Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya

Simon Brooker, George Okello, Kiambo Njagi, Margaret M Dubeck, Katherine E Halliday, Hellen Inyega, Matthew C H Jukes, Simon Brooker, George Okello, Kiambo Njagi, Margaret M Dubeck, Katherine E Halliday, Hellen Inyega, Matthew C H Jukes

Abstract

Background: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence on the benefits of school-based malaria prevention or how health interventions interact with other efforts to improve education quality. This study aims to evaluate the impact of school-based malaria prevention and enhanced literacy instruction on the health and educational achievement of school children in Kenya.

Design: A factorial, cluster randomised trial is being implemented in 101 government primary schools on the coast of Kenya. The interventions are (i) intermittent screening and treatment of malaria in schools by public health workers and (ii) training workshops and support for teachers to promote explicit and systematic literacy instruction. Schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention is implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months. The primary outcomes are educational achievement and anaemia, the hypothesised mediating variables through which education is affected. Secondary outcomes include malaria parasitaemia, school attendance and school performance. A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions.

Discussion: Across Africa, governments are committed to improve health and education of school-aged children, but seek clear policy and technical guidance as to the optimal approach to address malaria and improved literacy. This evaluation will be one of the first to simultaneously evaluate the impact of health and education interventions in the improvement of educational achievement. Reflection is made on the practical issues encountered in conducting research in schools in Africa.

Trial registration: National Institutes of Health NCT00878007.

Figures

Figure 1
Figure 1
The hypothesised causal pathways through which the malaria and literacy interventions are assumed to improve educational achievement. Open rectangular boxes indicate secondary and mediating outcomes; the incidence of clinical attacks is not measured. Circle boxes indicate contextual variables measured at household and school levels.
Figure 2
Figure 2
Timetable and flowchart of randomisation and study design. The number of children (and percentage of eligible children) randomised to each arm indicated.
Figure 3
Figure 3
Map of study areas in Kwale and Msambweni districts, Coastal Kenya. Insert: Map of Kenya with Kwale and Msambweni districts shaded in grey.

