Meals, Education, and Gardens for In-School Adolescents (MEGA) Project (MEGA)

This purpose of this study is to assess effects of a comprehensive, school-based nutrition intervention package on anemia status, anthropometric indicators, school performance/attendance, and development indicators among adolescents, and the knowledge, attitudes, and practices of nutrition, agriculture, and WASH among parents, in Tanzania.

Study Overview

• Status: Completed
• Conditions: Anemia
• Intervention / Treatment: Other: School meal, garden, education, and community workshops; Other: Garden, education, and community workshops

Detailed Description

The Meals, Education, and Gardens for In-School Adolescents (MEGA) Project aims to implement and evaluate a comprehensive, school-based nutrition intervention package among secondary schools in Dodoma, Tanzania. The intervention will include four primary components: (1) school garden, (2) school meal program, (3) agriculture, nutrition, and water, sanitation, and hygiene (WASH) education, and (4) community workshops.

This will be a cluster randomized trial with 3 arms, containing two schools each. At the beginning of the academic year, six schools will be randomized to intervention or control. Two schools will receive the full intervention package (school lunch, school garden, and education), two schools will receive the partial intervention package (school garden and education), and two schools will serve as control to receive the standard of care. Community workshops will also be provided to parents of adolescents in full and partial intervention schools.

In the full intervention schools, all adolescents will receive a midday meal, while a subset of Forms 1 or 2 adolescents will additionally participate in a school gardening program that includes nutrition, agriculture, and water, sanitation, and hygiene (WASH) education, led by selected teachers. Parents of adolescents in full intervention schools will be invited to participate in community workshops on nutrition, hygiene, and agricultural best practices, led by community Agriculture Extension Workers (AEWs).

In the partial intervention schools, Forms 1 or 2 adolescents will participate in the gardening and education components described above, but will not receive the midday meal. Parents of participating adolescents will also be invited to participate in the community workshops.

Adolescents in control schools will not receive any of these interventions but will be provided with standard of care practices at secondary schools in Dodoma. In addition, teachers in control schools will receive a hard copy of educational materials on nutrition, agriculture, and WASH to enhance their lesson plans. The intervention will take place over the course of one year.

The goal of the MEGA project is to study the effects of the integrated intervention on the nutrition and health of adolescents and their families in Tanzania. Ultimately, we aim to use the findings from this study to inform the scale-up of future school and community-based interventions to improve nutrition through training, improved crop production, and increased consumption of vegetables.

• Study Type: Interventional
• Enrollment (Actual): 1232
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Tanzania
  • Dodoma, Tanzania
    • University of Dodoma

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 17 years (Child)
• Accepts Healthy Volunteers: Yes

Description

INCLUSION CRITERIA:

Adolescents:

• Adolescents aged 14-17 years
• Enrolled in secondary school forms 1 or 2 at study initiation
• Member of one of the selected classes in a participating school
• Consent provided by the parent
• Assent provided by the adolescent
• Fluent in Swahili or English

Parents:

• Parent or guardian of participating adolescent
• Provides informed consent
• Fluent in Swahili or English

Teachers:

• Teacher facilitating the meal, garden, and/or education interventions
• Provides informed consent
• Fluent in Swahili or English

EXCLUSION CRITERIA:

Adolescents:

• No informed consent from parent/guardian or assent from adolescent

Parents:

• No informed consent

Teachers:

• No informed consent

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Full intervention; Full intervention: school meal, garden, education, and community workshops	Other: School meal, garden, education, and community workshops; School meal: midday meal provided at intervention schools School garden: garden used to grow crops (which will be used to supplement the school meal in the full intervention schools) Education: agriculture, nutrition, and water, sanitation, and hygiene (WASH) curriculum Community workshops: Led by agricultural extension workers and open to community members, the community workshops will cover nutrition messages, agricultural messages, and hands-on activities on nutrition, agriculture, and WASH.; Other Names: Full intervention package
Active Comparator: Partial intervention; Partial intervention: garden, education, and community workshops	Other: Garden, education, and community workshops; School garden: garden used to grow crops Education: agriculture, nutrition, and water, sanitation, and hygiene (WASH) curriculum Community workshops: Led by agricultural extension workers and open to community members, the community workshops will cover nutrition messages, agricultural messages, and hands-on activities on nutrition, agriculture, and WASH.; Other Names: Partial intervention package
No Intervention: Control; Control: standard of care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anemia status	Anemia status will be defined using the diagnostic criteria by the World Health Organization. Specifically, the following criteria will be used: < 12 g/dL for adolescent girls and adolescent boys aged 14 yrs and < 13 g/dL for adolescent boys aged 15-19 yrs	Up to one year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Height	Adolescent height will be measured in centimeters.	Up to one year
Weight	Adolescent weight will be measured in kilograms.	Up to one year.
BMI	Adolescent BMI (raw and BMI-for-age z-score based on the WHO adolescent growth standards).	Up to one year
Knowledge of adolescents regarding nutrition and dietary intake	Adolescents' knowledge of nutrition will be assessed by questions that evaluate their levels of nutrition-related knowledge.	Up to one year
Attitudes of adolescents regarding nutrition and dietary intake	Adolescents' attitudes of nutrition will be assessed by evaluating their preferences of food groups using Likert scales.	Up to one year
Practices of adolescents regarding nutrition and dietary intake	Nutritional and dietary practices will be assessed using a food frequency questionnaire.	Up to one year
Practices of adolescents regarding water, sanitation, and hygiene	Adolescents' practices of WASH will be assessed by questions that evaluate their WASH-related behaviors such as handwashing.	Up to one year
Educational outcomes of adolescents (school attendance)	School attendance will be measured as number of school days missed per student.	Up to one year
Educational outcomes of adolescents (School retention)	School retention will be measured as number of students who drop out of school.	Up to one year
Practices of WASH among parents	To be assessed using questions that evaluate parents' practices on water, sanitation, and hygiene.	Up to one year
Home gardening practices among parents	To be assessed using self-reported home gardening practice by parents.	Up to one year
Dietary practice among parents	To be assessed using a food frequency questionnaire among parents.	Up to one year
Nutrition knowledge among parents	To be assessed using questions that evaluate parents' knowledge on nutrition and dietary intake.	Up to one year

Collaborators and Investigators

• Sponsor: Harvard School of Public Health (HSPH)
• Collaborators: Africa Academy for Public Health; University of Dodoma

Publications and helpful links

General Publications

• Wang D, Katalambula LK, Modest AR, Young T, Ismail A, Mwanyika-Sando M, Tinkasimile A, Mosha D, Malero A, Vuai S, Fawzi WW. Meals, Education, and Gardens for In-School Adolescents (MEGA): study protocol for a cluster randomised trial of an integrated adolescent nutrition intervention in Dodoma, Tanzania. BMJ Open. 2022 Jul 7;12(7):e062085. doi: 10.1136/bmjopen-2022-062085.

Study record dates

Study Major Dates

• Study Start (Actual): January 24, 2022
• Primary Completion (Actual): September 30, 2022
• Study Completion (Actual): September 30, 2022

Study Registration Dates

• First Submitted: February 20, 2021
• First Submitted That Met QC Criteria: March 4, 2021
• First Posted (Actual): March 9, 2021

Study Record Updates

• Last Update Posted (Actual): May 3, 2023
• Last Update Submitted That Met QC Criteria: May 1, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: Anemia; Nutrition; Adolescent health; School lunch; School garden
• Additional Relevant MeSH Terms: Hematologic Diseases; Anemia
• Other Study ID Numbers: CNSG Project

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No