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Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya.

Brooker S, Okello G, Njagi K, Dubeck MM, Halliday KE, Inyega H, Jukes MC - Trials (2010)

Bottom Line: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement.A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions.National Institutes of Health NCT00878007.

View Article: PubMed Central - HTML - PubMed

Affiliation: Malaria Public Health & Epidemiology Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. simon.brooker@lshtm.ac.uk

ABSTRACT

Background: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence on the benefits of school-based malaria prevention or how health interventions interact with other efforts to improve education quality. This study aims to evaluate the impact of school-based malaria prevention and enhanced literacy instruction on the health and educational achievement of school children in Kenya.

Design: A factorial, cluster randomised trial is being implemented in 101 government primary schools on the coast of Kenya. The interventions are (i) intermittent screening and treatment of malaria in schools by public health workers and (ii) training workshops and support for teachers to promote explicit and systematic literacy instruction. Schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention is implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months. The primary outcomes are educational achievement and anaemia, the hypothesised mediating variables through which education is affected. Secondary outcomes include malaria parasitaemia, school attendance and school performance. A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions.

Discussion: Across Africa, governments are committed to improve health and education of school-aged children, but seek clear policy and technical guidance as to the optimal approach to address malaria and improved literacy. This evaluation will be one of the first to simultaneously evaluate the impact of health and education interventions in the improvement of educational achievement. Reflection is made on the practical issues encountered in conducting research in schools in Africa.

Trial registration: National Institutes of Health NCT00878007.

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Related in: MedlinePlus

Timetable and flowchart of randomisation and study design. The number of children (and percentage of eligible children) randomised to each arm indicated.
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Figure 2: Timetable and flowchart of randomisation and study design. The number of children (and percentage of eligible children) randomised to each arm indicated.

Mentions: The impact of the two interventions is being evaluated through a factorial design, cluster randomised trial, in which 101 schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention will be implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months to assess the impact of the two interventions. Both classes receive the malaria intervention, but the literacy intervention is targeted only towards class 1 as this is when children learn to read. This is an unblinded study as, following randomization, schools are aware of whether or not they will receive the malaria or literacy interventions. The timeline and flowchart of the study design is shown in figure 2. A nested qualitative process evaluation is included to consider how the interventions work to improve educational achievement and to identify key assumptions and conditions underlying potential sustainability and scaling-up of the interventions. In this way, the evaluation not only addresses the question 'Does it work?', but also considers 'How does it work?', 'For whom?' and 'Under what circumstances?' [24,29,30].


Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya.

Brooker S, Okello G, Njagi K, Dubeck MM, Halliday KE, Inyega H, Jukes MC - Trials (2010)

Timetable and flowchart of randomisation and study design. The number of children (and percentage of eligible children) randomised to each arm indicated.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2959045&req=5

Figure 2: Timetable and flowchart of randomisation and study design. The number of children (and percentage of eligible children) randomised to each arm indicated.
Mentions: The impact of the two interventions is being evaluated through a factorial design, cluster randomised trial, in which 101 schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention will be implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months to assess the impact of the two interventions. Both classes receive the malaria intervention, but the literacy intervention is targeted only towards class 1 as this is when children learn to read. This is an unblinded study as, following randomization, schools are aware of whether or not they will receive the malaria or literacy interventions. The timeline and flowchart of the study design is shown in figure 2. A nested qualitative process evaluation is included to consider how the interventions work to improve educational achievement and to identify key assumptions and conditions underlying potential sustainability and scaling-up of the interventions. In this way, the evaluation not only addresses the question 'Does it work?', but also considers 'How does it work?', 'For whom?' and 'Under what circumstances?' [24,29,30].

Bottom Line: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement.A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions.National Institutes of Health NCT00878007.

View Article: PubMed Central - HTML - PubMed

Affiliation: Malaria Public Health & Epidemiology Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. simon.brooker@lshtm.ac.uk

ABSTRACT

Background: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence on the benefits of school-based malaria prevention or how health interventions interact with other efforts to improve education quality. This study aims to evaluate the impact of school-based malaria prevention and enhanced literacy instruction on the health and educational achievement of school children in Kenya.

Design: A factorial, cluster randomised trial is being implemented in 101 government primary schools on the coast of Kenya. The interventions are (i) intermittent screening and treatment of malaria in schools by public health workers and (ii) training workshops and support for teachers to promote explicit and systematic literacy instruction. Schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention is implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months. The primary outcomes are educational achievement and anaemia, the hypothesised mediating variables through which education is affected. Secondary outcomes include malaria parasitaemia, school attendance and school performance. A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions.

Discussion: Across Africa, governments are committed to improve health and education of school-aged children, but seek clear policy and technical guidance as to the optimal approach to address malaria and improved literacy. This evaluation will be one of the first to simultaneously evaluate the impact of health and education interventions in the improvement of educational achievement. Reflection is made on the practical issues encountered in conducting research in schools in Africa.

Trial registration: National Institutes of Health NCT00878007.

Show MeSH
Related in: MedlinePlus