Effectiveness of specialised nutritious food, local diet promotion and social and behaviour change communication in preventing stunting among children in Afghanistan: a mixed-method study protocol

Introduction: Stunting is a global public health challenge, resulting from chronic undernutrition that begins in utero and continues through the first 2 years of life. In Afghanistan, the burden is severe, with nearly 45% of children under five being stunted. Maternal undernutrition, suboptimal breastfeeding, inadequate complementary feeding and other risks are the major contributors towards stunting. Despite ongoing nutrition interventions, evidence on integrated and context-specific approaches in Afghanistan is scarce. This study aims to assess the effectiveness of specialised nutritious food, promotion of local diets through local nutritious seasonal foods, appropriate maternal, infant and young child feeding practices and social and behaviour change communication (SBCC) to prevent stunting among children 6–24 months and to improve nutritional status and dietary diversity among pregnant and breastfeeding women (PBW). Methods and analysis: A mixed-method observational study design will be employed, combining a prospective longitudinal cohort study, process evaluation and pre–post cross-sectional surveys. The intervention package will be implemented in two districts through health posts and community-based platforms. Lipid-based nutrient supplements for children aged 6–24 months and wheat–soya blend for PBW will be distributed monthly, along with SBCC sessions. Statistical analysis will use descriptive analysis, time-to-event analysis, generalised linear mixed models and thematic analysis for qualitative process evaluation. Expected outcomes include improved dietary diversity, reduced prevalence of stunting, underweight and wasting and enhanced weight and linear growth. Process evaluation will assess programme implementation fidelity, acceptability and dose–response relationships.