Comprehensive school-based health programs to improve child and adolescent health: Evidence from Zambia

Abstract

Background: 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 paper, we evaluate the impact of a new and comprehensive primary school-based health intervention program on student-reported morbidity and anthropometric outcomes in Lusaka, Zambia.

Methods: A prospective matched control study identified 12 classes in 7 schools for the intervention and 12 classes in 7 matched schools as controls. Teachers in intervention schools were trained to deliver health lessons and to refer sick students to care. In addition, vitamin A and deworming medication were biannually administered to intervention students. The primary study outcome was student-reported morbidity. Secondary outcomes were weight, height, health knowledge, and absenteeism. Multivariable linear and logistic regression models were used to estimate program impact.

Results: 380 students ages 4-16 were enrolled in the study in 2015, and 97% were followed up at endline in 2016. The intervention decreased the adjusted odds of self-reported acute illnesses by 38% (95% CI: 0.48, 0.77) and the adjusted odds of stunting by 52% (95% CI: 0.26, 0.87). It also increased health knowledge by 0.53 standard deviations (95% CI: 0.24, 0.81). No impact was found on weight (adjusted mean difference β = 0.17, 95% CI: - 1.11, 1.44) and student absenteeism (adjusted odds ratio (aOR) = 0.89, 95% CI: 0.60, 1.33).

Conclusion: The results presented in this paper suggest that comprehensive school-based health programs may offer a highly effective way to improve students' health knowledge as well as their health status. Given their low cost, a more general adoption and implementation of such programs seems recommendable.

Trial registration: ClinicalTrials.gov Identifier: NCT03607084.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Sampling procedure of school-aged children in Lusaka, Zambia, 2015–2016.

Fig 2. Meta-analysis of estimated morbidity reductions.

Meta-analysis of estimated morbidity reductions among school-aged children in Lusaka, Zambia, 2015–2016. The overall estimate is based on random-effect meta-analysis. The coefficients and confidence intervals underlying this meta-analysis were computed through separate logistic regression models for each morbidity measure. All logistic models controlled for the illness outcome at baseline and baseline values of: age, grade, sex, wealth quintiles, deworming, vitamin A, confidence in teachers, perceived access to care, weight, thinness, overweight, stunting, health knowledge score, and absenteeism.

Fig 3. Change in proportion of children in stunting category from baseline to endline.

Changes in the prevalence of stunting and severe stunting between baseline and endline for intervention and control groups in Lusaka, Zambia, 2015–2016.