Reducing Malnutrition and Helminthic Infectious Disease Among Primary School Children by the School Nurses

Study Overview
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Brief Summary
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Title: Reducing malnutrition and helminthic infectious disease among primary school children by the school nurses: School-based non-randomized study in a developing country Introduction: Globally, malnutrition alone with the infectious disease a widespread problem among primary school (5 to 12 years) children. Infectious diseases such as worm infestations are aggravated with nutritional disorders which most often lead to anemia and several complications. The prevalence of malnutrition and intestinal worm infestation/ helminthic infection is still high and the awareness level of those issues is immensely poor. However, there are limited studies that evaluated the impact of increasing health awareness by the development of the Health Awareness Program for Primary School Children (HAPSC) which is conducted by the experimentally placed school nurse in Bangladesh. Objective: To increase health awareness and knowledge towards reducing malnutrition and intestinal worm infestation by implement and evaluate the impact of the Health Awareness Program for Primary School children (HAPSC) in Bangladesh. Methods: Design: A prospective, open-label, parallel-group (1:1), cluster non-randomization controlled trial (NRCT) Site and sample: School children from four primary schools in the rural areas of North Matlab at Chandpur district at Chittagong division in Bangladesh. Duration: The duration of this study is from August 2021 to March 2024 (32nd months). Outcome variables: Primary: changes in malnutrition among primary school children. Secondary: Evaluate and reduce the prevalence of intestinal worm infestation, increase awareness and knowledge regarding malnutritional and intestinal worm infestation, improvement of health behavior (eating and hygiene), frequency of school absent days, and health-related quality of life. Conclusion: Health education by the health professional in the school setting may be an effective method for improving health behavior, and increasing awareness and knowledge levels about malnutrition and intestinal worm infestation from early childhood.

Official Title
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Reducing Malnutrition and Helminthic Infectious Disease Among Primary School Children

Conditions
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Malnutrition, Child, Intestinal Worms

Intervention / Treatment
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* Behavioral: Health Awareness Program TO Reduce Malnutrition and Helminth Infestation among Primary School children


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The primary school children who are studying in class 1 to class 5 among male, female or others gender. The children's parents or legal guardians would like to give consent and are willing to participate in the study. Those, who will be agreed to receive health check-ups, answer questionnaires and are willing to give the sample for laboratory investigation. Who will stay in the same school and area till study completion. Exclusion Criteria: The child is absent from school during the health checkup periods (at baseline) due to severe illness or without any reason and information. Who does not want to give consent and is not willing to participate. Who does not want to share their information and does not want to give the sample for laboratory investigations.

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Intervention Group<br>Health assessment (health checkup) and health awareness program to reduce malnutrition and helminth infestation among primary school children | Behavioral: Health Awareness Program TO Reduce Malnutrition and Helminth Infestation among Primary School children<br>* This interventional study period started from September 2021 up to September 2022 (13 months) by school nurses to implement HAPSC. After completing four to five months of the educational session the school nurse will collect midline follow-up data and the endline data will be collected at the end of the interventional study. In this period a total of nine months (except annual leave) will be considered an interventional education period. The intervention group will receive one educational session per week every month. School nurses will be assigned for each class to provide health education. Each session will be conducted for a maximum of 45 minutes. The community worker will be assigned to assist the school nurse and they will communicate with the child's parents about their child's healthy nutrition and good hygiene practice. The significance of healthy eating and hygiene behavior for the children will be shared with the child's parents or guardians properly.<br>|
| No Intervention: Comparison group<br>Health assessment (health checkup) was provided but no health educational intervention during the intervention period | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in malnutrition rate among primary school children | The primary outcome will be evaluated by anthropometric health assessment (Body mass index). To calculate BMI, the body weight and height will be used following the BMI formula (BMI = weight (kg) / (height)^2 (m)^2) provided by World Health Organization (WHO). Children's nutritional status and BMI-for-age will be measured by comparing the z- scores against the WHO growth reference 2007 tables for 5-19 years. The cut-off values for overweight and obesity are > + 1SD, > + 2SD respectively. On the other hand, the cut-off value for thinness is <- 2SD>. | Baseline, 4th/ 5th month after baseline (Midline) and 12th month after baseline (Endline) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of the prevalence of intestinal worm infestation among primary school children | Evaluate by health assessment and laboratory test for helminth ova and the parasite | Baseline and 12th month after baseline (Endline) | 
| Change of the children's eating and drinking behavior, and health-related hygiene behavior | Evaluate by using a questionnaire which is developed by the researcher | Baseline, 4th/ 5th month after baseline (Midline) and 12th month after baseline (Endline) | 
| Change of the awareness and knowledge regarding malnutrition and intestinal worm infestation | Evaluate by using a questionnaire which is developed by the researcher | Baseline, 4th/ 5th month after baseline (Midline) and 12th month after baseline (Endline) | 
| Change of the frequency and number of school absent days among the children | Evaluate by using a questionnaire which is developed by the researcher | Baseline, 4th/ 5th month after baseline (Midline) and 12th month after baseline (Endline) | 
| Measuring the changes of Health-related quality of life (HRQoL) of the children | Evaluate by using KIDSCREEN survey form, parents' version | Baseline, 4th/ 5th month after baseline (Midline) and 12th month after baseline (Endline) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Malnutrition, Intestinal worm infestation, School nurse, Primary school children