Effects of a School-Based Health Intervention Program in Marginalized Communities of Port Elizabeth, South Africa (the KaziBantu Study): Protocol for a Randomized Controlled Trial

Abstract

Background The burden of poverty-related infectious diseases remains high in low- and middle-income countries, while noncommunicable diseases (NCDs) are rapidly gaining importance. To address this dual disease burden, the KaziBantu project aims at improving and promoting health literacy as a means for a healthy and active lifestyle. The project implements a school-based health intervention package consisting of physical education, moving-to-music, and specific health and nutrition education lessons from the KaziKidz toolkit. It is complemented by the KaziHealth workplace health intervention program for teachers. Objectives The aim of the KaziBantu project is to assess the effect of a school-based health intervention package on risk factors for NCDs, health behaviors, and psychosocial health in primary school children in disadvantaged communities in Port Elizabeth, South Africa. In addition, we aim to test a workplace health intervention for teachers. Methods A randomized controlled trial (RCT) will be conducted in 8 schools. Approximately 1000 grade 4 to grade 6 school children, aged 9 to 13 years, and approximately 60 teachers will be recruited during a baseline survey in early 2019. For school children, the study is designed as a 36-week, cluster RCT ( KaziKidz intervention), whereas for teachers, a 24-week intervention phase ( KaziHealth intervention) is planned. The intervention program consists of 3 main components; namely, (1) KaziKidz and KaziHealth teaching material, (2) workshops, and (3) teacher coaches. After randomization, 4 of the 8 schools will receive the education program, whereas the other schools will serve as the control group. Intervention schools will be further randomized to the different combinations of 2 additional intervention components: teacher workshops and teacher coaching. Results This study builds on previous experience and will generate new evidence on health intervention responses to NCD risk factors in school settings as a decision tool for future controlled studies that will enable comparisons among marginalized communities between South African and other African settings. Conclusions The KaziKidz teaching material is a holistic educational and instructional tool designed for primary school teachers in low-resource settings, which is in line with South Africa’s Curriculum and Assessment Policy Statement. The ready-to-use lessons and assessments within KaziKidz should facilitate the use and implementation of the teaching material. Furthermore, the KaziHealth interventions should empower teachers to take care of their health through knowledge gains regarding ...

Sustainability of a school-based health intervention for prevention of non-communicable diseases in marginalised communities: protocol for a mixed-methods cohort study

“…This study is conducted in the eight schools originally selected for the KaziBantu RCT. 30 These are quintile three primary schools in the townships and Northern areas of NMB, in the Eastern Cape province of South Africa. The quintiles of South African schools are determined through the national poverty table and are ranged on a scale from 1 (poorest) to 5 (least poor).…”

“…Originally, in the KaziBantu project, both KaziKidz and KaziHealth interventions were conducted in four schools, whereas the other four participating schools were used as controls. 30 In total, 975 children from fourth to sixth grade (aged 8–16 years) were enrolled in the study; 482 children were allocated to the intervention and 493 to the control arm. At the same time, 160 educators were enrolled among all participating schools; of those, 85 took part in KaziHealth, whereas 75 served as waiting-list controls.…”

“…This study is conducted in the eight schools originally selected for the KaziBantu RCT. 30 These are quintile…”

“…On the other hand, KaziHealth is designed as a workplace intervention targeting educators' health and well-being through health risk assessments and personalised lifestyle coaching. The interventions have been described in detail elsewhere 30 and all teaching materials and other project resources are freely available online. 37 After conclusion of the KaziBantu RCT in 2019, all eight schools were given the freedom to conduct Kazi-Kidz and KaziHealth.…”

“… 29 Building on these results and experience, KaziBantu , a comprehensive school-based lifestyle intervention programme aiming at promoting health literacy in both children and educators of primary schools from disadvantaged communities in Nelson Mandela Bay (NMB) was developed. 30 KaziBantu , which is a composite Swahili and isiXhosa phrase meaning «Active People», was designed as a dual approach consisting of two school-based health promotion interventions, KaziKidz for children and KaziHealth for educators, and was implemented as a cluster randomised controlled trial (RCT) between January and October 2019. Preliminary results show that more than half of the assessed children (544/975) presented at least one risk factor for NCDs.…”