Community members successfully implement school-based health programs

1. The Incidence of diarrheal illness decreased by almost 50% among rural primary school children at low-cost private schools in rural India who received school health program interventions implemented by lay community members, compared to those who did not.

2. Intervention coverage rates exceeded 90% of eligible children, and children in the intervention group at both low-cost private schools and government schools demonstrated improved health-knowledge acquisition compared to control groups.

Study Rundown: Most children spend a significant amount of time at school, thus this setting has been recognized as an important and effective environment to implement positive changes in health behaviors, with the potential to significantly reduce morbidity and mortality among children, particularly in low- and middle-income countries (LMICs). The World Health Organization (WHO) developed the health-promoting school framework for schools to make these changes, however implementation has been challenging, in part due to lack of trained delivery agents. In this study, investigators evaluated the impact of using lay community members to implement a Comprehensive Health and Hygiene Improvement Program (CHHIP) in resource-limited primary schools in the Himalayan region of India. Results showed a decrease in rates of diarrheal illness among children receiving the intervention at low-cost private schools, as well as improved health-knowledge acquisition among the intervention groups at both private and government schools. Coverage rates and health-knowledge acquisition were both >90%. Quality assessments showed stakeholders at both types of schools had positive perceptions of the impact of the field-worker-implemented improvement projects. Of note, lay-workers received immense support with their projects during the study, which may not be realistic in real-world conditions and may limit overall generalizability. Nevertheless, results suggest that this model of training community members to implement health improvement projects may be an effective way to improve health behaviors among children in LMICs.

Click to read the study, published today in Pediatrics 

Recommended reading: The WHO health promoting school framework for improving health and well-being of students and their academic achievement.

In-depth [non-randomized, cluster-controlled study]: Investigators in this study evaluated the effectiveness of using trained lay-field workers to implement CHHIP in 22 rural Indian primary schools (13 government, 9 low-cost private) to improve health outcomes and health-knowledge among children in kindergarten through 4th grade. The study took place over a 5-year time period (2100 student-years intervention, 933 student-years control). Four community members were trained in CHHIP implementation and spent 1 day per week teaching CHHIP at each of their 4 assigned schools. The cost of program implementation was roughly $2300 per school. Results showed students at low-cost private schools who received the intervention were significantly less likely to contract diarrheal disease compared to those in the control group (incidence rate ratio [IRR] 0.58; 95% CI 0.47-0.71, P<.001), whereas no difference was seen among the two groups in government schools (IRR 0.87; 95% CI 0.68-1.12, P=.29). Children who received intervention at both school types showed evidence of higher health-knowledge acquisition compared to the control group as measured by pre- and post-test assessments (mean difference 12.6%; 95% CI 8.8-16.4; P<.001). Feedback from parents and teachers showed these stakeholders had strong positive perceptions of the impact of CHHIP, as manifested by student weight gain, positive behavior change, and improved school learning environments. The cumulative intervention coverage rate was 93.9% (SD 2.0%), and SHA performance assessments had a mean value of 3.45 out of 5, (N=92; SD 0.69) which were both above the predefined threshold for quality and consistency of implementation.

Image: PD

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