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effectiveness for community-based PLA to prevent T2DM at scale in a rural Bangladesh setting. However, we encountered several challenges in applying the stepped-wedge design to our research context, with particular consideration given to balancing seasonality, timing and number of steps and estimation of partial versus full effect. ISRCTN ISRCTN42219712 . Registered on 31 October 2019. ISRCTN ISRCTN42219712 . Registered on 31 October 2019. Hepatic fibrosis is a common complication in transfusion-dependent thalassemia p