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

Dongqing Wang, Leonard Kamanga Katalambula, Andrea R Modest, Tara Young, Abbas Ismail, Mary Mwanyika-Sando, Amani Tinkasimile, Dominic Mosha, Augustine Malero, Said Vuai, Wafaie W Fawzi, Dongqing Wang, Leonard Kamanga Katalambula, Andrea R Modest, Tara Young, Abbas Ismail, Mary Mwanyika-Sando, Amani Tinkasimile, Dominic Mosha, Augustine Malero, Said Vuai, Wafaie W Fawzi

Abstract

Introduction: Secondary schools have the transformative potential to advance adolescent nutrition and provide a unique entry point for nutrition interventions to reach adolescents and their families and communities. Integrated school nutrition interventions offer promising pathways towards improving adolescent nutrition status, food security and building sustainable skill sets.

Methods and analysis: The Meals, Education, and Gardens for In-School Adolescents (MEGA) project aims to implement and evaluate an integrated, school-based nutrition intervention package among secondary schools in the Chamwino District of Dodoma, Tanzania. MEGA is a cluster-randomised controlled trial, including six public secondary schools assigned to three different arms. Two schools will receive the full intervention package, including school meals, school gardens, nutrition education and community workshops. Two schools will receive the partial intervention package, including the school garden, nutrition education and community workshops. Two schools will serve as the controls and will not receive any intervention. The intervention will be implemented for one academic year. Baseline and end-line quantitative data collection will include 750 adolescents and 750 parents. The domains of outcomes for adolescents will include haemoglobin concentrations, anthropometry, educational outcomes and knowledge, attitudes and practices regarding nutrition, agriculture and health. The domains of outcomes for parents will include knowledge, attitudes and practices of nutrition, agriculture and health. End-line focus group discussions will be conducted among selected adolescents, parents and teachers to assess the facilitators and barriers associated with the intervention.

Ethics and dissemination: This study was approved by the Institutional Review Board at Harvard T.H. Chan School of Public Health (approval number: IRB20-1623), the Institutional Research Review Committee at the University of Dodoma (approval number: MA.84/261/02) and the Tanzania National Institute for Medical Research (approval number: NIMR/HO/R.8a/Vol. IX/3801). A manuscript with the research findings will be developed for publication. Local dissemination meetings will be held with key stakeholders.

Trial registration number: NCT04788303.; ClinicalTrials.gov Identifier.

