Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.
University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
BMC Public Health. 2020 Feb 3;20(1):158. doi: 10.1186/s12889-019-8027-z.
It has been suggested that specific interventions delivered through the education sector in low- and middle-income countries might improve children's health and wellbeing. This cluster-randomised controlled trial aimed to evaluate the effects of a school garden programme and complementary nutrition, and water, sanitation and hygiene (WASH) interventions on children's health and nutritional status in two districts of Nepal.
The trial included 682 children aged 8-17 years from 12 schools. The schools were randomly allocated to one of three interventions: (a) school garden programme (SG; 4 schools, n = 172 children); (b) school garden programme with complementary WASH, health and nutrition interventions (SG+; 4 schools, n = 197 children); and (c) no specific intervention (control; 4 schools, n = 313 children). The same field and laboratory procedures were employed at the baseline (March 2015) and end-line (June 2016) surveys. Questionnaires were administered to evaluate WASH conditions at schools and households. Water quality was assessed using a Delagua kit. Dietary intake was determined using food frequency and 24-h recall questionnaire. Haemoglobin levels were measured using HemoCue digital device and used as a proxy for anaemia. Stool samples were subjected to a suite of copro-microscopic diagnostic methods for detection of intestinal protozoa and helminths. The changes in key indicators between the baseline and end-line surveys were analysed by mixed logistic and linear regression models.
Stunting was slightly lowered in SG+ (19.9 to 18.3%; p = 0.92) and in the control (19.7 to 18.9%). Anaemia slightly decreased in SG+ (33.0 to 32.0%; p < 0.01) and markedly increased in the control (22.7 to 41.3%; p < 0.01), a minor decline was found in the control (43.9 to 42.4%). Handwashing with soap before eating strongly increased in SG+ (from 74.1 to 96.9%; p = 0.01, compared to control where only a slight increase was observed from 78.0 to 84.0%). A similar observation was made for handwashing after defecation (increase from 77.2 to 99.0% in SG+ versus 78.0 to 91.9% in control, p = 0.15).
An integrated intervention consisting of school garden, WASH, nutrition and health components (SG+) increased children's fruit and vegetable consumption, decreased intestinal parasitic infections and improved hygiene behaviours.
ISRCTN17968589 (date assigned: 17 July 2015).
有人提出，在中低收入国家通过教育部门提供的具体干预措施可能会改善儿童的健康和福利。本项整群随机对照试验旨在评估学校花园计划和补充营养以及水、环境卫生和个人卫生（WASH）干预措施对尼泊尔两个地区儿童健康和营养状况的影响。
该试验纳入了来自 12 所学校的 682 名 8-17 岁的儿童。这些学校被随机分配到三个干预组之一：（a）学校花园计划（SG；4 所学校，n=172 名儿童）；（b）学校花园计划+补充 WASH、健康和营养干预（SG+；4 所学校，n=197 名儿童）；和（c）无特定干预（对照组；4 所学校，n=313 名儿童）。在基线（2015 年 3 月）和终线（2016 年 6 月）调查中采用了相同的现场和实验室程序。问卷调查评估学校和家庭的 WASH 条件。使用 Delagua 试剂盒评估水质。使用食物频率和 24 小时回顾问卷确定饮食摄入。使用 HemoCue 数字设备测量血红蛋白水平，并将其用作贫血的替代指标。粪便样本进行了一系列粪便显微镜诊断方法检测肠道原生动物和蠕虫感染。通过混合逻辑回归和线性回归模型分析关键指标在基线和终线调查之间的变化。
SG+组的发育迟缓略有降低（19.9%降至 18.3%；p=0.92），对照组也略有降低（19.7%降至 18.9%）。SG+组的贫血略有下降（33.0%降至 32.0%；p<0.01），对照组明显增加（22.7%增至 41.3%；p<0.01），对照组则略有下降（43.9%降至 42.4%）。SG+组饭前洗手用肥皂的比例大幅增加（从 74.1%增加到 96.9%；p=0.01，而对照组仅从 78.0%增加到 84.0%）。便后洗手也观察到类似的情况（SG+组从 77.2%增加到 99.0%，而对照组从 78.0%增加到 91.9%，p=0.15）。
由学校花园、WASH、营养和健康组成的综合干预措施增加了儿童水果和蔬菜的摄入量，减少了肠道寄生虫感染，并改善了卫生习惯。
ISRCTN85104554（2015 年 7 月 17 日分配）。
