A Feasibility Study of Delivering Adolescent Nutrition Interventions Through School-Based Platforms in Ethiopia
Condition: Dietary Diversity
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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:

        1. 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?

        2. What is the exposure to adolescent nutrition interventions delivered through
           school-based platforms?

        3. What factors influenced the integration of adolescent nutrition interventions into
           school-based platforms and their outcomes?
    

Intervention name(s): School Interventions; Community Interventions; School System Interventions
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): 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.; 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.; 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.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Adolescent Nutrition; Ethiopia