Keywords: community child health; epidemiology; nutrition; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Christian P, Smith ER. Adolescent undernutrition: global burden, physiology, and nutritional risks. Ann Nutr Metab 2018;72:316–28. 10.1159/000488865
    1. World Health Organization . Health for the world’s adolescents: a second chance in the second decade: summary. World Health Organization, 2014.
    1. Patton GC, Sawyer SM, Santelli JS, et al. . Our future: a Lancet commission on adolescent health and wellbeing. Lancet 2016;387:2423–78. 10.1016/S0140-6736(16)00579-1
    1. Hargreaves D, Mates E, Menon P, et al. . Strategies and interventions for healthy adolescent growth, nutrition, and development. Lancet 2022;399:198–210. 10.1016/S0140-6736(21)01593-2
    1. Ministry of Health CD, Gender, Elderly, Children - MoHCDGEC/Tanzania Mainland, Ministry of Health - MoH/Zanzibar . Tanzania demographic and health survey and malaria indicator survey 2015-2016. Dar es Salaam, Tanzania: MoHCDGEC, MoH, NBS, OCGS, and ICF, 2016.
    1. Bureau of Statistics/Tanzania, Macro International . Tanzania demographic and health survey 1996. Calverton, MD: Bureau of Statistics/Tanzania and Macro International, 1997.
    1. Mushengezi B, Chillo P. Association between body fat composition and blood pressure level among secondary school adolescents in Dar ES Salaam, Tanzania. Pan Afr Med J 2014;19:327. 10.11604/pamj.2014.19.327.5222
    1. Pangani IN, Kiplamai FK, Kamau JW, et al. . Prevalence of overweight and obesity among primary school children aged 8–13 years in Dar ES Salaam City, Tanzania. Adv Prev Med 2016;2016:1–5. 10.1155/2016/1345017
    1. Massawe SN, Ronquist G, Nyström L, et al. . Iron status and iron deficiency anaemia in adolescents in a Tanzanian suburban area. Gynecol Obstet Invest 2002;54:137–44. 10.1159/000067879
    1. Norris SA, Frongillo EA, Black MM, et al. . Nutrition in adolescent growth and development. Lancet 2022;399:172–84. 10.1016/S0140-6736(21)01590-7
    1. Lim SS, Vos T, Flaxman AD, et al. . A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet 2012;380:2224–60. 10.1016/S0140-6736(12)61766-8
    1. Blakemore S-J, Mills KL. Is adolescence a sensitive period for sociocultural processing? Annu Rev Psychol 2014;65:187–207. 10.1146/annurev-psych-010213-115202
    1. Mokdad AH, Forouzanfar MH, Daoud F, et al. . Global burden of diseases, injuries, and risk factors for young people’s health during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 2016;387:2383–401. 10.1016/S0140-6736(16)00648-6
    1. Gates M. Advancing the adolescent health agenda. Lancet 2016;387:2358–9. 10.1016/S0140-6736(16)30298-7
    1. Regan M, Fawzi WW, Patel V. Promoting global adolescent health: realizing the transformative potential of schools. J Adolesc Health 2020;66:526–8. 10.1016/j.jadohealth.2020.02.004
    1. Kristjansson B, Petticrew M, MacDonald B, et al. . School feeding for improving the physical and psychosocial health of disadvantaged students. Cochrane Database of Systematic Reviews 2007;90. 10.1002/14651858.CD004676.pub2
    1. Jomaa LH, McDonnell E, Probart C. School feeding programs in developing countries: impacts on children's health and educational outcomes. Nutr Rev 2011;69:83–98. 10.1111/j.1753-4887.2010.00369.x
    1. Watkins K, Gelli A, Hamdani S. Sensitive to nutrition? A literature review of school feeding effects in the child development lifecycle: working paper series 2015.
    1. Schreinemachers P, Rai BB, Dorji D, et al. . School gardening in Bhutan: evaluating outcomes and impact. Food Secur 2017;9:635–48. 10.1007/s12571-017-0673-3
    1. Schreinemachers P, Ouedraogo MS, Diagbouga S, et al. . Impact of school gardens and complementary nutrition education in Burkina Faso. J Dev Effect 2019;11:132–45. 10.1080/19439342.2019.1624595
    1. Mazengo R. Assessment of the effectivenes and sustainability of household food insecurity coping strategies in Chamwino district, Dodoma region. Sokoine University of Agriculture, 2011.
    1. Rector C, Afifa NN, Gupta V, et al. . School-based nutrition programs for adolescents in Dodoma, Tanzania: a situation analysis. Food Nutr Bull 2021;42:378–88. 10.1177/03795721211020715
    1. Blackwell M, Iacus S, King G, et al. . cem: Coarsened exact matching in Stata. Stata J 2009;9:524–46. 10.1177/1536867X0900900402
    1. Haahr M. Introduction to randomness and random numbers: RANDOM [online]. c1998-2011 1999.
    1. Cleveland DA, Soleri D. Food from dryland gardens: an ecological, nutritional and social approach to small-scale household food production. Center for People, Food and Environment, 1991.
    1. Menza V, Probart C. Eating well for good health: lessons on nutrition and healthy diets. Food and Agriculture Organization of the United Nations (FAO), 2013.
    1. Bhattarai D, Subedi G, Schreinemachers P. School vegetable gardening concept curriculum & action. Nepal Agricultural Research Council (NARC), Horticulture Research Division, 2016.
    1. Luoh J, Yang R, Sobgui C. Vegetables and nutrition for schools in Burkina Faso, 2017.
    1. Mosha D, Canavan CR, Bellows AL, et al. . The impact of integrated nutrition-sensitive interventions on nutrition and health of children and women in rural Tanzania: study protocol for a cluster-randomized controlled trial. BMC Nutr 2018;4:1–8. 10.1186/s40795-018-0238-7
    1. Open data kit: tools to build information services for developing regions. Proceedings of the 4th ACM/IEEE International Conference on information and communication technologies and development 2010.
    1. Dupont WD, Plummer WD. Power and sample size calculations. A review and computer program. Control Clin Trials 1990;11:116–28. 10.1016/0197-2456(90)90005-m
    1. World Health Organization . Nutritional anaemias: tools for effective prevention and control, 2017.

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