Evaluation of a Comprehensive School Health Programme in Zambia
NCT Number: NCT06560853
Status: ACTIVE_NOT_RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Helminth Infection|Malaria|Schistosomiasis|Anemia|UTI|Diarrhea|Skin Rash|Cough
Interventions: OTHER: Comprehensive School Health Programme|OTHER: Deworming and vitamin A supplementation delivery
Sponsor: London School of Economics and Political Science
Collaborators: University of Virginia|Healthy Learners|United States Agency for International Development (USAID)|Medical Research Council
Sex: ALL
Age: CHILD, ADULT, OLDER_ADULT
Enrollment: 28700
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: NONE|Primary Purpose: HEALTH_SERVICES_RESEARCH
Start Date: 2024-02-27
Completion Date: 2026-11-30
Locations: Chingola District Education Board, Chingola, Copperbelt, Zambia|Luanshya District Education Board, Luanshya, Copperbelt, Zambia|Masaiti District Education Board, Masaiti, Copperbelt, Zambia|Kawambwa District Education Board, Kawambwa, Luapula, Zambia|Mwense District Education Board, Mwense, Luapula, Zambia|Samfya District Education Board, Samfya, Luapula, Zambia

Summary:
In Zambia, the health and well-being of children aged 5 to 14 has often been overlooked, leading to various health challenges affecting their development and education. The Healthy Learners (HL) program, in collaboration with the Zambian Government, aims to address this gap by implementing a comprehensive school health program. Trained teachers, known as school health workers (SHWs), play a key role by delivering health education, coordinating preventative care with local clinics, and overseeing a 'school health room' for sick students.

This study is a large cluster-randomized control trial in 225 schools. The goal of this trial is to compare the effects of the comprehensive school health programme (SHP) developed by HL against two alternatives: the current level of school health provision and the current school health activities enhanced with deworming and vitamin A coordination by HL, with their technical and financial support ensuring the reliable delivery of all health activities currently planned by the government.

1. What is the impact of the program on health-seeking, health, and education outcomes?
2. What are the indirect effects of the program on teachers and clinics?
3. What is the added value of such a comprehensive SHP, compared to (i) optimized (ii) or imperfect (status-quo) delivery of a limited range of school health activities (e.g., deworming and vitamin A supplements)?
4. How costly is the comprehensive SHP, and what factors affect its implementation?
5. What are the potential benefits of the program for long-term human capital accumulation (learning, well-being etc)?

Primary Outcome Measures: Synthetic morbidity index, Because the SHP delivers treatment of several diseases, we will create a composite disease burden index of the following outcomes:

* malaria positive (using a rapid diagnostic test)
* moderate to high worm load (using a stool test)
* anaemia (using a hemocue test)
* schistosomiasis (using a urine test)
* diarrhoea in the past week (learner self-report) We test these outcomes in a randomly selected panel of 13,300 learners recruited at baseline, which ensures variety of age groups and balance of genders., 18 months after intervention start|Average attendance rate over 24 months, We will measure attendance during unannounced attendance spot checks (one per term over a 2-year period). Multiple measurements are required to capture seasonal variation. On each spot check visit, we will check attendance of a panel of learners randomly selected at baseline, which ensures variety of age groups and balance of genders. We will calculate each child's attendance rate across all the spot checks., 24 months after intervention start