Lay Fieldworker Led School Health Program for Rural Primary Schools

NCT03423615 | Completed

• 1 other identifier: 17-2105
• Study Type: interventional
• Target: 2,909
• Locations: 0 countries
• Sites: N/A

Brief Summary

School-aged children in low and middle-income countries (LMIC) face significant challenges to their health and development which contribute to poor academic achievement. Multi-component comprehensive school health programs guided by the World Health Organization's (WHO) Health Promoting Schools (HPS) framework have been shown to positively impact health outcomes. Such programs are implemented widely throughout the world. However, in LMIC the scope and reach of school health programs are limited by human resource constraints. A key challenge to effective implementation has been the identification of effective delivery agents. A potential alternative approach is to leverage existing community members as lay fieldworkers for the delivery of school health promotion. Our hypothesis is that lay-fieldworkers can effectively implement comprehensive school health programs in resource-constrained primary schools. This hypothesis will be tested by retrospectively analyzing data obtained during a 5-year pilot of a school health program (CHHIP) in rural primary schools of the Darjeeling Himalayas of India.

Conditions

Health Promotion; Diarrhea

Keywords

School Health Services; Health Education; Primary Schools; Republic of India

Outcome Measures

Primary Outcomes (1)

• Diarrhea incidence

  Diarrheal incidence was assessed by verbal parental recall based on previous 14-days.

  March, July, and November of each academic school year through the duration of the study (up to 5-years)

Secondary Outcomes (1)

• Health Knowledge

  Baseline and week 32 of each academic year through the duration of the study (up to 5-years)

Other Outcomes (2)

• Coverage rates

  At the time of intervention delivery

• Fidelity

  At the time of intervention delivery

Study Arms (2)

CHHIP Arm

EXPERIMENTAL

All enrolled students in schools in the CHHIP Arm were eligible to receive the CHHIP intervention. The CHHIP intervention was delivered by lay fieldworkers (SHAs). Intervention activities included: 1. Health Education: activity-based curriculum with lessons delivered once per week. Units include hygiene, nutrition, safety, disease prevention\& management, and social, emotional, and behavior development. 2. Basic Primary Health Services: school-based treatment including deworming and iron supplementation; screening and referral programs including growth monitoring, well-child exam, vision screening, epilepsy screening, and oral health; psychosocial and counseling support for students with atypical behaviors. 3. Health School Environment: improvements to physical infrastructure including latrines and water systems; modeling of positive behavior reinforcement, inclusive learning environment, and avoidance of corporal punishment.

Behavioral: Comprehensive Health & Hygiene Improvement Program (CHHIP)

Comparison Arm

NO INTERVENTION

All enrolled students in schools in the Comparison Arm received school health activities as were routinely available in their school, through their curriculum, or through special events.

Interventions

Comprehensive Health & Hygiene Improvement Program (CHHIP) BEHAVIORAL

CHHIP is an intense, multi-component holistic school health program based on the WHO Health Promoting School framework and designed for implementation by lay fieldworkers.

CHHIP Arm

Eligibility Criteria

• Age: 3 Years - 13 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

Three geographic regions representative of rural Darjeeling were identified and all primary schools in these regions were considered eligible for participation in the intervention. A convenience sample of 22 schools were pragmatically selected.

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• University of Colorado, Denver: lead
• Broadleaf Health and Education Alliance: collaborator
• Darjeeling Ladenla Road Prerna (DLRP): collaborator

Related Publications (1)

• Matergia M, Ferrarone P, Khan Y, Matergia DW, Giri P, Thapa S, Simoes EAF. Lay Field-worker-Led School Health Program for Primary Schools in Low- and Middle-Income Countries. Pediatrics. 2019 Apr;143(4):e20180975. doi: 10.1542/peds.2018-0975. Epub 2019 Mar 14.

  PMID: 30872330 DERIVED

MeSH Terms

Conditions

Diarrhea; Health Education

Condition Hierarchy (Ancestors)

Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Adherence Interventions; Medication Adherence; Patient Compliance; Patient Acceptance of Health Care; Treatment Adherence and Compliance; Health Behavior; Behavior

Study Officials

• Michael Matergia, MD

  Center for Global Health, Colorado School of Public Health, Aurora, Colorado, USA

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: We will use a stepped-wedge cluster controlled model to reflect the pragmatic enrollment and crossover of schools between intervention arms.

Study Record Dates

• First Submitted: January 20, 2018
• First Posted: February 6, 2018
• Study Start: February 1, 2012
• Primary Completion: November 15, 2016
• Study Completion: December 31, 2016
• Last Updated: February 6, 2018

Record last verified: 2018-01