Effectiveness of Edutainment-Based Interventions in Increasing Knowledge of Rheumatic Fever and Rheumatic Heart Disease Among School-Going Children in Nepal: Study Protocol for Colors to Save Hearts Quasi-Experimental Pretest-Posttest Study

The primary aim of this study is to evaluate the effectiveness of an edutainment-based educational intervention in improving knowledge about acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among school-going children in Nepal. The secondary aims are to assess the prevalence of RHD-related symptoms among school-going children through basic clinical screening, evaluate the baseline knowledge levels of students regarding ARF and RHD, and measure the effectiveness of the intervention in improving students' knowledge through a quasi-experimental pretest-posttest design.

Based on these aims, the primary hypothesis (H1) is that the edutainment-based intervention will lead to a statistically significant improvement in knowledge scores related to ARF and RHD among schoolchildren in the intervention group when compared to their baseline scores.

Methods Study Design This study will employ a quasi-experimental pretest-posttest design with a waitlist control group to evaluate the effectiveness of an edutainment-based educational intervention aimed at increasing knowledge about ARF and RHD among school-going children.

Study Setting This study will be conducted across six diverse districts of Nepal, selected to represent a range of geographical regions and socio-economic conditions. The chosen districts are Bardiya, Bajhang, Dailekh, Gulmi, Jhapa, and Siraha. Each of these districts includes a mix of urban, semi-urban, and rural areas, allowing the study to capture variation in health awareness, access to education, and healthcare infrastructure. These districts were purposively selected due to their involvement in the PEN-Plus project, an initiative led by the Kathmandu Institute of Child Health (KIOCH). Within each district, one municipality has been selected as the implementation site for the intervention.

Participants selection Inclusion and exclusion criteria This study includes school-going children enrolled in public schools from grades 6 to 9 within the selected municipalities of six districts in Nepal. Students will be eligible for inclusion in the study if they are formally enrolled in one of the selected public schools and are studying in grades 6 to 9 during implementation of this study. To ensure ethical compliance, only those students whose parents or guardians provide written informed consent will be allowed to participate. In addition, assent will be obtained from the students themselves. Students will be excluded from the study if they or their guardians decline to participate or fail to provide the required consent and assent. Students who are absent during both the baseline and post-intervention assessments will also be excluded from the final analysis.