoglobin measurements. Table S2. Correlations of unweighted and survey-weighted estimates of key variables. Figure S2. Mean hemoglobin concentration by country and survey type (a) children and (b) women.

IDI Block official: In-depth interview guide for block officials. (DOCX 19Â kb)

IDI State official: In-depth interview guide for state level official. (DOCX 20Â kb)

Questionnaire ANM: Survey administered to Auxiliary Nurse Midwives. (DOCX 18Â kb)

IDI Block storekeeper: In-depth interview guide for block storekeepers. (DOCX 19Â kb)

IDI ANM: In-depth interview guide for Auxiliary Nurse Midwives. (DOCX 20Â kb)

IDI District official: In-depth interview guide for district officials. (DOCX 19Â kb)

IDI District storekeeper: In-depth interview guide for district storekeepers. (DOCX 21Â kb)

IDI ASHA: In-depth interview guide for Accredited Social Health Activists. (DOCX 18Â kb)

IDI AWW: In-depth interview guide for Anganwadi workers. (DOCX 18Â kb)