Effect of Hygiene and Menstrual Hygiene Interventions on Learning and Psychosocial Wellbeing in Madagascar (KILONGA2)
Disentangling the Effects of Infrastructure, Sensitization, and Sanitary Pad Distribution on Health, Learning, and Psychosocial Wellbeing Among Adolescent Girls in Rural Madagascar: A Cluster-Randomized Trial
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
140 secondary schools were randomly assigned to one of four arms: (1) control, (2) infrastructure only, (3) sensitization + free sanitary pads, or (4) the full combined package. Outcomes are assessed via girls' surveys, teacher/director surveys, and school-level surveys at baseline (Oct 2024), midline, and endline.
This registration draws on two overlapping analytic samples. The first is the full 140-school evaluation sample (35 schools/arm; approximately 3,080 girls, ~22/school), used for the cognitive/academic composite, self-reported psychosocial well-being (GAD-7, PHQ-9), and health outcomes that do not require biospecimen collection or laboratory processing - self-reported infectious disease symptoms, mid-upper-arm circumference (MUAC), and self-reported urinary tract infection. These are collected during the social-science endline survey (May-June 2026), concurrent with the parent trial's learning and psychosocial data collection. The second is a 80-school biomarker subsample (approximately 20 schools/arm; ~1,360 girls, ~17/school), used specifically for salivary cortisol and blood-based C-reactive protein (CRP) drawn from a venipuncture. These outcomes require biospecimen collection, cold-chain transport, and laboratory assay, and are therefore restricted to the subset of schools logistically accessible for that purpose. They are collected at a separate endline health/biomarker visit at a Basic Health Center (July-August 2026, ~19 months post-baseline).
This registration covers the biomarker outcomes component of the trial, with data collection and analysis completing by approximately December 2026; the broader parent Kilonga 2 trial (registered with the AEA RCT Registry, AEARCTR-0014423) has a longer overall completion date of December 2027, covering the full set of learning and psychosocial endpoints. The biospecimen collection protocol includes additional biomarkers, cortisol and C-reactive protein, as registered secondary outcomes.
This trial was registered with ClinicalTrials.gov retrospectively, after participant enrollment had already begun. At inception (October 2024), the study was designed and IRB-approved (Paris School of Economics IRB #2024-046, approved September 17, 2024) as a social science evaluation focused on learning outcomes, and was prospectively registered with the AEA RCT Registry (AEARCTR-0014423) on September 23, 2024. Registration with ClinicalTrials.gov was initiated upon expanding the study to include health-related biomarker secondary endpoints, in order to comply with ICMJE requirements for biomedical journal publication. The Pre-Analysis Plan covering these health endpoints will be timestamped on the Open Science Framework prior to the start of health data collection in July 2026.
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Non applicabile
Contatti e Sedi
Luoghi di studio
-
-
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Antananarivo, Madagascar
- Laboratoire d'Analyses Médicales Malagasy
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-
Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
- Bambino
- Adulto
Accetta volontari sani
Descrizione
Inclusion Criteria:
- Girl identified in the Kilonga 2 evaluation sample (randomly selected during the December 2024-January 2025 baseline from class registers across the 140 participating schools); participants were 11-20 years old at baseline enrollment and are approximately 12-21 years old at the time of endline/health-outcomes data collection (May-August 2026)
- Full evaluation sample (n~3,080; ~22 girls/school): all girls in the Kilonga 2 sample across the 140 schools are eligible for the cognitive, self-reported psychosocial, and non-biospecimen health outcomes, collected at the social-science endline.
- Biomarker subsample (n~1,360; ~17 girls/school): girls attending one of the 80 schools selected for the health biomarker subsample (logistically accessible for biospecimen collection and cold-chain maintenance) are additionally eligible for salivary cortisol and blood-based C-reactive protein outcomes.
