SNAP: Evaluation of School-based Nutrition Intervention for Adolescents in Bangladesh

Sponsor
Nutrition International (Other)
Overall Status
Completed
CT.gov ID
NCT05455073
Collaborator
Centers for Disease Control and Prevention (U.S. Fed), CDC Foundation (Other), Institute of Public Health and Nutrition, Ministry of Health and Family Welfare, Bangladesh (Other), Directorate of Secondary and Higher Education, Ministry of Education, Bangladesh (Other)
3,018
1
3
31
97.4

Study Details

Study Description

Brief Summary

Addressing the nutrition needs of adolescents could be an important initiative for breaking the vicious cycle of intergenerational malnutrition, chronic diseases and poverty. To respond to these diverse needs of adolescents, the Government of Bangladesh (GoB) in 2012, instituted a national policy for adolescent girls' weekly iron and folic acid (WIFA) supplementation in secondary schools to reduce anemia. Efforts are in place to roll out a national WIFA supplementation program for both in-school and out-of-school adolescent girls aged 10-19 years. Responding to the need to demonstrate the feasibility of such a new initiative before it is scaled-up, Nutrition International (NI) with funding support from the Government of Canada committed to providing technical and financial support to demonstrate to the GoB, the feasibility of a school-based delivery of nutrition interventions to improve the nutrition and health status of adolescents in Joypurhat and Sirajganj districts of Bangladesh. The project developed and began roll out of a multi-sectorial holistic and integrated nutrition approach consisting of both a nutrition-specific and nutrition-sensitive program model for improving the general health and nutrition of adolescents in schools. This was delivered in an integrated package for girls and boys including WIFA supplementation (girls only), promotion of improved water, sanitation and hygiene (WASH), behavior change interventions (BCI) on all topics, and support for menstrual hygiene management (MHM) for girls, including sale of menstrual products in schools. To evaluate the program, the GoB (Institute of Public Health and Nutrition, Ministry of Health and Family Welfare (IPHN) and The Directorate of Secondary and Higher Education, Ministry of Education (DSHE) and NI with technical assistance from the CDC Foundation and CDC planned process and outcome evaluations for the first year of the program's implementation.

Condition or Disease Intervention/Treatment Phase
  • Dietary Supplement: Weekly Iron and Folic Acid Supplementation (WIFA)
  • Combination Product: WASH
  • Combination Product: Menstrual Hygiene Management
  • Behavioral: Nutrition Behavior Change Intervention (BCI)
  • Behavioral: MHM & WASH Behavior Change Intervention (BCI)
N/A

Detailed Description

The outcome evaluation was a school (cluster)-based, randomized controlled trial with three equal size intervention arms, sampling adolescents, teachers, and student leaders in 75 selected schools. The study investigated the impact of the school-based program implemented in Joypurhat and aimed to examine the effectiveness and factors influencing scalability of using the secondary school platform to deliver WIFA co-packaged with WASH, MHM, and BCI to improve the nutrition and health status of adolescents in Bangladesh. The process evaluation sampled adolescents, teachers, and student leaders from 12 schools selected through convenience sampling for qualitative interviews, and determined whether the school-based program was implemented as intended, and why and how the intervention components worked to produce an impact - specifically, assessing the level of adherence.

Study Design

Study Type:
Interventional
Actual Enrollment :
3018 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Prevention
Official Title:
Evaluation of a Package of Nutrition Interventions to School-based Nutrition and Health Intervention for Adolescents in Bangladesh
Actual Study Start Date :
Jul 31, 2019
Actual Primary Completion Date :
Mar 22, 2021
Actual Study Completion Date :
Feb 28, 2022

Arms and Interventions

Arm Intervention/Treatment
Experimental: Full package intervention arm

Dietary Supplement of Weekly Iron and Folic Acid (WIFA) Supplementation (containing 60 mg of elemental iron and 2800 µg of folic acid) and; Associated behavior change intervention (BCI) to change the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming Water, sanitation and hygiene (WASH) intervention: ensure availability (or provision) of water, sanitation, and hygiene supplies Menstrual hygiene management (MHM) intervention: support for menstrual hygiene, including sale of menstrual products in schools Associated behavior change intervention (BCI) to change the knowledge, attitudes, and practices (KAP) of WASH and menstrual hygiene management (MHM)

