Department of Economics, Faculty of Economics, Meiji Gakuin University, Tokyo, Japan.
Department of Education and Child Development, International Programs, Save the Children Federation, Inc., Fairfield, Connecticut, USA.
BMC Public Health. 2024 Nov 27;24(1):3300. doi: 10.1186/s12889-024-20787-0.
Poor child health and hygiene practices are persistent issues in resource-constrained settings, particularly in low-income countries. This study assessed the impact of skill-based health education (SBHE) on school and child hygiene practices in rural Bangladesh.
A cluster-randomised-controlled intervention with cross-cutting/factorial design was conducted in 180 randomly selected primary schools, stratified by school type, in Jhenaidah District, Bangladesh. Weekly SBHE sessions were delivered to half of the schools by locally recruited para-teachers for one year. A cross-cutting soap provision treatment was given monthly to half of the SBHE-treatment schools and half of the SBHE-control schools. Treatment assignment was masked to all baseline and endline surveyors. Data were collected at both the school and child levels, with child-level data aggregated at the school level. Outcome measures were grouped into five thematic families. The primary outcome families were school hygiene practice & maintenance, school-aggregated child handwashing and school-aggregated child dentalcare. Utilising the difference-in-differences estimator with seemingly unrelated regression, we estimated the average treatment effect for each family of multiple outcomes. The intervention spillover effect to neighbouring schools along with the time-period effect were also evaluated. The project's cost-effectiveness was additionally assessed.
Our findings revealed that SBHE had a positive impact on primary outcomes related to healthy practices and behavioural changes, resulting in a 0.32SD improvement in school hygiene practices and maintenance (p < 0.001), a 0.47SD increase in child handwashing (p < 0.001), and a 0.43SD enhancement in child dentalcare (p < 0.01). Despite its imperfect implementation, the provision of soap itself showed no significant effect. Furthermore, significant spillover effects of healthy practices were observed in neighbouring non-treatment schools. The cost-effectiveness analysis indicated that our SBHE program was cost-effective.
Our study provides compelling evidence of the positive impact of SBHE on school hygiene and child health practices in rural Bangladesh, with notable spillover effects. The cost-effectiveness analysis underscores the value of SBHE, affirming its potential as an effective intervention method in improving school health and hygiene practices in primary schools and beyond.
在资源有限的环境中，儿童健康和卫生习惯较差是一个长期存在的问题，尤其是在低收入国家。本研究评估了基于技能的健康教育（SBHE）对孟加拉国农村地区学校和儿童卫生习惯的影响。
本研究采用了一种具有跨领域/因子设计的整群随机对照干预研究，在孟加拉国杰纳迪区随机选择了 180 所小学进行。由当地招募的助教每周向一半的学校提供 SBHE 课程，为期一年。每月向一半的 SBHE 治疗学校和一半的 SBHE 对照学校提供跨领域的肥皂供应治疗。所有基线和终线调查员均对治疗分配情况不知情。数据在学校和儿童两个层面进行收集，儿童层面的数据汇总到学校层面。结果指标分为五个主题类别。主要结果类别为学校卫生实践和维护、学校综合儿童洗手和学校综合儿童口腔保健。我们利用似乎不相关回归的差异中的差异估计量，估计了多个结果类别的平均处理效果。还评估了干预措施对相邻学校的溢出效应以及时间效应。此外，还评估了该项目的成本效益。
我们的研究结果表明，SBHE 对健康实践和行为改变相关的主要结果产生了积极影响，使学校卫生实践和维护提高了 0.32SD（p<0.001），儿童洗手增加了 0.47SD（p<0.001），儿童口腔保健提高了 0.43SD（p<0.01）。尽管实施并不完美，但提供肥皂本身并没有产生显著效果。此外，在非治疗学校中观察到了健康实践的显著溢出效应。成本效益分析表明，我们的 SBHE 项目具有成本效益。
本研究为 SBHE 对孟加拉国农村地区学校卫生和儿童健康实践的积极影响提供了有力证据，并且具有显著的溢出效应。成本效益分析强调了 SBHE 的价值，肯定了其作为一种有效干预方法，可提高小学乃至更广泛范围内的学校健康和卫生实践的潜力。
