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Additional file 5: Supplementary Table 4. Multivariable logistic regression analysis of factors associated with timely initiation of breastfeeding (recall of the first days of life) among children aged 0–12 months. Supplementary Table 5. Multivariable logistic regression analysis of factors associated with colostrum feeding (recall of the first days of life) among children aged 0–12 months. Supplementary Table 6. Multivariable logistic regression analysis of factors associated with no pre-lacteal feeding (recall of the first days of life) among children aged 0–12 months. Supplementary Table 7. Multivariable logistic regression analysis of factors associated with exclusive breastfeeding in past 24 hours before survey among children aged 0–5 months. Supplementary Table 8. Multivariable logistic regression analysis of factors associated with timing of the introduction of solid, semi-solid or soft foods among children aged 7–59 months. Supplementary Table 9. Multivariable logistic regression analysis of factors associated with minimum dietary diversity among children aged 7–59 months. Supplementary Table 10. Multivariable logistic regression analysis of factors associated with consumption of animal foods among children aged 7–59 months. Supplementary Table 11. Multivariable logistic regression analysis of factors associated with consumption of fruits and vegetables among children aged 7–59 months.

Additional file 2: Supplementary Table 1. A summary of indicators available from each of 6-week questionnaire and the follow-up survey sample.

Additional file 3: Supplementary Table 2. The timing of the data collection for each of the IYCF indicators and the age range.

Additional file 4: Supplementary Table 3. Definition and categorisation of potential explanatory variables used in the study.

Additional file 1: Supplementary Figure 1. Flow chart of study participants. Supplementary Figure 2. Multivariable modelling procedure. Supplementary Figure 3. Complementary feeding practices in the past 24-hours by age when children were 7 to 59 months. Supplementary Figure 4. Percentage of children aged 7 to 59 months who experienced types of learning activities with different caregivers *other adults refers to maternal and paternal grandparents. Supplementary Figure 5. Early childhood index score by gender and wealth index when children were 36 -59 months.

Cheng, Zhiqiang, Kellar, Matthew, Nagata, Norman, Bhandari, Bishnu, Manandhar, Roshan (2018): Lobate Lac Scale (Paratachardina pseudolobata Kondo and Gullan) Invades from Oahu into Neighbor Islands: Statewide Survey in Hawaii. Proceedings of the Hawaiian Entomological Society 50: 1-8, DOI: http://doi.org/10.5281/zenodo.8159629, {"references":["Bhandari, B.P., and Z. Cheng. 2018. Lobate lac scale, Paratachardina pseudolobata (Hemiptera: Keriidae), in Hawaii's urban landscape: hosts and management. International J. Tropical Insect Sci. 38(1): 71-76.","Cheng, Z., and B.P. Bhandari. 2015. Biology, management, and updated host range of the lobate lac scale (Paratachardina pseudolobata) in Hawai'i's urban landscapes. CTAHR, University of Hawaii at Manoa. www.ctahr.hawaii.edu/oc/freepubs/pdf/IP-34.pdf (accessed March 08, 2018).","Hamon, A.B., and G. Hodges. 2001. Pest alert: Lobate lac scale, Paratachardina pseudolobata Kondo & Gullan (Hemiptera: Kerriidae). Florida Department of Agriculture and Consumer Services, Division of Plant Industry. http://www.freshfromflorida. com/content/download/68152/1612623/ Pest_Alert_-_Paratachardina_pseudolo-","bata,_Lobate_lac_scale.pdf (accessed March 08, 2018).","Hawaii Department of Agriculture. 2013. Lobate lac scale Paratachardina pseudolobata Kondo and Gullan (Hemiptera: Kerriidae). New Pest Advisory, January 2013, No. 12-03. https://hdoa.hawaii.gov/pi/ files/2013/01/3-27-2013-Lobate-lac-scale- NPA.pdf (accessed March 08, 2018)","Howard, F.W., R.W. Pemberton, G.S. Hodges, B. Steinberg, D. McLean, and H. Liu. 2006. Host plant range of lobate lac scale, Paratachardina lobata, in Florida. Proc.Fl. State Hort. Soc. 119: 398-408.","Howard, F.W., R.W. Pemberton, S. Shroer, and G. Hodges. 2010. Paratachardina pseudolobata (Coccoidea: Kerriidae): Bionomics in Florida. Fl. Entomol. 93: 1-7.","Howard, F.W., and B. Steinberg. 2005. Root drenches and topical insecticide treatments for control of the lobate lac scale, Paratachardina lobata (Chamberlin). Proc. Fl. State Hort. Soc. 118: 314-318.","Kaufman, L.V., and C.H.V. Higashi. 2015. Expansion of lobate lac scale distribution into Oahu forest systems. Proc. Hawaiian Entomol. Soc. 47: 83-92.","Molet, T., and L.D. Jackson. 2015. CPHST Pest Datasheet for Paratachardina pseudolobata. USDA-APHIS-PPQ-CPHST. https://caps.ceris.purdue.edu/webfm_ send/2832 (accessed March 08, 2018).","Pemberton, R.W. 2003. Invasion of Paratachardina lobata lobata (Hemiptera: Kerriidae) in South Florida: A snapshot sample of an infestation in a residential yard. Fl. Entomol. 86(3): 373-377."]}

