A School-Based Cluster Randomized Controlled Trial to Evaluate the Effectiveness of Nutrition Behavior Change Communication Interventions in Improving Nutritional Status and Academic Performance of Schoolchildren in South Ethiopia: Study Protocol

Abstract

Background: School aged children in developing countries are vulnerable to malnutrition, which leads to stunting and can have adverse effects on mental development and academic performance at school. Despite several decades of work in improving childhood nutrition in Ethiopia, stunting remains a major public health concern with lack of evidence on its effect on school performance. The primary aim of this study is to addresses this gap by evaluating the effect of behavior change communication intervention on nutritional status and academic performance among school aged children in Meskan District of South Ethiopia. Methods: This school-based cluster randomized trial (c-RCT) compares the intervention arm with control arm. The intervention arm receives behavior change communication (BCC) on essential nutrition actions. The control arm receives only routine health and nutrition services. From a Meskan District, 10 clusters were selected and randomly assigned to the two study arms by randomization. The study participants will be children 10-15 years of age. Total sample size was 408 study participants. Anthropometric measurements, academic performance, nutritional knowledge, and dietary diversity will be measured at both baseline and end line. A behavior change and key poster message was providing based on essential nutrition actions for science teachers and students using class sessions and school visits. A binary logistic regression analysis will be used to identify independent predictors of nutritional status and academic performance of schoolchildren after controlling for confounding variables. The effect of BCC on micronutrient will be determined using generalized estimating equations (GEE) and or linear mixed effects models. Results: A total of 378 primary schoolchildren (10-15 years of age) were involved in the study giving a response rate of 93%. The mean age of the students was 12.8 years (SD ± 1.3 years). The prevalence of stunting and underweight was 16.9% and 37.3% respectively. The mean score of overall grades was 64.52 ± 8.45. Discussion: The findings of this study will provide sufficient evidence to develop policies and programs aimed to improve dietary diversity in children as well as nutritional knowledge (10-15 years) and to prevent micronutrient deficiencies and poor academic performance in school settings. It will also provide recommendations for strengthening the school nutrition component of behavior change communication in child health and nutrition programs. Trial registration: The study was retrospectively registered on October 28, 2016 and is available online at ClinicalTrials.gov (ID: NCT02956941).