School-based Health Programs on Children's Wellbeing in Lusaka, Zambia

Evaluating the Impact of School-based Health Programs on Children's Well-being and Academic Performance

This study evaluates the impact of a new and comprehensive school-based health program implemented in Lusaka, Zambia.

Study Overview

• Status: Completed
• Conditions: Acute Disease; Morbidity
• Intervention / Treatment: Behavioral: School Health Worker Program

Detailed Description

While school-aged children in low- and middle-income countries remain highly exposed to acute infections, programs targeting this age group remain limited in scale and scope. In this study, we evaluate the impact of a new and comprehensive primary school-based health intervention program on student health outcomes and academic performance in Lusaka, Zambia. The intervention involved the training of teachers to become school health workers and the provision of vitamin A supplementation and deworming medication on a bi-annual basis. Teachers in intervention schools were trained to deliver health lessons and to refer sick students to care. This study is designed as a prospective matched control study. Students from the seven intervention schools are matched with students from control schools.

• Study Type: Interventional
• Enrollment (Actual): 614
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Children attending one of the 14 schools in the study.

Exclusion Criteria:

• Children not attending one of the 14 schools in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; The intervention group receives a school health program that has two components: the training of selected teachers to become school Health Workers and bi-annual health screenings of all students.	Behavioral: School Health Worker Program; The intervention trains selected teachers to deliver health lessons to students, perform basic first aid, recognize common illnesses, refer student to skilled medical attention when needed. The intervention provides schools with basic medical supplies including pain relief medication, thermometers, bandages, antiseptics, and oral rehydration solution. Vitamin A supplementation and presumptive deworming medication are administered to students during biannual health screenings.
No Intervention: Control; The control group receives regular school programming.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in prevalence of acute disease	Students report on the presence of 14 systemic, genitourinary, respiratory, and gastrointestinal illnesses in the past two week. Acute illnesses are combined into a summary index of morbidity.	Baseline, 6 months, and one-year follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in weight	Calculate body mass index (BMI)-for-age z-scores using the World Health Organization AnthroPlus Software macro for Stata. Thinness and overweightness are defined respectively as: BMI-for-age below -2 SD and as BMI-for-age above 1 standard deviation.	Baseline, 6 months, and one-year follow-up
Change in height	Calculate standardized height-for-age (HAZ) z-scores using the World Health Organization AnthroPlus Software macro for Stata. Stunting was defined as HAZ below -2 standard deviation.	Baseline, 6 months, and one-year follow-up
Change in health knowledge	Calculate the percentage of correct answers on 11-question quiz on various health topics.	Baseline, 6 months, and one-year follow-up
Change in school attendance	Calculate percentage of students who missed one or more days from school in the past two weeks.	Baseline, 6 months, and one-year follow-up
Change in academic performance	Students report on their own school performance and academic performance is verified by term marks.	Baseline, 6 months, and one-year follow-up

Collaborators and Investigators

• Sponsor: Harvard School of Public Health (HSPH)
• Collaborators: Healthy Kids/Brighter Future

Publications and helpful links

General Publications

• Wei D, Brigell R, Khadka A, Perales N, Fink G. Comprehensive school-based health programs to improve child and adolescent health: Evidence from Zambia. PLoS One. 2019 May 31;14(5):e0217893. doi: 10.1371/journal.pone.0217893. eCollection 2019.

Study record dates

Study Major Dates

• Study Start (Actual): June 17, 2015
• Primary Completion (Actual): July 28, 2016
• Study Completion (Actual): July 28, 2016

Study Registration Dates

• First Submitted: July 11, 2018
• First Submitted That Met QC Criteria: July 30, 2018
• First Posted (Actual): July 31, 2018

Study Record Updates

• Last Update Posted (Actual): July 31, 2018
• Last Update Submitted That Met QC Criteria: July 30, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Keywords: Zambia; school-aged children; school-based health program; child and adolescent health
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Acute Disease
• Other Study ID Numbers: IRB15-1539

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO