Information on sociodemographic characteristics, infant immunization status, household water and sanitation facilities, maternal hand washing, administration of worm medication and vitamin A supplements was collected in the prospective cohort study during home visits by the field doctors using a structured interviewer-administered questionnaire. Socio-economic status (SES) of the households was measured by an asset-based wealth index calculated using principal component analyses described earlier.

We applied the operational definitions used by WHO and UNICEF [15] for “improved” sources of drinking water and sanitation facilities. A drinking water source was considered “improved” when by nature of its construction or through active intervention it was protected from outside contamination, in particular with fecal matter. The household sanitary facility was considered “improved” if it consisted of a flush toilet, piped sewer system, septic tank and flush/out flush to a pit latrine. A handwashing score was created based on the number of occasions the mother in the household performed handwashing after going to the toilet, after changing a diaper, before cooking, eating, feeding her infant, and after handling raw food and trash, with a total score of seven. Maternal height, and infant length were measured using standardized techniques and calibrated equipment [10] from which infant LAZ were calculated at 6, 9, and 12 months of age using the WHO growth reference data [16]. Infant LAZ were all within the biological plausible range set by WHO Multicentre Growth Reference Study Group [16]. The proportion of mothers with height less than 145 cm was determined in view of the evidence that the offspring of mothers shorter than 145 cm have an increased risk of mortality, underweight, and stunting [17].

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