School health education program in Pakistan (SHEPP)—a threefold health education feasibility trial in schoolchildren from a lower-middle-income country

Abstract

Background: The school environment plays an essential role in promoting health education and physical activity for children and adolescence, and they are more likely to adapt it into their adulthood. School health education program has been endorsed and emphasized by the World Health Organization has not been implemented in true spirit in Pakistan yet. We aim to test feasibility of threefold health education program in children and its potential efficacy on physical activity and diet and cardiometabolic risk factors by including BP, BMI, and waist circumference. Methods: It is a parallel-group feasibility intervention trial. It is being conducted in two schools from lower to middle-income areas, at different locations but having the same school curriculum under the Aga Khan Education Service, Pakistan (AKESP). All children aged 9-11 years enrolled from the schools mentioned above were included. Children with any physical disability were excluded. One school received threefold intervention (focused on children, parents, and teachers) of school health education program in Pakistan (SHEPP) while the other school continued routine activity. Intervention of SHEPP is directed towards educating children, parents, and teachers about healthy behaviors. Children will receive interactive educational sessions and specially designed physical activity sessions. A 3-h health education session focusing on same healthy behaviors as for children will be conducted for both parents and teachers. Primary outcome is feasibility of SHEPP in terms of recruitment, retention, and treatment fidelity. Secondary outcomes are physical activity levels, dietary intake (of fruits, vegetable), and cardiometabolic risk factors (blood pressure, BMI, and waist circumference (WC)). The total number of children recruited were 982 (82.5 %); 505 from school A and 477 from school B and 496 (50.5) were boys. Conclusion: SHEPP is a unique health education program for children as it focuses on children while involving the parents and teachers in the behavior change process. If found feasible and demonstrating potential efficacy on physical activity, dietary behaviors, and cardiometabolic parameters, we will be able to replicate this on a larger scale in public sector schools also.

School Health Education Program in Pakistan (SHEPP): findings from a feasibility trial in pre-adolescent school children from a lower middle-income country

“…The SHEPP was a parallel group feasibility intervention trial conducted from September 2017 to November 2019 including 10 months SHEPP intervention. The details of methods and interventions have been published earlier [ 22 ]. In brief, it was conducted in two schools located in lower- to middle-income class, at different locations in Karachi but following similar school curriculum under the Aga Khan Education Service, Pakistan.…”

“…Additionally, after completion of initial 12 sessions of physical activity, children were asked “If they had any other games they wanted to play” and these were incorporated into the SHEPP Physical activity sessions The SHEPP-Physical Activity sessions consisted of 12 different activities of 10–15 min structured exercise and 15–20 min games,10 min physical activity daily during assembly and 1 min between class physical activities . Details of physical activity sessions have been published earlier [ 22 ].…”

A PRECEDE‐PROCEED model‐based educational intervention to promote healthy eating habits in middle school girls

“…In developing countries, dietary intake of school children is limited to consumption of fruits and vegetables. In Pakistan, the life style has drastically changed especially in the urban areas where the shift is seen due to lack of time among working population (Almas et al, 2020). With the sudden expansion of technology and increased production as well as ready availability of highly processed foods, have shifted preadolescent's dietary patterns from healthier to less healthy foods (Ochola et al, 2014).…”

“…More intake of the processed food has been found to result in development of chronic diseases (Aziz et al, 2018). Research in the diet of children indicates that nutritional deficiency in primary school students is among the causes of low enrolment in school, high absenteeism on daily basis, early dropout, as well as poor classroom performance (Almas et al, 2020). The National Nutrition Survey (NNS) conducted by the Government of Pakistan along with UNICEF shows that 41.5% of children under the age of 5 years are underweight, 11.6% of them have wasting, of those underweight, 31% have stunted growth and about half of them are anemic (Achakzai, 2016; FAO‐UN, 2019).…”

“…More intake of the processed food has been found to result in development of chronic diseases (Aziz et al, 2018). Research in the diet of children indicates that nutritional deficiency in primary school students is among the causes of low enrolment in school, high absenteeism on daily basis, early dropout, as well as poor classroom performance (Almas et al, 2020).…”