Evaluation of a Comprehensive School Health Programme in Zambia

London School of Economics and Political Science

Status: Active, not recruiting

Conditions: Anemia; UTI; Diarrhea; Schistosomiasis; Cough; Skin Rash; Malaria; Helminth Infection

Treatments: Other: Deworming and vitamin A supplementation delivery; Other: Comprehensive School Health Programme

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT06560853

264865

Details and patient eligibility

About

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)?

Enrollment: 28,700 patients

Sex: All

Ages: 5+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

• 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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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28,700 participants in 3 patient groups

School health programme (SHP)

Experimental group

Description:

SHP developed by Healthy Learners (HL) in collaboration with the Ministry of Education (MOE), which follows the WHO guidelines on school health activities. HL supports the upgrading of basic sanitation facilities and construction of a dedicated 'health room' in the school; trains selected teachers to become school health workers (SHWs) who deliver health and sanitation education, coordinate deworming and vitamin A supplementation in the school, and assess sick learners in the school health room using a clinical decision support system (CDSS), either treating in school or referring to the local health centre. At the health centre, children referred by SHWs are given priority by health care workers who see them within 30 minutes of arriving at the facility. Schools also create student networks (a "buddy" system) whereby learners monitor each other's absence and coordinate with SHWs, who can then follow up with the household.

Treatment:

Other: Comprehensive School Health Programme

Other: Deworming and vitamin A supplementation delivery

Deworming and vitamin A supplementation

Active Comparator group

Description:

Healthy Learners will enusre reliable delivery of the national deworming programme twice a year, during the same period as in the SHP arm, for comparability of the effect of prevention alone to the full SHP.

Treatment:

Other: Deworming and vitamin A supplementation delivery

Status quo

No Intervention group

Description:

Schools to operate as usual with no intervention other than the usual activities planned and organized by the government, as set out the 2006 School Health and Nutrition Policy, until the end of the trial.