Sinharoy 2017 RWA.

Methods	Cluster RCT
Participants	Number: 10,793 children aged < 5 years at end of study (7934 HHs) (after 18.6% of children < 5 years LTFU) Inclusion criteria: all HHs with a child aged < 5 years in the study area
Interventions	Interventions, 2 arms testing 2 different versions of the CBEHPP, which used the CHC approach to promote healthy practices. Lite intervention (50 villages), baseline: 2773 HHs (4171 children aged < 5 years), end of study: 2482 HHs (3369 children aged < 5 years): lite intervention held 8 sessions on village mapping, personal hygiene, handwashing, diarrhoea, water sources, safe storage of drinking water, treatment of drinking water, and sanitation. Classic intervention (50 villages), baseline: 3013 HHs (4558 children aged < 5 years), end of study: 2729 HHs (3642 children aged < 5 years): included 20 sessions, consisting of all the lite sessions plus common diseases, skin diseases, infant care (weaning and immunization), worms and intestinal parasites, food hygiene, nutrition, food safety and food security, the model home, good parenting, respiratory disease, malaria, bilharzia, and HIV/AIDS. Facilitators had a training manual and visual aids. CHCs in villages allocated the classic intervention also had attendance cards and organized graduation ceremonies, at which participants received certificates. Both the lite and classic intervention included messages on child sanitation under the topic of sanitation (zero open defecation). The participants were mainly recommended the following: children should defecate into chamber‐pot; children faeces should be buried if there is no latrine (cat sanitation) – but always emphasize in throwing the faeces in the latrine; never let the dog or pig eat children's faeces after defecation. Control (50 villages), baseline: 2948 HHs (4523 children aged < 5 years); end of study: 2723 HHs (3782 children aged < 5 years): no intervention
Outcomes	Diarrhoea (7‐day recall) Height‐for‐age or LAZ score WHZ or weight‐for‐length Z score Colony‐forming units of thermotolerant (faecal) coliforms per 100 mL water Intermediary outcomes: improved drinking water source HH water treatment (boiling, filtration, chlorination, or solar disinfection) presence of improved sanitation facility sanitary disposal of children's (aged < 3 years) faeces: child used toilet/latrine or faeces put/rinsed into toilet/latrine/buried, child used potty/nappies and thrown in the latrine immediately after the structure of sanitation facility (presence of floors, walls, and a roof) presence of faeces (human, animal, or both) in the HH courtyard presence of a handwashing station with soap and water exclusive breastfeeding for infants aged < 6 months dietary diversity for children aged 6–23 months HH food security clinical data for diarrhoea and malaria and data for infant and child mortality (these outcomes will be reported elsewhere)
Notes	Location: 150 villages in Rusizi district, Western Rwanda Length of study: 32 months (May 2013 to December 2015) Publication status: published
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "We assessed villages for eligibility then randomly selected 150 [villages] for the study using a simple random sampling routine in STATA. We stratified villages by wealth index and by the proportion of children younger than 2 years with caregiver‐reported diarrhoea within the past 7 days. We randomly allocated these villages to three study groups: no intervention (control; n = 50), eight community health club sessions (Lite intervention; n = 50), or 20 community health club sessions (Classic intervention; n = 50)."
Allocation concealment (selection bias)	Low risk	Quote: "used Stata to randomly order the villages and divide them into three groups with approximately the same number of villages in each group."
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding.
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding and some outcomes were self‐reported.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Quote: "No difference in attrition between intervention groups."
Selective reporting (reporting bias)	Low risk	Report on outcomes specified in methods apart from clinical data for diarrhoea and malaria and data for infant and child mortality, but authors stated that these outcomes will be reported elsewhere.
Other bias	Unclear risk	—
Similarity of baseline outcome measurements	Unclear risk	—
Similarity of baseline characteristics	Unclear risk	—
Adequate allocation of intervention concealment during the study	Unclear risk	—
Adequate protection against contamination	Unclear risk	—
Confounders adequately adjusted for in analysis/design	Unclear risk	—
Recruitment bias	Low risk	Conducted baseline first then allocated villages to intervention arms.
Baseline imbalance	Low risk	Conducted stratification on average fraction of children aged < 2 years with caregiver‐reported diarrhoea in the previous 7 days; and mean wealth index.
Loss of clusters	Low risk	No loss of clusters.
Incorrect analysis	Low risk	Used generalized estimating equations to account for village‐level clustering.