BACKGROUND: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. METHODS: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. RESULTS: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). CONCLUSIONS: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. TRIAL REGISTRATION:ISRCTN17968589 (date assigned: 17 July 2015).

译文

背景:有研究表明,低收入和中等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祉。这项整群随机对照试验旨在评估尼泊尔两个地区的学校花园计划和补充营养以及水,环境卫生(WASH)干预对儿童健康和营养状况的影响。
方法:该试验包括来自12所学校的682名8-17岁的儿童。这些学校被随机分配到以下三种干预措施之一:(a)学校花园计划(SG; 4所学校,n = 172名儿童); (b)带有WASH,健康和营养干预措施的学校花园计划(SG; 4所学校,n = 197名儿童); (c)没有具体的干预措施(对照; 4所学校,n = 313儿童)。在基线(2015年3月)和终点(2016年6月)调查中采用了相同的现场和实验室程序。调查问卷被用来评估学校和家庭的WASH条件。使用Delagua试剂盒评估水质。使用食物频率和24小时召回问卷确定饮食摄入量。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。粪便样品经过一套协原显微镜诊断方法检测肠道原生动物和蠕虫。通过混合逻辑和线性回归模型分析了基线调查和最终调查之间关键指标的变化。
结果:SG的发育迟缓略有降低(19.9%至18.3%; p = 0.92),而对照组(19.7%至18.9%)。 SG的贫血略有减少(33.0%至32.0%; p <0.01),而对照组则明显增加(22.7%至41.3%; p <0.01),而对照组则略有下降(43.9%至42.4%)。进食前用肥皂洗手使SG显着增加(从74.1%增至96.9%; p = 0.01,而对照组则只有78.0%增至84.0%)。排便后的洗手也得到了类似的观察结果(SG从77.2%增加到99.0%,而对照从78.0%增加到91.9%,p = 0.15)。
结论:由学校花园,WASH,营养和健康成分(SG)组成的综合干预措施可增加儿童的水果和蔬菜消费量,减少肠道寄生虫感染并改善卫生行为。
试用注册:ISRCTN17968589(分配日期:2015年7月17日)。

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