Evaluation of a Comprehensive School Health Programme in Zambia

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)?

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Key information

Conditions

Helminth Infection Anemia Cough Diarrhea Exanthema Helminthiasis Hematologic Diseases Hemic and Lymphatic Diseases Infections Malaria Mosquito-Borne Diseases Parasitic Diseases Pathological Conditions, Signs and Symptoms Protozoan Infections Respiration Disorders Respiratory Tract Diseases Schistosomiasis Signs and Symptoms Signs and Symptoms, Digestive Signs and Symptoms, Respiratory Skin Diseases Skin Rash Skin and Connective Tissue Diseases Trematode Infections UTI Vector Borne Diseases

Age range

5 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Chingola District Education Board, Chingola, Copperbelt, Zambia

Who can participate

Healthy volunteers accepted: Yes

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

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

Treatment and study plan

Comprehensive School Health Programme

Other

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.

Other names: SHP

Deworming and vitamin A supplementation delivery

Other

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.

Other names: Deworming

Primary outcomes

Synthetic morbidity index

Time frame: 18 months after intervention start
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.
Average attendance rate over 24 months

Time frame: 24 months after intervention start

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.

Sponsors and collaborators

Lead sponsor

London School of Economics and Political Science

Other

Collaborators

Healthy Learners
Medical Research Council
United States Agency for International Development (USAID)
University of Virginia

Registry information

Official study title

Evaluation of a Comprehensive School Health Programme in Zambia: a Cluster-randomised Controlled Trial

Important dates

Study start: 2024
Primary completion: 2026
Study completion: 2026
First posted: Aug 19, 2024
Registry last updated: Aug 19, 2024

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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