BACKGROUND: Undernutrition during pregnancy leads to low birthweight, poor growth and inter-generational undernutrition. We did a non-blinded cluster-randomised controlled trial in the plains districts of Dhanusha and Mahottari, Nepal to assess the impact on birthweight and weight-for-age z-scores among children aged 0-16 months of community-based participatory learning and action (PLA) women's groups, with and without food or cash transfers to pregnant women. METHODS: We randomly allocated 20 clusters per arm to four arms (average population/cluster = 6150). All consenting married women aged 10-49 years, who had not had tubal ligation and whose husbands had not had vasectomy, were monitored for missed menses. Between 29 Dec 2013 and 28 Feb 2015 we recruited 25,092 pregnant women to surveillance and interventions: PLA alone (n = 5626); PLA plus food (10 kg/month of fortified wheat-soya 'Super Cereal', n = 6884); PLA plus cash (NPR750≈US$7.5/month, n = 7272); control (existing government programmes, n = 5310). 539 PLA groups discussed and implemented strategies to improve low birthweight, nutrition in pregnancy and hand washing. Primary outcomes were birthweight within 72 hours of delivery and weight-for-age z-scores at endline (age 0-16 months). Only children born to permanent residents between 4 June 2014 and 20 June 2015 were eligible for intention to treat analyses (n = 10936), while in-migrating women and children born before interventions had been running for 16 weeks were excluded. Trial status: completed. RESULTS: In PLA plus food/cash arms, 94-97% of pregnant women attended groups and received a mean of four transfers over their pregnancies. In the PLA only arm, 49% of pregnant women attended groups. Due to unrest, the response rate for birthweight was low at 22% (n = 2087), but response rate for endline nutritional and dietary measures exceeded 83% (n = 9242). Compared to the control arm (n = 464), mean birthweight was significantly higher in the PLA plus food arm by 78·0 g (95% CI 13·9, 142·0; n = 626) and not significantly higher in PLA only and PLA plus cash arms by 28·9 g (95% CI -37·7, 95·4; n = 488) and 50·5 g (95% CI -15·0, 116·1; n = 509) respectively. Mean weight-for-age z-scores of children aged 0-16 months (average age 9 months) sampled cross-sectionally at endpoint, were not significantly different from those in the control arm (n = 2091). Differences in weight for-age z-score were as follows: PLA only -0·026 (95% CI -0·117, 0·065; n = 2095); PLA plus cash -0·045 (95% CI -0·133, 0·044; n = 2545); PLA plus food -0·033 (95% CI -0·121, 0·056; n = 2507). Amongst many secondary outcomes tested, compared with control, more institutional deliveries (OR: 1.46 95% CI 1.03, 2.06; n = 2651) and less colostrum discarding (OR:0.71 95% CI 0.54, 0.93; n = 2548) were found in the PLA plus food arm but not in PLA alone or in PLA plus cash arms. INTERPRETATION: Food supplements in pregnancy with PLA women's groups increased birthweight more than PLA plus cash or PLA alone but differences were not sustained. Nutrition interventions throughout the thousand-day period are recommended. TRIAL REGISTRATION: ISRCTN75964374.

