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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

Map of study areas in Kwale and Msambweni districts, Coastal Kenya. Insert: Map of Kenya with Kwale and Msambweni districts shaded in grey.
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Figure 3: Map of study areas in Kwale and Msambweni districts, Coastal Kenya. Insert: Map of Kenya with Kwale and Msambweni districts shaded in grey.

Mentions: The study is being conducted in rural government primary schools in Kwale and Msambweni districts, situated approximately 50 km south from Mombasa on the Kenyan coast (Figure 3). The study was carried out in these districts for several reasons. First, continuous precipitation supports intense year-round malaria (predominantly Plasmodium falciparum) transmission, with two seasonal peaks in malaria cases reflecting the bimodal rainfall pattern, with the heaviest rainfall typically occurring between April and June, with a smaller peak in October and November each year [31]. A 2008 survey among 20 schools in the study area found that up to 50% of school children harbor malaria parasites (Brooker, unpublished data), yet there are no initiatives specifically targeting malaria control in schools. Second, under-nutrition is common: the 2008 survey found that 21% of children were anaemic, reaching 38% in some schools (Brooker, unpublished data). Third, in terms of education, the area is one of the poorest in Kenya, having the worst mean national examination scores since 2005. The district is ranked as the seventh poorest district out of 76 districts in the country, and second poorest out of the seven districts in the Coast Province [32]. Around 80% of children attend primary school in these communities, but few proceed to secondary school.


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)

Map of study areas in Kwale and Msambweni districts, Coastal Kenya. Insert: Map of Kenya with Kwale and Msambweni districts shaded in grey.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Map of study areas in Kwale and Msambweni districts, Coastal Kenya. Insert: Map of Kenya with Kwale and Msambweni districts shaded in grey.
Mentions: The study is being conducted in rural government primary schools in Kwale and Msambweni districts, situated approximately 50 km south from Mombasa on the Kenyan coast (Figure 3). The study was carried out in these districts for several reasons. First, continuous precipitation supports intense year-round malaria (predominantly Plasmodium falciparum) transmission, with two seasonal peaks in malaria cases reflecting the bimodal rainfall pattern, with the heaviest rainfall typically occurring between April and June, with a smaller peak in October and November each year [31]. A 2008 survey among 20 schools in the study area found that up to 50% of school children harbor malaria parasites (Brooker, unpublished data), yet there are no initiatives specifically targeting malaria control in schools. Second, under-nutrition is common: the 2008 survey found that 21% of children were anaemic, reaching 38% in some schools (Brooker, unpublished data). Third, in terms of education, the area is one of the poorest in Kenya, having the worst mean national examination scores since 2005. The district is ranked as the seventh poorest district out of 76 districts in the country, and second poorest out of the seven districts in the Coast Province [32]. Around 80% of children attend primary school in these communities, but few proceed to secondary school.

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