The purpose of the comprehensive evaluation is to assess USAID supported Community Health and Nutrition (CHN) program's ability to effect change, the comprehensive evaluation will assess the effectiveness of CHN in influencing the knowledge, attitudes, practices, motivation, and support of health care providers, as well as the behavior change in pregnant and lactating women of reproductive age and their infants/young children thus supporting optimal maternal, infant and young child nutrition and health.

Breastfeeding (BF) plays an important foundation for a healthy and well-developed child, and complementary feeding (CF) builds upon this foundation. Appropriate timing and introduction of high-quality complementary foods are key to sound infant, young child feeding (IYCF) practices. There is compelling evidence that BF and CF are crucial for the growth and development of a child, and in preventing malnutrition. Given this context, the USAID-supported "Community Health and Nutrition" (CHN) is being implemented in three governorates (Amman, Karak, Zarqa) of Jordan to improve the nutritional status of pregnant and lactating women (PLW) and children under the age of two years. The program will fulfill this goal by implementing activities to support improvement in IYCF practices, increase adoption of optimal family planning practices and maternal, infant, and young child nutrition (MIYCN) practices, and by improving health care provider support for proper IYCF practices and use of modern contraceptives methods (MCMs).

The purpose of the comprehensive evaluation is to assess USAID supported Community Health and Nutrition (CHN) program's ability to effect change. The evaluation will assess the effectiveness of CHN in influencing the knowledge, attitudes, practices, motivation, and support of health care providers, as well as the behavior change in pregnant and lactating women of reproductive age and their infants/young children thus supporting optimal maternal, infant and young child nutrition and health.

The study will utilize a cluster-randomized stratified stepped wedge design with two steps and two strata (cohort I and cohort 2). The stepped wedge study design is a staggered rollout design in which treatments are introduced to clusters at different time points. This design is particularly well suited for evaluating large-scale programs, like CHN, that roll out the intervention across clusters in phases. The use of strata (stratification) ensures representation of both regional and facility-level differences across the two cohorts.

The investigators will conduct 4 repeat annual cross-sectional surveys on women of reproductive age who are pregnant or are lactating and have a child under 2 years of age. Women will be recruited in the facilities and data will be collected at 12-month intervals. They will also conduct 3 repeat annual cross-sectional surveys on service providers (health care providers and community health agents) who work at these health facilities and within districts that are targets of the CHN program.

Inclusion Criteria:

• Pregnant and Lactating women with child under 2 years:

Currently a beneficiary of CHN (except at baseline, prior to CHN implementation) Pregnant or lactating women (18-49 years) with children under the age of two years Willing to participate in the study and able to provide informed consent Currently lives within the study area

• Service providers:

Currently working in a CHN accredited social franchise facility Currently working in a maternal and child health department and actively providing services to PLWs Willing to participate in the study Received training from CHN on integrated maternal and child nutrition and healthcare services

Exclusion Criteria:

• Pregnant and Lactating Women with child under 2 years Not willing to participate or provide informed consent Not living in the study area
• Service providers No specific exclusion criteria

Jordanian Pregnant women and lactating women between 18 to 49 years who have a child under two years of age and are visiting a participating health facility targeted by the CHN program will be eligible to participate in the comprehensive evaluation.

Healthcare providers and community based agents from the participating health facility targeted by the CHN program will be eligible to participate in the service providers' evaluation

Researchers outside of Tufts requesting access to the study data will be required to enter into a data-sharing agreement (modeled after examples such as the AHRQ National Inpatient Sample http://www.ahcpr.gov/data/hcup/datause.htm.) This agreement will: (i) require requesters to protect participants' privacy and data confidentiality (and restrictions against attempting to identify study participants), (ii) prohibit the recipient from transferring the data to other users; (iii) require destruction of the data after the planned analyses are completed; (iv) require that the data be used for research purposes only; (v) requires proper acknowledgment of the data resource; and (vi) require IRB approval from the requester's institution.

publicly accessible in 2027-28

Anyone who wishes to have access to the de-identified dataset for any research purpose will have access to the data. Data will be publicly available in the United States Agency for International Development's (USAID) Development Data Library (DDL), and Tufts Research Data Management platform.URLs will be added later once the data is successfully uploaded and data-sharing URLs have been generated.