Evaluation of School-based Nutrition Intervention for Adolescents in Bangladesh

NCT ID: NCT05455073

Last Updated: 2022-07-13

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 3018 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-07-31
• Study Completion Date: 2022-02-28

Brief Summary

Addressing the nutrition needs of adolescents could be an important initiative for breaking the vicious cycle of intergenerational malnutrition, chronic diseases and poverty. To respond to these diverse needs of adolescents, the Government of Bangladesh (GoB) in 2012, instituted a national policy for adolescent girls' weekly iron and folic acid (WIFA) supplementation in secondary schools to reduce anemia. Efforts are in place to roll out a national WIFA supplementation program for both in-school and out-of-school adolescent girls aged 10-19 years. Responding to the need to demonstrate the feasibility of such a new initiative before it is scaled-up, Nutrition International (NI) with funding support from the Government of Canada committed to providing technical and financial support to demonstrate to the GoB, the feasibility of a school-based delivery of nutrition interventions to improve the nutrition and health status of adolescents in Joypurhat and Sirajganj districts of Bangladesh. The project developed and began roll out of a multi-sectorial holistic and integrated nutrition approach consisting of both a nutrition-specific and nutrition-sensitive program model for improving the general health and nutrition of adolescents in schools. This was delivered in an integrated package for girls and boys including WIFA supplementation (girls only), promotion of improved water, sanitation and hygiene (WASH), behavior change interventions (BCI) on all topics, and support for menstrual hygiene management (MHM) for girls, including sale of menstrual products in schools. To evaluate the program, the GoB (Institute of Public Health and Nutrition, Ministry of Health and Family Welfare (IPHN) and The Directorate of Secondary and Higher Education, Ministry of Education (DSHE) and NI with technical assistance from the CDC Foundation and CDC planned process and outcome evaluations for the first year of the program's implementation.

Detailed Description

The outcome evaluation was a school (cluster)-based, randomized controlled trial with three equal size intervention arms, sampling adolescents, teachers, and student leaders in 75 selected schools. The study investigated the impact of the school-based program implemented in Joypurhat and aimed to examine the effectiveness and factors influencing scalability of using the secondary school platform to deliver WIFA co-packaged with WASH, MHM, and BCI to improve the nutrition and health status of adolescents in Bangladesh. The process evaluation sampled adolescents, teachers, and student leaders from 12 schools selected through convenience sampling for qualitative interviews, and determined whether the school-based program was implemented as intended, and why and how the intervention components worked to produce an impact - specifically, assessing the level of adherence.

Conditions

Anemia; Menstrual Hygiene Management; Improved Water, Sanitation and Hygiene (WASH)

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Full package intervention arm

• Dietary Supplement of Weekly Iron and Folic Acid (WIFA) Supplementation (containing 60 mg of elemental iron and 2800 µg of folic acid) and;
• Associated behavior change intervention (BCI) to change the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming
• Water, sanitation and hygiene (WASH) intervention: ensure availability (or provision) of water, sanitation, and hygiene supplies
• Menstrual hygiene management (MHM) intervention: support for menstrual hygiene, including sale of menstrual products in schools
• Associated behavior change intervention (BCI) to change the knowledge, attitudes, and practices (KAP) of WASH and menstrual hygiene management (MHM)

Group Type: EXPERIMENTAL

Weekly Iron and Folic Acid Supplementation (WIFA)

Intervention Type: DIETARY_SUPPLEMENT

Weekly school provision of WIFA tablets to adolescent girls

WASH

Intervention Type: COMBINATION_PRODUCT

Ensure availability (or provision) of water, sanitation, and hygiene supplies for adolescent girls and boys

Menstrual Hygiene Management

Intervention Type: COMBINATION_PRODUCT

Support for adolescent girls' menstrual hygiene

Nutrition Behavior Change Intervention (BCI)

Intervention Type: BEHAVIORAL

Changing the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming

MHM & WASH Behavior Change Intervention (BCI)

Intervention Type: BEHAVIORAL

Changing the knowledge, attitudes, and practices of WASH and menstrual hygiene management

Limited package intervention arm

• Dietary Supplement of Weekly Iron and Folic Acid (WIFA) Supplementation (containing 60 mg of elemental iron and 2800 µg of folic acid; weekly school provision of WIFA tablets) and;
• Associated behavior change intervention (BCI) to change the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming

Group Type: EXPERIMENTAL

Weekly Iron and Folic Acid Supplementation (WIFA)

Intervention Type: DIETARY_SUPPLEMENT

Weekly school provision of WIFA tablets to adolescent girls

Nutrition Behavior Change Intervention (BCI)

Intervention Type: BEHAVIORAL

Changing the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming

Control

No intervention.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Weekly Iron and Folic Acid Supplementation (WIFA)

Weekly school provision of WIFA tablets to adolescent girls

Intervention Type: DIETARY_SUPPLEMENT

WASH

Ensure availability (or provision) of water, sanitation, and hygiene supplies for adolescent girls and boys

Intervention Type: COMBINATION_PRODUCT

Menstrual Hygiene Management

Support for adolescent girls' menstrual hygiene

Intervention Type: COMBINATION_PRODUCT

Nutrition Behavior Change Intervention (BCI)

Changing the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming

Intervention Type: BEHAVIORAL

MHM & WASH Behavior Change Intervention (BCI)

Changing the knowledge, attitudes, and practices of WASH and menstrual hygiene management

Intervention Type: BEHAVIORAL

Other Intervention Names

Behavior Change Intervention

Eligibility Criteria

Inclusion Criteria

• Randomly selected adolescent girl or boy
• Present on the day(s) of the survey
• Verbal assent and parental/guardian written consent
• School level headteacher, assigned teacher or student leader in the various grades

Exclusion Criteria

• Girl or boy enrolled in grades other than grades 8 or 9
• Enrolled after random selection of participants

• Minimum Eligible Age: 10 Years
• Maximum Eligible Age: 19 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Centers for Disease Control and Prevention

FED

Sponsor Role: collaborator

CDC Foundation

OTHER

Sponsor Role: collaborator

Institute of Public Health and Nutrition, Ministry of Health and Family Welfare, Bangladesh

UNKNOWN

Sponsor Role: collaborator

Directorate of Secondary and Higher Education, Ministry of Education, Bangladesh

UNKNOWN

Sponsor Role: collaborator

Nutrition International

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Nutrition International

Ottawa, Ontario, Canada

Countries

Canada

References

Demuyakor ME, Jalal C, Williams AM, Bouckaert KP, Whitehead RD Jr, Bhuiyan MM, Siraj S, Ara R, Pike V, Jefferds MED. Design, Methods, and Select Baseline Results from a School Nutrition Project for Adolescents in Bangladesh. Curr Dev Nutr. 2023 Mar 30;7(4):100070. doi: 10.1016/j.cdnut.2023.100070. eCollection 2023 Apr.

Reference Type: DERIVED

PMID: 37304846 (View on PubMed)

Other Identifiers

NI-02-2019-SNAP

Identifier Type: -

Identifier Source: org_study_id