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NCT Number: NCT05455073

Evaluation of School-based Nutrition Intervention for Adolescents in Bangladesh

Addressing the nutrition needs of adolescents could be an important initiative for breaking the vicious cycle of intergenerational malnutrition, chronic diseases and poverty. To respond to these diverse needs of adolescents, the Government of Bangladesh (GoB) in 2012, instituted a national policy for adolescent girls' weekly iron and folic acid (WIFA) supplementation in secondary schools to reduce anemia. Efforts are in place to roll out a national WIFA supplementation program for both in-school and out-of-school adolescent girls aged 10-19 years. Responding to the need to demonstrate the feasibility of such a new initiative before it is scaled-up, Nutrition International (NI) with funding support from the Government of Canada committed to providing technical and financial support to demonstrate to the GoB, the feasibility of a school-based delivery of nutrition interventions to improve the nutrition and health status of adolescents in Joypurhat and Sirajganj districts of Bangladesh. The project developed and began roll out of a multi-sectorial holistic and integrated nutrition approach consisting of both a nutrition-specific and nutrition-sensitive program model for improving the general health and nutrition of adolescents in schools. This was delivered in an integrated package for girls and boys including WIFA supplementation (girls only), promotion of improved water, sanitation and hygiene (WASH), behavior change interventions (BCI) on all topics, and support for menstrual hygiene management (MHM) for girls, including sale of menstrual products in schools. To evaluate the program, the GoB (Institute of Public Health and Nutrition, Ministry of Health and Family Welfare (IPHN) and The Directorate of Secondary and Higher Education, Ministry of Education (DSHE) and NI with technical assistance from the CDC Foundation and CDC planned process and outcome evaluations for the first year of the program's implementation.

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Key information

Conditions

Anemia Hematologic Diseases Hemic and Lymphatic Diseases Improved Water, Sanitation and Hygiene (WASH) Menstrual Hygiene Management

Age range

10 year–19 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Nutrition International

Ottawa, Ontario, K2P2K3, Canada

About this study

The outcome evaluation was a school (cluster)-based, randomized controlled trial with three equal size intervention arms, sampling adolescents, teachers, and student leaders in 75 selected schools. The study investigated the impact of the school-based program implemented in Joypurhat and aimed to examine the effectiveness and factors influencing scalability of using the secondary school platform to deliver WIFA co-packaged with WASH, MHM, and BCI to improve the nutrition and health status of adolescents in Bangladesh. The process evaluation sampled adolescents, teachers, and student leaders from 12 schools selected through convenience sampling for qualitative interviews, and determined whether the school-based program was implemented as intended, and why and how the intervention components worked to produce an impact - specifically, assessing the level of adherence.

Who can participate

Healthy volunteers accepted: Yes

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

Inclusion criteria

  • Randomly selected adolescent girl or boy
  • Present on the day(s) of the survey
  • Verbal assent and parental/guardian written consent
  • School level headteacher, assigned teacher or student leader in the various grades

Exclusion criteria

  • Girl or boy enrolled in grades other than grades 8 or 9
  • Enrolled after random selection of participants

Treatment and study plan

Weekly Iron and Folic Acid Supplementation (WIFA)

Dietary Supplement

Weekly school provision of WIFA tablets to adolescent girls

Other names: Behavior Change Intervention

WASH

Combination Product

Ensure availability (or provision) of water, sanitation, and hygiene supplies for adolescent girls and boys

Menstrual Hygiene Management

Combination Product

Support for adolescent girls' menstrual hygiene

Nutrition Behavior Change Intervention (BCI)

Behavioral

Changing the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming

MHM & WASH Behavior Change Intervention (BCI)

Behavioral

Changing the knowledge, attitudes, and practices of WASH and menstrual hygiene management

Primary outcomes

  1. Hemoglobin concentration and anemia prevalence among adolescent girls

    Time frame: Up to 12 months

    Assessment of hemoglobin concentration and anemia prevalence among adolescent girls, using HemoCue® Hb-301 photometer

  2. Iron and folate status, iron deficiency and folate insufficiency among adolescent girls

    Time frame: Up to 12 months

    a) Iron status and inflammation was assessed using a sandwich ELISA method, including 2 indicators of iron status (ferritin, sTfR) and 2 indicators of inflammation (C-reactive protein (CRP) and alpha 1-acid glycoprotein (AGP)); b) Folate status was assessed using a microbiological assay to test for red blood cell (RBC) folate and serum folate

  3. Decrease morbidity among adolescents due to improved water, sanitation and hygiene (WASH) behaviour.

    Time frame: Up to 12 months

    Recall of morbidity symptoms over the past 3 days

  4. Decrease barriers to menstrual hygiene management (MHM) for adolescent girls and thereby improve their school attendance

    Time frame: Up to 12 months

    In-school subsidized purchase of sanitary pads for menstruating girls

Sponsors and collaborators

Lead sponsor

Nutrition International

Other

Collaborators

  • CDC Foundation
  • Centers for Disease Control and Prevention
  • Directorate of Secondary and Higher Education, Ministry of Education, Bangladesh
  • Institute of Public Health and Nutrition, Ministry of Health and Family Welfare, Bangladesh

Registry information

Official study title

Evaluation of a Package of Nutrition Interventions to School-based Nutrition and Health Intervention for Adolescents in Bangladesh

Acronym: SNAP

Important dates

Study start
2019
Primary completion
2021
Study completion
2022
First posted
Jul 13, 2022
Registry last updated
Jul 13, 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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