- Informed consent obtained from parent/legal guardian, and assent obtained from the participant herself
Exclusion Criteria:
- Adolescents not meeting the inclusion criteria above
- Adolescents (or their parent/legal guardian) who refuse to participate or who withdraw consent/assent at any time
- Adolescents for whom sample collection is judged impossible or contraindicated at the time of collection (e.g., health status precluding collection)
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Prevenzione
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione fattoriale
- Mascheramento: Separare
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Nessun intervento: Controllo
Nessun intervento
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Sperimentale: School infrastructure only
Construction of latrines and handwashing basins
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Construction of latrines and handwashing basins
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Sperimentale: Peer leadership/sensitization + sanitary pads
Young Girl Leaders program, teacher sensitization, WASH competition, free sanitary pad vouchers
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Young Girl Leaders program, teacher sensitization, WASH competition, free sanitary pad vouchers
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Sperimentale: Full package
Combination of all interventions: Construction of latrines and handwashing basins and Peer leadership/sensitization + sanitary pads
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Construction of latrines and handwashing basins
Young Girl Leaders program, teacher sensitization, WASH competition, free sanitary pad vouchers
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Learning - Academic Test Scores
Lasso di tempo: Up to 19 months
|
Standardized math/literacy test scores and official school grades (140-school full evaluation sample and 80-school biomarker subsample)
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Up to 19 months
|
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Learning - School Grades
Lasso di tempo: Up to 19 months
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Official school grades (140-school full evaluation sample and and 80-school biomarker subsample)
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Up to 19 months
|
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Psychosocial Wellbeing - Heart Rate
Lasso di tempo: Up to 19 months
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Objective stress measure: heart rate, beats per minute (140-school full evaluation sample and 80-school biomarker subsample)
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Up to 19 months
|
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Psychosocial Wellbeing - Blood Pressure
Lasso di tempo: Up to 19 months
|
Objective stress measure: systolic/diastolic blood pressure, mmHg (140-school full evaluation sample and 80-school biomarker subsample)
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Up to 19 months
|
|
Psychosocial Wellbeing - Salivary Cortisol Reactivity
Lasso di tempo: Up to 19 months
|
Salivary cortisol reactivity (80-school biomarker subsample).
Cortisol reactivity, calculated as the area under the curve with respect to increase (AUCi), based on samples collected at clinic arrival (baseline), 5-8 minutes pre-venipuncture, and 20 minutes post-venipuncture.
AUCi is calculated using the trapezoidal method: the area under the curve with respect to ground (AUCg) is first calculated by summing the areas of the trapezoids formed between each pair of consecutive cortisol values and their corresponding time interval, then subtracting the area under the baseline value across the total sampling duration.
This is expressed as AUCg = Σ[(Ci + Ci+1)/2 × Ti], where Ci is the cortisol concentration at a given timepoint, Ci+1 is the concentration at the subsequent timepoint, and Ti is the time interval between them.
AUCi = AUCg - (baseline cortisol × total sampling duration).
Reported in µg/dL×min.
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Up to 19 months
|
|
Menstrual stigma
Lasso di tempo: Up to 17 months
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Self-reported menstrual stigma (140-school full evaluation sample)
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Up to 17 months
|
Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Hygiene Knowledge
Lasso di tempo: Up to 17 months
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Self-reported hygiene knowledge (140-school full evaluation sample)
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Up to 17 months
|
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Hygiene Behavior
Lasso di tempo: Up to 17 months
|
Self-reported hygiene behavior (140-school full evaluation sample)
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Up to 17 months
|
|
Menstrual Knowledge
Lasso di tempo: Up to 17 months
|
Self-reported menstrual hygiene knowledge (140-school full evaluation sample)
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Up to 17 months
|
|
Menstrual Behavior
Lasso di tempo: Up to 17 months
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Self-reported menstrual hygiene behavior (140-school full evaluation sample)
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Up to 17 months
|
|
Student/Teacher Motivation
Lasso di tempo: Up to 17 months
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Self-reported student/teacher motivation (140-school full evaluation sample)
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Up to 17 months
|
|
Network Integration
