Gelli Aulo, Masset Edoardo, Folson Gloria, Kusi Anthoni, Arhinful Daniel K, Asante Felix, Ayi Irene, Bosompem Kwabena M, Watkins Kristie, Abdul-Rahman Lutuf, Agble Rosanna, Ananse-Baden Getrude, Mumuni Daniel, Aurino Elisabetta, Fernandes Meena, Drake Lesley
International Food Policy Research Institute (IFPRI), 2033 K Street NW, Washington, DC, 20006, USA.
Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK.
Trials. 2016 Jan 20;17:37. doi: 10.1186/s13063-015-1116-0.
BACKGROUND: 'Home-grown' school feeding programmes are complex interventions with the potential to link the increased demand for school feeding goods and services to community-based stakeholders, including smallholder farmers and women's groups. There is limited rigorous evidence, however, that this is the case in practice. This evaluation will examine explicitly, and from a holistic perspective, the simultaneous impact of a national school meals programme on micronutrient status, alongside outcomes in nutrition, education and agriculture domains. The 3-year study involves a cluster-randomised control trial designed around the scale-up of the national school feeding programme, including 116 primary schools in 58 districts in Ghana. The randomly assigned interventions are: 1) a school feeding programme group, including schools and communities where the standard government programme is implemented; 2) 'home-grown' school feeding, including schools and communities where the standard programme is implemented alongside an innovative pilot project aimed at enhancing nutrition and agriculture; and 3) a control group, including schools and households from communities where the intervention will be delayed by at least 3 years, preferably without informing schools and households. Primary outcomes include child health and nutritional status, school participation and learning, and smallholder farmer income. Intermediate outcomes along the agriculture and nutrition pathways will also be measured. The evaluation will follow a mixed-method approach, including child-, household-, school- and community-level surveys as well as focus group discussions with project stakeholders. The baseline survey was completed in August 2013 and the endline survey is planned for November 2015. RESULTS: The tests of balance show significant differences in the means of a number of outcome and control variables across the intervention groups. Important differences across groups include marketed surplus, livestock income, per capita food consumption and intake, school attendance, and anthropometric status in the 2-5 and 5-15 years age groups. In addition, approximately 19 % of children in the target age group received some form of free school meals at baseline. CONCLUSION: Designing and implementing the evaluation of complex interventions is in itself a complex undertaking, involving a multi-disciplinary research team working in close collaboration with programme- and policy-level stakeholders. Managing the complexity from an analytical and operational perspective is an important challenge. The analysis of the baseline data indicates that the random allocation process did not achieve statistically comparable treatment groups. Differences in outcomes and control variables across groups will be controlled for when estimating treatment effects. TRIAL REGISTRATION NUMBER: ISRCTN66918874 (registered on 5 March 2015).
背景:“本土”学校供餐计划是复杂的干预措施,有可能将对学校供餐商品和服务不断增长的需求与包括小农和妇女团体在内的社区利益相关者联系起来。然而,在实践中,鲜有确凿证据表明情况确实如此。本评价将从整体角度明确考察一项全国学校供餐计划对微量营养素状况的同时影响,以及营养、教育和农业领域的成果。这项为期3年的研究涉及一项围绕全国学校供餐计划扩大规模设计的整群随机对照试验,涵盖加纳58个区的116所小学。随机分配的干预措施包括:1)学校供餐计划组,包括实施标准政府计划的学校和社区;2)“本土”学校供餐,包括实施标准计划并同时开展旨在改善营养和农业的创新试点项目的学校和社区;3)对照组,包括来自干预至少推迟3年的社区的学校和家庭,最好不通知学校和家庭。主要成果包括儿童健康和营养状况、学校参与度和学习情况以及小农收入。还将衡量农业和营养途径方面的中间成果。评价将采用混合方法,包括儿童、家庭、学校和社区层面的调查以及与项目利益相关者的焦点小组讨论。基线调查于2013年8月完成,终线调查计划于2015年11月进行。 结果:均衡性检验显示,各干预组在一些成果变量和对照变量的均值上存在显著差异。组间的重要差异包括市场剩余、畜牧收入、人均食物消费和摄入量、学校出勤率以及2至5岁和5至15岁年龄组的人体测量状况。此外,目标年龄组中约19%的儿童在基线时接受了某种形式的免费学校供餐。 结论:设计和实施复杂干预措施的评价本身就是一项复杂的工作,需要一个多学科研究团队与项目和政策层面的利益相关者密切合作。从分析和操作角度应对复杂性是一项重大挑战。对基线数据的分析表明,随机分配过程并未产生统计学上可比的治疗组。在估计治疗效果时,将对组间成果变量和对照变量的差异进行控制。 试验注册号:ISRCTN66918874(于2015年3月5日注册)。
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