A Feasibility Study of Delivering Adolescent Nutrition Interventions Through School-Based Platforms in Ethiopia

Not Applicable

Completed

• Conditions: Dietary Diversity
• Interventions: Behavioral: School Interventions; Behavioral: Community Interventions; Behavioral: School System Interventions

• Registration Number: NCT04121559
• Lead Sponsor: International Food Policy Research Institute

Brief 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?

Study Timeline

• Study Start: 2019-10-08
• Study First Submitted: 2019-10-08
• Study First Submitted QC: 2019-10-08
• Study First Posted: 2019-10-10
• Primary Completion: 2021-04-29
• Study Completion: 2021-04-29
• Status Verified: 2022-02
• Last Update Submitted: 2022-02-23
• Last Update Posted: 2022-03-10

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 1712

Inclusion Criteria

• Currently enrolled in primary school grades 4-8
• Parental consent and informed assent received
• Principals, teachers, service providers and primary schools in the areas

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Exclusion Criteria

• Age <10 years or >14 years

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	School Interventions	A\&T intervention areas: adolescent-nutrition-focused behavior change interventions delivered through government primary schools and communities
Intervention	Community Interventions	A\&T intervention areas: adolescent-nutrition-focused behavior change interventions delivered through government primary schools and communities
Intervention	School System Interventions	A\&T intervention areas: adolescent-nutrition-focused behavior change interventions delivered through government primary schools and communities

Primary Outcome Measures

Name	Time	Method
Dietary diversity among adolescent girls	Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021	Mean number of food groups consumed by adolescent girls on the day preceding the interview.
Minimum dietary diversity among adolescent girls	Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021	Proportion of adolescent girls who consumed 5 or more food groups on the day preceding the interview.

Secondary Outcome Measures

Name	Time	Method
Nutrition and handwashing knowledge among school science teachers, principals, and HEWs	Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021	Proportion of school science teachers, principals, and HEWs with correct knowledge of nutrition and appropriate handwashing practices based on survey responses
Exposure to nutrition interventions at school and in the community	Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021	Proportion of adolescent girls exposed to nutrition interventions at school and in the community
Availability of supporting resources	Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021	Proportion of primary schools with training and supportive supervision for teachers/staff, educational materials, and healthy food environments based on enumerator observation and survey responses
Meal frequency	Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021	Number of meal/snack times in the previous 24 hours
Consumption of unhealthy foods	Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021	Consumption of sweets, baked sweets, sweetened beverages, and fried and salty foods in the previous 24 hours
Nutrition and handwashing knowledge and practices among adolescent girls and their parents	Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021	Proportion of adolescent girls and parents with correct knowledge of nutrition and appropriate handwashing practices based on survey responses
Delivery of adolescent nutrition interventions by school science teachers, principals, and HEWs	Approximately 17 months after baseline in a cross-sectional endline survey in March-April 2021	Proportion of school science teachers, principals, and HEWs providing adolescent nutrition interventions at school and in the community based on survey responses

Trial Locations

Locations (1)

International Food Policy Research Institute; 🇺🇸 Washington, District of Columbia, United States