Nutritional and health status of children 15 months after integrated school garden, nutrition, and water, sanitation and hygiene interventions: a cluster-randomised controlled trial in Nepal

Abstract

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 copromicroscopic 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.

Nudging children toward healthier food choices: An experiment combining school and home gardens

“…Nepal was selected for the study in order to build on a previous school garden project that had designed and tested a school garden model ( Schreinemachers et al, 2017a ; Shrestha et al, 2020 ). Furthermore, the government of Nepal has showed much interest in school gardens as it fits the country's Multi-sector Nutrition Plan, which emphasizes the need for combining health, education, agriculture and social welfare for addressing malnutrition in the country ( Government of Nepal, 2017 ).…”

Diarrhea, Helminth Infection, Dehydration, and Malnutrition Associated with Water, Sanitation, and Hygiene Facilities and Poor Handwashing in Schools in Metro Manila, Philippines: A Cross-Sectional Study

“…decreasing the prevalence of: diarrhea, 75 diarrhea-related school absences, 76 moderate to severe STH infection 77 STH reinfection 78 and stunting. 79 The low rate of handwashing with soap found in our study may be attributed not only to students’ behavior or lack of knowledge, but also to the lack of soap provided by schools. Such a finding is of concern, considering that community interventions using handwashing with soap, assessed via observation, have reduced the risk of diarrheal diseases by up to 47%.…”

Integrated Approach in Addressing Undernutrition in Developing Countries: A Scoping Review of Integrated Water Access, Sanitation, and Hygiene (WASH) + Nutrition Interventions

“…To ensure a complete understanding of the effectiveness of the trials, all 5 WASH-Benefits trials papers presenting nutrition-related outcomes were included for review. However, the descriptions of the basic characteristics and comparisons of the interventions are presented for 8 different interventions ( 21 – 28 ).…”

“…In particular, the majority of the studies were carried out in sub-Saharan Africa and represented such countries as Malawi ( 23 ), Ethiopia ( 24 , 25 ), Zimbabwe ( 26 ), Burkina Faso ( 27 ), and Kenya ( 22 ). In Asia, the studies specifically took place in Nepal ( 28 ) and Bangladesh ( 21 ). The average duration of the studies was ∼3 y, involving 3 main consecutive stages: the baseline measurements, the intervention, and a follow-up.…”

“…Six of the 8 studies represented interventions at the community or household level ( 21 – 26 ); for the remaining 2 studies ( 27 , 28 ), the intervention was implemented at the school level, targeting older children (aged 8–17 y old). All of the studies involved comparisons between groups encompassing different intervention and control arms.…”