Lasso di tempo: Up to 17 months
|
Self-reported social network integration (140-school full evaluation sample)
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Up to 17 months
|
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Bullying
Lasso di tempo: Up to 17 months
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Self-reported bullying (140-school full evaluation sample)
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Up to 17 months
|
|
Self-reported Psychosocial Wellbeing
Lasso di tempo: Up to 19 months
|
Self-reported psychosocial wellbeing (140-school full evaluation sample and 80-school biomarker subsample)
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Up to 19 months
|
|
Information Diffusion
Lasso di tempo: Up to 17 months
|
Self-reported exposure to hygiene/menstruation discussions (140-school full evaluation sample)
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Up to 17 months
|
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School Attendance
Lasso di tempo: Up to 17 months
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Official school attendance records (140-school full evaluation sample)
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Up to 17 months
|
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School History
Lasso di tempo: Up to 17 months
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Official school records of dropout/withdrawal status and grade repetition (140-school full evaluation sample)
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Up to 17 months
|
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Sexual Activity
Lasso di tempo: Up to 17 months
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Self-reported early sexual activity (140-school full evaluation sample)
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Up to 17 months
|
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Pregnancy
Lasso di tempo: Up to 19 months
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Self-reported pregnancy (140-school full evaluation sample and 80-school biomarker subsample)
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Up to 19 months
|
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Health - Infectious Disease Symptoms
Lasso di tempo: Up to 19 months
|
Self-reported infectious disease symptoms (140-school full evaluation sample and 80-school biomarker subsample)
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Up to 19 months
|
|
Health - Mid-Upper-Arm Circumference (MUAC)
Lasso di tempo: Up to 19 months
|
MUAC, cm (140-school full evaluation sample and 80-school biomarker subsample)
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Up to 19 months
|
|
Health - Urinary Tract Infection
Lasso di tempo: Up to 19 months
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Self-reported urinary tract infection (140-school full evaluation sample and 80-school biomarker subsample)
|
Up to 19 months
|
|
Health - C-Reactive Protein
Lasso di tempo: Up to 19 months
|
Blood-based C-reactive protein, mg/L (80-school biomarker subsample)
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Up to 19 months
|
Collaboratori e investigatori
Sponsor
Sponsor
Collaboratori
Collaboratori
Investigatori
Investigatori
- Investigatore principale: Audrie Lin, PhD, MPH, University of California Santa Cruz
- Investigatore principale: Karen Macours, PhD, Paris School of Economics
- Investigatore principale: Duncan Webb, PhD, Nova School of Business and Economics
- Investigatore principale: Mariachiara Iannuzzi, MS, Paris School of Economics
- Investigatore principale: Oscar M Díaz, MS, Paris School of Economics
- Investigatore principale: William Amedanou, MS, Paris School of Economics
- Investigatore principale: Juliet Ellenbach, BS, University of California Santa Cruz
- Investigatore principale: Eliane Z Ralison, Consultant Associates
- Investigatore principale: Andry M Andrianarivelo, MD, Laboratoire d'Analyses Médicales Malagasy
- Investigatore principale: Ianja I Razanadrakoto, MD, Laboratoire d'Analyses Médicales Malagasy
- Investigatore principale: Tantely J Ramontalambo, MD, Laboratoire d'Analyses Médicales Malagasy
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
- biomarcatori
- anemia
- adolescenti
- infiammazione
- microbioma intestinale
- cortisolo
- trial randomizzato a grappolo
- Madagascar
- infezione del tratto urinario
- intervento scolastico
- stress psicosociale
- disfunzione enterica ambientale
- menstrual hygiene management
- menstrual hygiene intervention
- menstrual stigma reduction intervention
- WASH (water, sanitation, and hygiene)
- menstrual stigma
Termini MeSH pertinenti aggiuntivi
- Malattie urogenitali
- Processi patologici
- Disturbi della nutrizione
- Malattie urogenitali maschili
- Malattie urologiche
- Malattie urogenitali femminili
- Malattie urogenitali femminili e complicanze della gravidanza
- Infezioni
- Malattie ematologiche
- Condizioni patologiche, segni e sintomi
- Malattie nutrizionali e metaboliche
- Malattie emiche e linfatiche
- Malnutrizione
- Infiammazione
- Infezioni del tratto urinario
- Anemia
- Attrezzatura e forniture
- Prodotti di igiene femminile
- Prodotti per l'Igiene Mestruale
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- HS-FY2025-210
- AEARCTR-0014423 (Identificatore di registro: The American Economic Association's RCT Registry)
Piano per i dati dei singoli partecipanti (IPD)
Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?
Descrizione del piano IPD
Informazioni su farmaci e dispositivi, documenti di studio
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Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .