1921
Volume 97, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The potential health benefits of combined agricultural, nutrition, water, sanitation, and hygiene (WASH) interventions are poorly understood. We aimed to determine whether complementary school garden, nutrition, and WASH interventions reduce intestinal parasites and improve school children’s nutritional status in two regions of Burkina Faso. A cluster-randomized controlled trial was conducted in the Plateau Central and Center-Ouest regions of Burkina Faso. A total of 360 randomly selected children, aged 8–15 years, had complete baseline and end-line survey data. Mixed regression models were used to assess the impact of the interventions, controlling for baseline characteristics. The prevalence of intestinal parasitic infections decreased both in intervention and control schools, but the decrease was significantly higher in the intervention schools related to the control schools (odds ratio [OR] of the intervention effect = 0.2, 95% confidence interval [CI] = 0.1–0.5). Indices of undernutrition did not decrease at end-line in intervention schools. Safe handwashing practices before eating and the use of latrines at schools were significantly higher in the intervention schools than in the control schools at end-line (OR = 6.9, 95% CI = 1.4–34.4, and OR = 14.9, 95% CI = 1.4–153.9, respectively). Parameters of water quality remained unchanged. A combination of agricultural, nutritional, and WASH-related interventions embedded in the social–ecological systems and delivered through the school platform improved several child health outcomes, including intestinal parasitic infections and some WASH-related behaviors. Sustained interventions with stronger household and community-based components are, however, needed to improve school children’s health in the long-term.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.16-0964
2017-09-07
2018-09-23
Loading full text...

Full text loading...

/deliver/fulltext/14761645/97/3/tpmd160964.html?itemId=/content/journals/10.4269/ajtmh.16-0964&mimeType=html&fmt=ahah

References

  1. Daboné C, Delisle HF, Receveur O, , 2011. Poor nutritional status of schoolchildren in urban and peri-urban areas of Ouagadougou (Burkina Faso). Nutr J 10: 34.
  2. INSD and ICF International, 2012. Enquête Démographique et de Santé et à Indicateurs Multiples du Burkina Faso 2010. Calverton, MD: Institut National de la Statistique et de la Démographie and ICF International.
  3. Erismann S, ., 2016. Prevalence of intestinal parasitic infections and associated risk factors among schoolchildren in the Plateau Central and Centre-Ouest regions of Burkina Faso. Parasit Vectors 9: 554.
  4. Erismann S, ., 2017. Prevalence and risk factors of undernutrition among schoolchildren in the Plateau Central and Centre-Ouest regions of Burkina Faso. Infect Dis Poverty 6: 17.
  5. Ameratunga S, Denny S, , 2016. GBD 2013: a window into the world of young people. Lancet 387: 23532354.
  6. Utzinger J, N’Goran EK, Caffrey CR, Keiser J, , 2011. From innovation to application: social-ecological context, diagnostics, drugs and integrated control of schistosomiasis. Acta Trop 120 (Suppl 1) : S121S137.
  7. Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC, , 2014. Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS Med 11: e1001620.
  8. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J, , 2008. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371: 243260.
  9. Black RE, ., 2013. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382: 427451.
  10. United Nations Children’s Fund, 2013. Improving Child Nutrition: The Achievable Imperative for Global Progress. New York, NY: United Nations Children’s Fund.
  11. Cumming O, Cairncross S, , 2016. Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications. Matern Child Nutr 12: 91105.
  12. Katona P, Katona-Apte J, , 2008. The interaction between nutrition and infection. Clin Infect Dis 46: 15821588.
  13. Ziegelbauer K, Speich B, Mäusezahl D, Bos R, Keiser J, Utzinger J, , 2012. Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis. PLoS Med 9: e1001162.
  14. Mbuya MN, Humphrey JH, , 2016. Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries. Matern Child Nutr 12 (Suppl 1) : 106120.
  15. Nakagawa J, ., 2015. Towards effective prevention and control of helminth neglected tropical diseases in the Western Pacific Region through multi-disease and multi-sectoral interventions. Acta Trop 141: 407418.
  16. Bundy DAP, ., 2006. School-based health and nutrition programs. Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, eds. Disease Control Priorities in Developing Countries. Washington, DC: World Bank.
  17. Food and Agriculture Organization, 2010. A new deal for school gardens. Rome, Italy: Food and Agriculture Organization.
  18. Bundy DAP, , 2009. Rethinking School Feeding: Social Safety Nets, Child Development, and the Education Sector. Washington, DC: The International Bank for Reconstruction and Development/World Bank.
  19. Park S, Lee EY, Gittelsohn J, Nkala D, Choi BY, , 2015. Understanding school health environment through interviews with key stakeholders in Lao PDR, Mongolia, Nepal and Sri Lanka. Health Educ Res 30: 285297.
  20. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE, , 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382: 452477.
  21. Monse B, Benzian H, Naliponguit E, Belizario V, Schratz A, van Palenstein Helderman W, , 2013. The fit for school health outcome study-a longitudinal survey to assess health impacts of an integrated school health programme in the Philippines. BMC Public Health 13: 256.
  22. Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M, , 2008. What works? Interventions for maternal and child undernutrition and survival. Lancet 371: 417440.
  23. Ruel MT, Alderman H, , 2013. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet 382: 536551.
  24. Waage J, Hawkes C, Turner R, Ferguson E, Johnston D, Shankar B, McNeill G, Hussein J, Homans H, Marais D, , 2013. Current and planned research on agriculture for improved nutrition: a mapping and a gap analysis. Proc Nutr Soc 72: E316.
  25. Christian MS, Evans CE, Nykjaer C, Hancock N, Cade JE, , 2014. Evaluation of the impact of a school gardening intervention on children’s fruit and vegetable intake: a randomised controlled trial. Int J Behav Nutr Phys Act 11: 99.
  26. Olney DK, Bliznashka L, Pedehombga A, Dillon A, Ruel MT, Heckert J, , 2016. A 2-year integrated agriculture and nutrition program targeted to mothers of young children in Burkina Faso reduces underweight among mothers and increases their empowerment: a cluster-randomized controlled trial. J Nutr 146: 11091117.
  27. Erismann S, ., 2016. Complementary school garden, nutrition, water, sanitation and hygiene interventions to improve children’s nutrition and health status in Burkina Faso and Nepal: a study protocol. BMC Public Health 16: 244.
  28. Ministère de la Santé (Burkina Faso), 2010. Plan Strategique Nutrition 2010–2015. Ouagadougou, Burkina Faso: Ministère de la Santé.
  29. Ministère de la Santé (Burkina Faso), 2011. Plan National de Développement Sanitaire 2011–2020. Ouagadougou, Burkina Faso: Ministère de la Santé.
  30. Campbell MK, Elbourne DR, Altman DG, , 2004. CONSORT statement: extension to cluster randomised trials. BMJ 328: 702708.
  31. Schulz KF, Altman DG, Moher D, , 2010. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8: 18.
  32. World Health Organization, 2016. Growth Reference 5–19 Years. Available at: http://www.who.int/growthref/en/. Accessed 30 March 2017.
  33. World Health Organization, 2011. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Geneva, Switzerland: World Health Organization.
  34. Katz N, Chaves A, Pellegrino J, , 1972. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 14: 397400.
  35. Utzinger J, ., 2010. Microscopic diagnosis of sodium acetate-acetic acid-formalin-fixed stool samples for helminths and intestinal protozoa: a comparison among European reference laboratories. Clin Microbiol Infect 16: 267273.
  36. World Health Organization, 1994. Bench Aids for the Diagnosis of Intestinal Parasites. Geneva, Switzerland: World Health Organization, 1–20.
  37. World Health Organization, 2002. Prevention and control of schistosomiasis and soil-transmitted helminthiasis: report of a WHO expert committe. WHO Tech Rep Ser 912: 157.
  38. American Public Health Association, American Water Works Association, World Peace Choral Festival, 1998. Standard Methods for the Examination of Water and Wastewater, 20th edition. Washington, DC: American Public Health Association, American Water Works Association and Water Pollution Control Federation.
  39. Marías Y, Glasauer P, , 2014. Guidelines for Assessing Nutrition-Related Knowledge, Attitudes and Practices. Rome, Italy: Food and Agriculture Organization.
  40. Open Data Kit, 2008. Available at: https://opendatakit.org/. Accessed March 30, 2017.
  41. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J, , 2007. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85: 660667.
  42. Filmer D, Pritchett LH, , 2001. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography 38: 115132.
  43. Muthayya S, Eilander A, Transler C, Thomas T, van der Knaap HC, Srinivasan K, van Klinken BJ, Osendarp SJ, Kurpad AV, , 2009. Effect of fortification with multiple micronutrients and n-3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (Children’s Health and Mental Performance Influenced by Optimal Nutrition) study. Am J Clin Nutr 89: 17661775.
  44. Ash DM, Tatala SR, Frongillo EA, Jr Ndossi GD, Latham MC, , 2003. Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania. Am J Clin Nutr 77: 891898.
  45. Best C, Neufingerl N, Del Rosso JM, Transler C, van den Briel T, Osendarp S, , 2011. Can multi-micronutrient food fortification improve the micronutrient status, growth, health, and cognition of schoolchildren? A systematic review. Nutr Rev 69: 186204.
  46. Stoltzfus RJ, Albonico M, Tielsch JM, Chwaya HM, Savioli L, , 1997. Linear growth retardation in Zanzibari school children. J Nutr 127: 10991105.
  47. Leroy JL, Ruel M, Habicht JP, Frongillo EA, , 2014. Linear growth deficit continues to accumulate beyond the first 1000 days in low- and middle-income countries: global evidence from 51 national surveys. J Nutr 144: 14601466.
  48. Prentice AM, Ward KA, Goldberg GR, Jarjou LM, Moore SE, Fulford AJ, Prentice A, , 2013. Critical windows for nutritional interventions against stunting. Am J Clin Nutr 97: 911918.
  49. Leroy JL, Ruel M, Habicht JP, , 2013. Critical windows for nutritional interventions against stunting. Am J Clin Nutr 98: 854855.
  50. Speich B, Croll D, Fürst T, Utzinger J, Keiser J, , 2016. Effect of sanitation and water treatment on intestinal protozoa infection: a systematic review and meta-analysis. Lancet Infect Dis 16: 8799.
  51. Park S, Lee EY, Gittelsohn J, Nkala D, Choi BY, , 2015. Understanding school health environment through interviews with key stakeholders in Lao PDR, Mongolia, Nepal and Sri Lanka. Health Educ Res 30: 285297.
  52. Benzian H, Monse B, Belizario V, Jr Schratz A, Sahin M, Helderman W, , 2012. Public health in action: effective school health needs renewed international attention. