Evaluation of School-based Nutrition Intervention for Adolescents in Bangladesh
Condition: Anemia; Menstrual Hygiene Management; Improved Water, Sanitation and Hygiene (WASH)
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Weekly Iron and Folic Acid Supplementation (WIFA); WASH; Menstrual Hygiene Management; Nutrition Behavior Change Intervention (BCI); MHM & WASH Behavior Change Intervention (BCI)
Intervention type(s): Dietary Supplement; Combination Product; Combination Product; Behavioral; Behavioral
Intervention description(s): Weekly school provision of WIFA tablets to adolescent girls; Ensure availability (or provision) of water, sanitation, and hygiene supplies for adolescent girls and boys; Support for adolescent girls' menstrual hygiene; Changing the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming; Changing the knowledge, attitudes, and practices of WASH and menstrual hygiene management
Other intervention name(s): Behavior Change Intervention
Intervention MeSH terms: Folic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention