Impact of Malaria Prevention on Health and Education in Kenyan Schoolchildren
Condition: Anaemia; Malaria
MeSH terms: Malaria
Study type: Interventional

Summary: 
      While malaria represents one of the main health problems afflicting schoolchildren, the
      evidence base for policy development and programme implementation for school-based malaria
      control remains inadequate. A recent study in western Kenya showed that delivering
      intermittent preventive treatment (IPT) to schoolchildren improved rates of anaemia and
      classroom concentration, but did not improve school performance. This study aims to (i)
      investigate the impact of malaria prevention using a strategy of periodic screening using
      malaria rapid diagnostic tests and treatment positives using artemether-lumefantrine (AL) on
      health and education among schoolchildren and (ii) determine the interaction between health
      and improved literacy instruction. The study hypothesis is that that school-based malaria
      prevention will reduce rates of anaemia or improve educational outcomes in Kenyan
      schoolchildren, when compared to comparison schools. In addition, a programme of training for
      primary school teachers to improve literacy instruction will improve literacy rates and there
      will be no interaction between the malaria intervention and the education intervention, such
      that learning will not be improved when teaching is effective and children are healthy. The
      study will be undertaken in 101 randomly selected primary schools in Kwale District. The
      malaria intervention consists of screening all children using rapid diagnostic tests (RDTs)
      for malaria. Children (with or without clinical malaria symptoms) found to be RDT-positive
      will be treated with AL according to national guidelines. Screening and treatment will be
      administered by district public health staff once a school term, observed by the evaluation
      research team. This intervention has been changed from IPT due to the withdrawal of
      amodiaquine in Kenya. The education intervention includes a programme of training for primary
      school teachers to improve literacy instruction. The study is designed to detect a 25%
      reduction in anaemia and an improvement of 0.2 standard deviations in mathematics and
      literacy tests. Additional outcomes will also be measured including malaria parasitaemia,
      classroom attention and school attendance. Cost-effectiveness and community acceptability of
      the interventions will be assessed. Anaemia and educational outcomes will be assessed before
      interventions and 12 and 24 months later. Malaria parasitaemia using blood slides will only
      be assessed at follow-up.
    

Detailed description: 
      This study will be a factorial-design, cluster-randomised trial with a comparison group to
      assess the impact of (i) malaria prevention, based on screening and treatment, and (ii)
      enhanced literacy instruction by teachers on the health and educational achievement of
      healthy schoolchildren.

      The target population in this study includes children attending primary schools in Kenya. The
      accessible population includes the children attending the participating primary schools in
      classes 1 and 5 in Kwale district. Schools will be randomized to one of four groups,
      receiving either the screening and treatment intervention alone, the education intervention
      alone, the malaria and education interventions combined, or neither intervention. The unit of
      analysis is the school, but individual-level analysis using suitable generalised linear
      models, adjusted for clustering by school, will also be undertaken to explore differences in
      impact of the interventions according to child age, sex, home environment, school quality as
      well as differences in the uptake of each intervention.
    

Intervention name(s): Intermittent screening and treatment for malaria; Teacher training on literacy instruction; IST plus literacy instruction programme
Intervention type(s): Drug; Behavioral; Other
Intervention description(s): All children will be screened for malaria using rapid diagnostic tests (RDTs) once a term (thrice yearly). Children (with or without clinical malaria symptoms) found to be RDT-positive will be treated with artemether-lumefantrine according to national guidelines. Screening and treatment will be administered by district public health staff once a school term, observed by the evaluation research team.; Education intervention designed to improved early grade literacy instruction, focusing on phonological awareness & vocabulary and relationship between letters and sounds in a systematic and explicit fashion. Specific interventions will include training on (i) how to monitor students' progress in large classes (ii) developing and using instructional materials for reading (iii) lesson planning for explicit teaching of letter-sound relationships (iv) instructional techniques for large classes.; Schools will receive both IST and the literacy instruction programme
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Anaemia; Malaria; Literacy; Kenya