Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
Department of Health Policy, University of California Berkeley School of Public Health, Berkeley, California, United States of America.
PLoS One. 2019 May 31;14(5):e0217893. doi: 10.1371/journal.pone.0217893. eCollection 2019.
While school-aged children in low- and middle-income countries remain highly exposed to acute infections, programs targeting this age group remain limited in scale and scope. In this paper, we evaluate the impact of a new and comprehensive primary school-based health intervention program on student-reported morbidity and anthropometric outcomes in Lusaka, Zambia.
A prospective matched control study identified 12 classes in 7 schools for the intervention and 12 classes in 7 matched schools as controls. Teachers in intervention schools were trained to deliver health lessons and to refer sick students to care. In addition, vitamin A and deworming medication were biannually administered to intervention students. The primary study outcome was student-reported morbidity. Secondary outcomes were weight, height, health knowledge, and absenteeism. Multivariable linear and logistic regression models were used to estimate program impact.
380 students ages 4-16 were enrolled in the study in 2015, and 97% were followed up at endline in 2016. The intervention decreased the adjusted odds of self-reported acute illnesses by 38% (95% CI: 0.48, 0.77) and the adjusted odds of stunting by 52% (95% CI: 0.26, 0.87). It also increased health knowledge by 0.53 standard deviations (95% CI: 0.24, 0.81). No impact was found on weight (adjusted mean difference β = 0.17, 95% CI: - 1.11, 1.44) and student absenteeism (adjusted odds ratio (aOR) = 0.89, 95% CI: 0.60, 1.33).
The results presented in this paper suggest that comprehensive school-based health programs may offer a highly effective way to improve students' health knowledge as well as their health status. Given their low cost, a more general adoption and implementation of such programs seems recommendable.
ClinicalTrials.gov Identifier: NCT03607084.
尽管中低收入国家的学龄儿童仍高度暴露于急性感染，但针对该年龄组的项目在规模和范围上仍然有限。在本文中，我们评估了一项新的、综合性的小学基础健康干预计划对赞比亚卢萨卡学生报告发病率和人体测量学结果的影响。
前瞻性匹配对照研究确定了 7 所学校的 12 个班级作为干预组，7 所匹配学校的 12 个班级作为对照组。干预学校的教师接受了教授健康课程和将患病学生转介至治疗的培训。此外，每年两次向干预组学生发放维生素 A 和驱虫药物。主要研究结果是学生报告的发病率。次要结果是体重、身高、健康知识和缺勤率。使用多变量线性和逻辑回归模型来估计项目的影响。
2015 年，380 名 4-16 岁的学生参加了该研究，其中 97%的学生在 2016 年随访结束时被跟踪。干预措施使自我报告的急性疾病的调整后几率降低了 38%（95%置信区间：0.48，0.77），使发育迟缓的调整后几率降低了 52%（95%置信区间：0.26，0.87）。它还使健康知识增加了 0.53 个标准差（95%置信区间：0.24，0.81）。体重（调整后平均差异β=0.17，95%置信区间：-1.11，1.44）和学生缺勤率（调整后比值比（aOR）=0.89，95%置信区间：0.60，1.33）均未受到影响。
本文介绍的结果表明，综合性学校基础健康计划可能是提高学生健康知识和健康状况的一种非常有效的方法。鉴于其低成本，更广泛地采用和实施此类计划似乎是值得推荐的。
ClinicalTrials.gov 标识符：NCT03607084。