References

    1. UNESCO. EFA Global Monitoring Report 2010: Reaching the marginalized. Paris: UNESCO; 2010.
    1. Jukes MCH, Drake LJ, Bundy DAP. School health, nutrition and education for all. Levelling the playing field. Wallingford, UK: CABI Publishing; 2008.
    1. Hall A, Bobrow E, Brooker S, Jukes M, Nokes K, Lambo J, Guyatt H, Bundy D, Adjei S, Wen ST. et al.Anaemia in schoolchildren in eight countries in Africa and Asia. Public Health Nutrition. 2001;4(3):749–756. doi: 10.1079/PHN2000111.
    1. Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. Journal of Nutrition. 2001;131:649S–666S.
    1. Grigorenko EL, Sternberg RJ, Jukes MCH, Alcock K, Lambo J, Ngorosho D, Nokes C, Bundy DAP. Effects of antiparasitic treatment on dynamically and statically tested cognitive skills over time. Journal of Applied Developmental Psychology. 2006;27:499–526. doi: 10.1016/j.appdev.2006.08.005.
    1. Miguel EA, Kremer M. Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities. Econometrica. 2004;72:159–217. doi: 10.1111/j.1468-0262.2004.00481.x.
    1. Soemantri AG, Pollitt E, Kim I. Iron deficiency anemia and educational achievement. American Journal of Clinical Nutrition. 1985;42:1221–1228.
    1. Bundy DAP, Shaeffer S, Jukes M, Beegle K, Gillespie A, Drake L, Seung-heem FL, Hoffman AM, Jones J, Mitchell A, In: Disease Control Priorities for Developing Countries. Jamison D, Breman J, Meacham A, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, editor. New York: Oxford University Press; 2006. School based health and nutrition programs; pp. 1091–1108.
    1. Brooker S. Malaria control in schools. A toolkit on effective education responses to malaria in Africa. London: Partnership for Child Development; 2009.
    1. Brooker S, Clarke S, Snow RW, Bundy DA. Malaria in African schoolchildren: options for control. Transaction of the Royal Society of Tropical Medicine and Hygiene. 2008;102(4):304–305. doi: 10.1016/j.trstmh.2008.01.010.
    1. Lalloo DG, Olukoya P, Olliaro P. Malaria in adolescence: burden of disease, consequences, and opportunities for intervention. Lancet Infectious Disease. 2006;6(12):780–793. doi: 10.1016/S1473-3099(06)70655-7.
    1. Fernando D, de Silva D, Carter R, Mendis KN, Wickremasinghe R. A randomized, double-blind, placebo-controlled, clinical trial of the impact of malaria prevention on the educational attainment of school children. American Journal of Hygiene and Tropical Medicine. 2006;74(3):386–393.
    1. Clarke SE, Jukes MC, Njagi JK, Khasakhala L, Cundill B, Otido J, Crudder C, Estambale BB, Brooker S. Effect of intermittent preventive treatment of malaria on health and education in schoolchildren: a cluster-randomised, double-blind, placebo-controlled trial. Lancet. 2008;372(9633):127–138. doi: 10.1016/S0140-6736(08)61034-X.
    1. Blair C, Razza RP. Relating effortful control, executive function, and false belief understanding to emerging math and literacy ability in kindergarten. Child Development. 2007;78(2):647–663. doi: 10.1111/j.1467-8624.2007.01019.x.
    1. Alderman H, Kim J, Orazem PF. Design, evaluation, and sustainability of private schools for the poor: the Pakistan urban and rural fellowship school experiments. Economics of Education Review. 2003;22:265–274. doi: 10.1016/S0272-7757(02)00051-1.
    1. Banerjee AV, Cole S, Duflo E, Linden L. Remedying education: evidence from two randomized experiments in India. The Quarterly Journal of Economics. 2007;122:1235–1264. doi: 10.1162/qjec.122.3.1235.
    1. Duflo E, Dupas P, Kremer M, Sinei S. World Bank Policy Research Paper. Washington D.C.: World Bank; 2006. Education and HIV/AIDS prevention: evidence from a randomized evaluation in western Kenya.
    1. Glewwe P, Ilias N, Kremer M. Teacher incentives. Cambridge, MA: National Bureau of Economic Research; 2003.
    1. Glewwe P, Kremer M, Moulin S, Zitzewitz E. Retrospective versus prospective analyses of school inputs: the case of flip charts in Kenya. Journal of Development Economics. 2004;74:251–268. doi: 10.1016/j.jdeveco.2003.12.010.
    1. Kremer M. Randomized evaluations of educational programs in developing countries: some lessons. The American Economic Review. 2003;93:102–106. doi: 10.1257/000282803321946886.
    1. Kremer M, Miguel E, Thornton R. Incentives to learn. Cambridge, MA: National Bureau of Economic Research; 2003.
    1. Muralidharan KSV. Teacher performance pay: experimental evidence from India. Cambridge, MA: National Bureau of Economic Research; 2009.
    1. Levinger B. Nutrition, health and education for all. Newton, Mass.: Education Development Center; 2004.
    1. White H. Theory-based impact evaluation: principles and practice. Journal of Development Effectiveness. 2009;1:271–284. doi: 10.1080/19439340903114628.
    1. Obonyo CO, Juma EA, Ogutu BR, Vulule JM, Lau J. Amodiaquine combined with sulfadoxine/pyrimethamine versus artemisinin-based combinations for the treatment of uncomplicated falciparum malaria in Africa: a meta-analysis. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007;101(2):117–126. doi: 10.1016/j.trstmh.2006.07.001.
    1. Government.of.Kenya. National malaria strategy. 2009-2017. Nairobi: Division of Malaria Control. Ministry of Public Health and Sanitation; 2009.
