Evaluation of a Comprehensive School Health Programme in Zambia

N/AActive Not RecruitingNCT06560853

London School of Economics and Political Science28,700 enrolled

Overview

In Zambia, the health and well-being of children aged 5 to 14 has often been overlooked, leading to various health challenges affecting their development and education. The Healthy Learners (HL) program, in collaboration with the Zambian Government, aims to address this gap by implementing a comprehensive school health program. Trained teachers, known as school health workers (SHWs), play a key role by delivering health education, coordinating preventative care with local clinics, and overseeing a 'school health room' for sick students. This study is a large cluster-randomized control trial in 225 schools. The goal of this trial is to compare the effects of the comprehensive school health programme (SHP) developed by HL against two alternatives: the current level of school health provision and the current school health activities enhanced with deworming and vitamin A coordination by HL, with their technical and financial support ensuring the reliable delivery of all health activities currently planned by the government. 1. What is the impact of the program on health-seeking, health, and education outcomes? 2. What are the indirect effects of the program on teachers and clinics? 3. What is the added value of such a comprehensive SHP, compared to (i) optimized (ii) or imperfect (status-quo) delivery of a limited range of school health activities (e.g., deworming and vitamin A supplements)? 4. How costly is the comprehensive SHP, and what factors affect its implementation? 5. What are the potential benefits of the program for long-term human capital accumulation (learning, well-being etc)?

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

28,700

Conditions

Interventions

Comprehensive School Health ProgrammeOTHER

Combination intervention which consists of: * Upgrading sanitation facilities and constructing a 'health room' in the school * Health teacher training: 5-10 teachers per school are recruited and trained for two weeks to become School Health Workers (SHWs) by Healthy Learners * The SHWs: (1) deliver education on health and good sanitation and hygiene (2) coordinate with local clinics to deliver preventive care (e.g. school deworming and vitamin A supplementation); (3) assess sick students in the health room with a tablet-based clinical decision support system (CDSS); (4) treat sick students in the health room for some conditions (malaria, diarrhoea, schistosomiasis, pneumonia, conjunctivitis) or (5) refer to the health facility for treatment; (6) monitor absence of learners * Referral: learners referred by SHWs are given a referral form by the SHW, which contains information about symptoms and suggested diagnosis by the CDSS. The learners are prioritised in the local clinic.

Deworming and vitamin A supplementation deliveryOTHER

Schools implement the government policy of distributing deworming drugs and vitamin A supplementation to learners twice a year. Additional support from Healthy Learners ensures reliable delivery.

Eligibility

Sex: ALLMin age: 5 YearsHealthy volunteers:

Medical Language ↔ Plain English

* Schools: eligible for SHP (not inaccessible in the rainy season, within 10km of health centre) * School administrator: has at least one year experience in school and is the primary or deputy school manager (e.g., headteacher, deputy headteacher, senior teacher acting as financial officer) * Learners: registered and in attendance in school during baseline, in grade 1, grade 3, or grade 5 * Parents, primary caregivers or guardians of selected learners. Guardians are eligible if they stay with the child and make schooling and health decisions for the child in the absence of parents/primary caregivers. * Teachers: any teacher employed by study eligible schools (not volunteers) * Health facilities: designated facilities in the catchment area of study schools * Health facility staff: any staff doing OPD consultation present during facility data collection days

Locations (6)

Chingola District Education Board

Chingola, Copperbelt, Zambia

Luanshya District Education Board

Luanshya, Copperbelt, Zambia

Masaiti District Education Board

Masaiti, Copperbelt, Zambia

Kawambwa District Education Board

Kawambwa, Luapula Province, Zambia

Mwense District Education Board

Mwense, Luapula Province, Zambia

Samfya District Education Board

Samfya, Luapula Province, Zambia

Outcomes

Primary Outcomes

Synthetic morbidity index

Because the SHP delivers treatment of several diseases, we will create a composite disease burden index of the following outcomes: * malaria positive (using a rapid diagnostic test) * moderate to high worm load (using a stool test) * anaemia (using a hemocue test) * schistosomiasis (using a urine test) * diarrhoea in the past week (learner self-report) We test these outcomes in a randomly selected panel of 13,300 learners recruited at baseline, which ensures variety of age groups and balance of genders.

Time frame: 18 months after intervention start

Average attendance rate over 24 months

We will measure attendance during unannounced attendance spot checks (one per term over a 2-year period). Multiple measurements are required to capture seasonal variation. On each spot check visit, we will check attendance of a panel of learners randomly selected at baseline, which ensures variety of age groups and balance of genders. We will calculate each child's attendance rate across all the spot checks.

Time frame: 24 months after intervention start