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NCT Number: NCT04121559

A Feasibility Study of Delivering Adolescent Nutrition Interventions Through School-Based Platforms in Ethiopia

Alive & Thrive (A&T) is an initiative that supports the scaling up of nutrition interventions to save lives, prevent illnesses, and contribute to healthy growth and development through improved maternal nutrition, breastfeeding and complementary feeding practices. In Ethiopia, A&T tested the feasibility of implementing a package of locally tailored adolescent nutrition interventions through school-based (flag assemblies, classroom lessons, girls' clubs, peer mentoring, weight and height measurement, and parent-teacher meetings) and community platforms (health post and home visits and community gatherings). The evaluation used a two-arm cluster-randomized, non-masked trial design, consisting of two cross-sectional surveys in 2019 and 2021.

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Key information

Conditions

Dietary Diversity

Age range

10 year–14 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

International Food Policy Research Institute

Washington D.C., District of Columbia, 20005, United States

About this study

Adolescence is a critical period of physical and psychological development and for achieving human potential. Rapid physical, psychosocial and cognitive growth and development is coupled with increased energy and nutrient requirements (Das et al., 2017; Spear 2002). Poor nutrition during adolescence can have adverse consequences impacting health in adulthood. The significance of nutrition during adolescence is especially important for girls, as poor nutrition can affect their well-being as well as the survival, health and well-being of their children (Das et al. 2017).

A&T Ethiopia implemented a package of adolescent nutrition interventions through school-based (flag assemblies, classroom lessons, girls' clubs, peer mentoring, weight and height measurement, and parent-teacher meetings) and community platforms (health post and home visits and community gatherings). IFPRI tested the feasibility of the behavior-change interventions and examined their impacts on adolescent girls' diets, compared with standard school and community activities in control areas.

The evaluation used a two-arm cluster-randomized, non-masked trial design, consisting of two cross-sectional surveys of in-school adolescent girls aged 10-14 years enrolled in grades 4-8. The unit of randomization is the primary school which includes grades 1-8. The baseline survey was conducted in October-November 2019 (at the beginning of the school year), and the endline survey took place in March-April 2021 (following the end of first semester classes). In 2020, after 3 months of program implementation, program activities were halted from March to October (over 6 months) due to the COVID-19 pandemic, thus the endline survey was postponed to the following school year after implementation was reinitiated.

The overall study objective was to determine the feasibility of delivering adolescent nutrition interventions primarily through school-based platforms and their impact on the diet of adolescent girls.

Research questions include:

  • What is the program impact on the diet of adolescent girls: (1) dietary diversity, (2) meal frequency, and (3) less consumption of unhealthy foods/junk foods?
  • What is the exposure to adolescent nutrition interventions delivered through school-based platforms?
  • What factors influenced the integration of adolescent nutrition interventions into school-based platforms and their outcomes?

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Currently enrolled in primary school grades 4-8
  • Parental consent and informed assent received
  • Principals, teachers, service providers and primary schools in the areas

Exclusion criteria

  • Age <10 years or >14 years

Treatment and study plan

School Interventions

Behavioral
  • Classroom lessons on nutrition, dietary diversity, healthy food choices and handwashing.
  • Principals provide messages on nutrition, dietary diversity, healthy food choices and handwashing at flag events or school assemblies.
  • Selected adolescent girls are mentored by science teachers as peer mentors and hold weekly group discussions with other girls to discuss nutrition, dietary diversity, healthy food choices and handwashing.
  • Trained science teachers take anthropometric measurements of adolescent girls to calculate BMI and provide nutrition counseling.
  • Parent-teacher meetings to inform and encourage parents about adolescent nutrition, dietary diversity, healthy snacks, and handwashing.

Community Interventions

Behavioral
  • Home visits by HEWs and/or community volunteers to discuss with parents about adolescent nutrition, dietary diversity, healthy food choices, and handwashing.
  • Community gatherings by HEWs and meetings with religious leaders to discuss with parents about adolescent nutrition, dietary diversity, healthy food choices, and handwashing.

School System Interventions

Behavioral
  • Workshop on the adolescent nutrition interventions for school principals, science teachers, HEWs, supervisors, and woreda officers.
  • Biweekly supportive supervision on adolescent nutrition activities for schools and HEWs by school supervisors or woreda health/education office.

Primary outcomes

  1. Dietary diversity among adolescent girls

    Time frame: Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021

    Mean number of food groups consumed by adolescent girls on the day preceding the interview.

  2. Minimum dietary diversity among adolescent girls

    Time frame: Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021

    Proportion of adolescent girls who consumed 5 or more food groups on the day preceding the interview.

Secondary outcomes

  1. Meal frequency

    Time frame: Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021

    Number of meal/snack times in the previous 24 hours

  2. Consumption of unhealthy foods

    Time frame: Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021

    Consumption of sweets, baked sweets, sweetened beverages, and fried and salty foods in the previous 24 hours

  3. Exposure to nutrition interventions at school and in the community

    Time frame: Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021

    Proportion of adolescent girls exposed to nutrition interventions at school and in the community

  4. Nutrition and handwashing knowledge and practices among adolescent girls and their parents

    Time frame: Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021

    Proportion of adolescent girls and parents with correct knowledge of nutrition and appropriate handwashing practices based on survey responses

  5. Nutrition and handwashing knowledge among school science teachers, principals, and HEWs

    Time frame: Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021

    Proportion of school science teachers, principals, and HEWs with correct knowledge of nutrition and appropriate handwashing practices based on survey responses

  6. Delivery of adolescent nutrition interventions by school science teachers, principals, and HEWs

    Time frame: Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021

    Proportion of school science teachers, principals, and HEWs providing adolescent nutrition interventions at school and in the community based on survey responses

  7. Availability of supporting resources

    Time frame: Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021

    Proportion of primary schools with training and supportive supervision for teachers/staff, educational materials, and healthy food environments based on enumerator observation and survey responses

Sponsors and collaborators

Lead sponsor

International Food Policy Research Institute

Other

Collaborators

  • Addis Continental Institute of Public Health
  • FHI 360

Registry information

Official study title

A Feasibility Study of Delivering Adolescent Nutrition Interventions Through School-Based Platforms in Ethiopia: A Cluster-Randomized Evaluation

Important dates

Study start
2019
Primary completion
2021
Study completion
2021
First posted
Oct 10, 2019
Registry last updated
Mar 10, 2022

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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