    1. August D, Shanahan T, (eds.) Developing literacy in second-language learners: Report of the National Literacy Panel on language minority children and youth. Mahwah, N.J; 2006.
    1. Snow CE, Burns MS, Griffin P, (eds.) Preventing Reading Difficulties in Young Children. Washington, DC: National Academy Press; 1998.
    1. Pawson R, N T. Realistic evaluation. London: Sage Publications; 1997.
    1. Ravallion M. Evaluating three stylized interventions. Journal of Development Effectiveness. 2009;1:227–236. doi: 10.1080/19439340903114644.
    1. Snow RW, Schellenberg JR, Peshu N, Forster D, Newton CR, Winstanley PA, Mwangi I, Waruiru C, Warn PA, Newbold C. et al.Periodicity and space-time clustering of severe childhood malaria on the coast of Kenya. Trans R Soc Trop Med Hyg. 1993;87(4):386–390. doi: 10.1016/0035-9203(93)90007-D.
    1. RTI.International. Early grade reading Kenya baseline assessment: Analyses and implications for teaching interventions design. Final report. Research Triangle Park, NC RTI.International; 2008.
    1. Juel C. Learning to read and write: A longitudinal study of 54 children from first through fourth grades. Journal of Educational Psychology. 1988;80(4):437–447. doi: 10.1037/0022-0663.80.4.437.
    1. Manly T, Robertson IH, Anderson V, Nimmo-Smith I. Test of Everyday Attention for Children: TEA-Ch. Bury St Edmunds, UK: Thames Valley Test Company; 1999.
    1. Raven JC, Styles I, Raven MA. Raven's Progressive Matrices: CPM parallel test booklet. Oxford, England: Oxford Psychologists Press; 1998.
    1. Newman FM, Secada WG, Wehlage GG. A guide to authentic assessment and instruction: Vision, scoring and standards. Madison, WI: Wisconsin Center for Educational Research; 1995.
    1. Stallings J. Allocated academic learning time revisited, or beyond time on task. Educational Researcher. 1980;9:11–16.
    1. Scanlon DM, Gelzheiser L, Fanuele D, Sweeney J, Newcomer L. Classroom Language Arts Systematic Sampling and Instructional Coding (CLASSIC) Albany, NY Child Research and Study Center, The University at Albany; 2003.
    1. Filmer D, Prichett L. Estimating wealth effects without expenditure data - or tears: an application to educational enrolment in states of India. Demography. 2001;38:115–132.
    1. Steckler L, Linnan A. Process evaluation for public health interventions and research. San Francisco: Jossey-Bass; 2004.
    1. Varvasovszky Z, Brugha R. A stakeholder analysis. Health Policy and Planning. 2000;15(3):338–345. doi: 10.1093/heapol/15.3.338.
    1. Bernard HR. Research methods in anthropology: qualitative and quantitative approaches. Oxford, UK: AltaMira Press; 2006.
    1. Jones C, Abeku TA, Rapuoda B, Okia M, Cox J. District-based malaria epidemic early warning systems in East Africa: perceptions of acceptability and usefulness among key staff at health facility, district and central levels. Social Science and Medicine. 2008;67(2):292–300. doi: 10.1016/j.socscimed.2008.03.001.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. 2009;4:50. doi: 10.1186/1748-5908-4-50.
    1. Drummond MF, Schlpher MJ, Torrance GW, O'Brian B, Stoddartt GL. Methods for the economic evaluation of health care programmes. 3. Oxford: Oxford University Press; 2005.
    1. Jimenez E, Patrinos HA. Can cost-benefit analysis guide education policy in developing countries? Washington D.C.: World Bank; 2009.
    1. Evans DK, Ghosh A. Prioritizing Educational Investments in Children in the Developing World. Santa Monica, CA: RAND Corporation; 2008.
    1. Brooker S, Kabatereine NB, Fleming F, Devlin N. Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: intra-country variation and effects of scaling-up. Health Policy and Planning. 2008;23(1):24–35. doi: 10.1093/heapol/czm041.
    1. Guyatt HL, Brooker S, Kihamia CM, Hall A, Bundy DA. Evaluation of efficacy of school-based anthelmintic treatments against anaemia in children in the United Republic of Tanzania. Bulletin of the World Health Organization. 2001;79(8):695–703.
    1. Temperley M, Mueller DH, Njagi JK, Akhwale W, Clarke SE, Jukes MC, Estambale BB, Brooker S. Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya. Malaria Journal. 2008;7:196. doi: 10.1186/1475-2875-7-196.
    1. Hayes RJ, Moulton LH. Cluster Randomised Trials. Boba Raton: CRC Press; 2009.
    1. HLM.Software. Optimal design for multi-level and longitudinal research (Version 1.77) Michigan: Survey Research Center, Institute of Social Research, University of Michigan; 2006.
    1. Weiss C. In: Evaluation and povery reduction. Feinstein O, Piccioto R, editor. New Brunswick, NJ: Transaction Publications; 2001. Theory-based evaluation: theories of change for poverty reduction programs.
    1. Court J, Hovland I, Young J. Bridging research and policy in international development: evidence and the change process. London: ITDG Publishing; 2004.
    1. Raudenbush SW, Martinez A, Spybrook J. Strategies for improving precision in group-randomized experiments. Educational Evaluation and Policy Analysis. 2007;29(1):5–29. doi: 10.3102/0162373707299460.

Source: PubMed

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