Dietary Supplement: Weekly Iron and Folic Acid Supplementation (WIFA)
Weekly school provision of WIFA tablets to adolescent girls
Other Names:
  • Behavior Change Intervention
  • Combination Product: WASH
    Ensure availability (or provision) of water, sanitation, and hygiene supplies for adolescent girls and boys

    Combination Product: Menstrual Hygiene Management
    Support for adolescent girls' menstrual hygiene

    Behavioral: Nutrition Behavior Change Intervention (BCI)
    Changing the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming

    Behavioral: MHM & WASH Behavior Change Intervention (BCI)
    Changing the knowledge, attitudes, and practices of WASH and menstrual hygiene management

    Experimental: Limited package intervention arm

    Dietary Supplement of Weekly Iron and Folic Acid (WIFA) Supplementation (containing 60 mg of elemental iron and 2800 µg of folic acid; weekly school provision of WIFA tablets) and; Associated behavior change intervention (BCI) to change the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming

    Dietary Supplement: Weekly Iron and Folic Acid Supplementation (WIFA)
    Weekly school provision of WIFA tablets to adolescent girls
    Other Names:
  • Behavior Change Intervention
  • Behavioral: Nutrition Behavior Change Intervention (BCI)
    Changing the knowledge, attitudes, and practices of nutrition (including dietary diversity), IFA, deworming

    No Intervention: Control

    No intervention.

    Outcome Measures

    Primary Outcome Measures

    1. Hemoglobin concentration and anemia prevalence among adolescent girls [Up to 12 months]

      Assessment of hemoglobin concentration and anemia prevalence among adolescent girls, using HemoCue® Hb-301 photometer

    2. Iron and folate status, iron deficiency and folate insufficiency among adolescent girls [Up to 12 months]

      a) Iron status and inflammation was assessed using a sandwich ELISA method, including 2 indicators of iron status (ferritin, sTfR) and 2 indicators of inflammation (C-reactive protein (CRP) and alpha 1-acid glycoprotein (AGP)); b) Folate status was assessed using a microbiological assay to test for red blood cell (RBC) folate and serum folate

    3. Decrease morbidity among adolescents due to improved water, sanitation and hygiene (WASH) behaviour. [Up to 12 months]

      Recall of morbidity symptoms over the past 3 days

    4. Decrease barriers to menstrual hygiene management (MHM) for adolescent girls and thereby improve their school attendance [Up to 12 months]

      In-school subsidized purchase of sanitary pads for menstruating girls

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    10 Years to 19 Years
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    Yes
    Inclusion Criteria:
    • Randomly selected adolescent girl or boy

    • Present on the day(s) of the survey

    • Verbal assent and parental/guardian written consent

    • School level headteacher, assigned teacher or student leader in the various grades

    Exclusion Criteria:
    • Girl or boy enrolled in grades other than grades 8 or 9

    • Enrolled after random selection of participants

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Nutrition International Ottawa Ontario Canada K2P2K3

    Sponsors and Collaborators

    • Nutrition International
    • Centers for Disease Control and Prevention
    • CDC Foundation
    • Institute of Public Health and Nutrition, Ministry of Health and Family Welfare, Bangladesh
    • Directorate of Secondary and Higher Education, Ministry of Education, Bangladesh

    Investigators

    None specified.

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Nutrition International
    ClinicalTrials.gov Identifier:
    NCT05455073
    Other Study ID Numbers:
    • NI-02-2019-SNAP
    First Posted:
    Jul 13, 2022
    Last Update Posted:
    Jul 13, 2022
    Last Verified:
    Apr 1, 2022
    Individual Participant Data (IPD) Sharing Statement:
    No
    Plan to Share IPD:
    No
    Studies a U.S. FDA-regulated Drug Product:
    No
    Studies a U.S. FDA-regulated Device Product:
    No
    Additional relevant MeSH terms:

    Study Results

    No Results Posted as of Jul 13, 2022