Background Low birth weight (LBW, < 2500 g) affects one third of newborn infants in rural south Asia and compromises child survival, infant growth, educational performance and economic prospects. We aimed to assess the impact on birth weight and weight-for-age Z-score in children aged 0–16 months of a nutrition Participatory Learning and Action behaviour change strategy (PLA) for pregnant women through women’s groups, with or without unconditional transfers of food or cash to pregnant women in two districts of southern Nepal. Methods The study is a cluster randomised controlled trial (non-blinded). PLA comprises women’s groups that discuss, and form strategies about, nutrition in pregnancy, low birth weight and hygiene. Women receive up to 7 monthly transfers per pregnancy: cash is NPR 750 (~US$7) and food is 10 kg of fortified sweetened wheat-soya Super Cereal per month. The unit of randomisation is a rural village development committee (VDC) cluster (population 4000–9200, mean 6150) in southern Dhanusha or Mahottari districts. 80 VDCs are randomised to four arms using a participatory ‘tombola’ method. Twenty clusters each receive: PLA; PLA plus food; PLA plus cash; and standard care (control). Participants are (mostly Maithili-speaking) pregnant women identified from 8 weeks’ gestation onwards, and their infants (target sample size 8880 birth weights). After pregnancy verification, mothers may be followed up in early and late pregnancy, within 72 h, after 42 days and within 22 months of birth. Outcomes pertain to the individual level. Primary outcomes include birth weight within 72 h of birth and infant weight-for-age Z-score measured cross-sectionally on children born of the study. Secondary outcomes include prevalence of LBW, eating behaviour and weight during pregnancy, maternal and newborn illness, preterm delivery, miscarriage, stillbirth or neonatal mortality, infant Z-scores for length-for-age and weight-for-length, head circumference, and postnatal maternal BMI and mid-upper arm circumference. Exposure to women’s groups, food or cash transfers, home visits, and group interventions are measured. Discussion Determining the relative importance to birth weight and early childhood nutrition of adding food or cash transfers to PLA women’s groups will inform design of nutrition interventions in pregnancy. Trial registration ISRCTN75964374, 12 Jul 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1102-x) contains supplementary material, which is available to authorized users.

BACKGROUND: Recent research has highlighted the need for additional studies on the nutrition input required to stabilize growth. OBJECTIVE: Our objective was to examine the association between dietary diversity and conditional growth in children aged 0-89 mo. METHODS: We analyzed cohort data from 529 mothers and children living in a remote and food-insecure region in the mountains of Nepal. Children were aged 0-59 mo at baseline and were followed up after 9 and 29 mo. Conditional growth was calculated as the deviation from the expected height-for-age difference (HAD) trajectory based on previous measures of HAD and the pattern of growth in the population. Dietary diversity was assessed with the use of a count of the foods consumed from 7 food groups in the previous 7 d. The association between dietary diversity and conditional growth during the 2 follow-up periods (of 9 and 20 mo, respectively) was estimated with the use of ordinary least-squares regressions. RESULTS: Prevalence of stunting and absolute height deficits was very high and increased over the course of the study. At the last measurement (age range 29-89 mo), 76.5% were stunted and the mean ± SD HAD was -11.7 ± 4.6 cm. Dietary diversity was associated positively with conditional growth in the later (May 2012-December 2013) but not the earlier (July 2011-May 2012) growth period. Children's ages ranged from 0 to 59 mo in July 2011, 9 to 69 mo in May 2012, and 29 to 89 mo in December 2013. After adjustment, increasing the dietary diversity by one food group was associated with a 0.09 cm (95% CI: 0.00, 0.17 cm) increase in conditional growth in the second growth period. CONCLUSIONS: Increasing dietary diversity for children reduces the risk of stunting and improves growth after growth faltering. Future efforts should be directed at enabling families in food-insecure areas to feed their children a more diverse diet.

Background: There is a large burden of psychological distress in low and middle-income countries, and culturally relevant interventions must be developed to address it. This requires an understanding of how distress is experienced. We conducted a qualitative grounded theory study to understand how mothers experience and manage distress in Dhanusha, a low-resource setting in rural Nepal. We also explored how distressed mothers interact with their families and the wider community.Methods: Participants were identified during a cluster-randomised controlled trial in which mothers were screened for psychological distress using the 12-item General Health Questionnaire (GHQ-12). We conducted 22 semi-structured interviews with distressed mothers (GHQ-12 score ≥5) and one with a traditional healer (dhami), as well as 12 focus group discussions with community members. Data were analysed using grounded theory methods and a model was developed to explain psychological distress in this setting.Results: We found that distress was termed tension by participants and mainly described in terms of physical symptoms. Key perceived causes of distress were poor health, lack of sons, and fertility problems. Tension developed in a context of limited autonomy for women and perceived duty towards the family. Distressed mothers discussed several strategies to alleviate tension, including seeking treatment for perceived physical health problems and tension from doctors or dhamis, having repeated pregnancies until a son was delivered, manipulating social circumstances in the household, and deciding to accept their fate. Their ability to implement these strategies depended on whether they were able to negotiate with their in-laws or husbands for resources.Conclusions: Vulnerability, as a consequence of gender and social disadvantage, manifests as psychological distress among mothers in Dhanusha. Screening tools incorporating physical symptoms of tension should be envisaged, along with interventions to address gender inequity, support marital relationships, and improve access to perinatal healthcare.