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Article History

Received: 19 August 2024

Accepted: 23 November 2025

First Online: 22 December 2025

Declarations

:

: The institutional review committee of Kathmandu University School of Medical Sciences/Dhulikhel Hospital (81/14), the Nepal Health Research Council (461/2016), the Brigham and Women’s Hospital institutional review board (2015P000058/BWH and 2017P000709/PHS), and Mount Sinai institutional review board (MSSM IRB-18–01091) provided human subjects approval for the study. The Boston Medical Center (H-38196) institutional review board exempted the study since the first author W. Wu had moved from Brigham and Women's Hospital to Boston Medical Center after the data collection process was already complete. At that point, only de-identified data were being used for analysis and manuscript preparation. Since the study already had approval from the Nepal Health Research Council and Brigham and Women's institutional review boards, the primary author's scope of work was not considered human subjects research that the Boston Medical Center was engaged in and was considered exempt.During enrollment into the RMNCH intervention, CHWs read the consent form and obtained verbal informed consent to enroll households and individuals into the CHW program, provide care, and use their programmatic data for research. Consent was documented electronically in CommCare. Households and individuals could choose to participate only in the care program and decline use of their data in research activities. Their data were excluded from this study. For the children who were under two years, their mothers provided verbal consent for enrollment into the care program and use of their data for research. For the qualitative interview and FGD participants, the research team member read a structured script and obtained verbal informed consent. Consent included use of de-identified quotes for publication purposes.

: Not applicable.

: All authors declare that we have no competing financial interests. NC is a PhD candidate at a private university (NYU Grossman School of Medicine) and was employed by the non-profit Possible and a private medical school (Icahn School of Medicine at Mount Sinai) when most of this work was completed. WW, SM, and DM are employed by, and WW, SM, DC, DM, and S. Sapkota are faculty members at a private medical school (Icahn School of Medicine at Mount Sinai). NC, WW, SM, DC and SH serve as advisors to the US-based non-profit organization Possible, for which they receive no compensation. S. Sapkota is employed by a Nepal-based non-governmental organization, Possible that operates with support from US-based Possible. RK, A. Tiwari, A. Thapa, VB, AB, BB, LDB, DC, SH, SK, YKBK, LBK, KRM, NM, IN, R. Paudel, S. Saud, R. Shrestha, PT, HJR were employed by the non-profit organizations Nyaya Health Nepal/Possible at the time of this work. S. Saud is employed by a government hospital of Nepal (Civil Service Hospital). R. Shrestha is a student at the School of Health and Allied Sciences, Pokhara University. IB is a board chair of Nepal-based Possible. DC is a faculty member at the University of Washington and SH is employed by the Washington State Department of Children, Youth & Families (Olympia, WA). R. Schwarz is employed at an academic medical center (Brigham and Women’s Hospital) and is a faculty member at a private medical school (Harvard Medical School) and an academic medical center (Massachusetts General Hospital). SA is a faculty member at a private medical school (NYU Grossman School of Medicine). LBK is employed by a non-profit (Medic). PT is currently a postdoctoral fellow at School of Population and Global Health, McGill University, Quebec, Canada. KRM is employed by Transcultural Psychosocial Organization Nepal (TPO Nepal). DS is employed by Possible Nepal. GNS is director of and BR is Senior Hospital Nursing Administrator Chief of the Nursing and Social Security Division under the Government of Nepal Ministry of Health and Population.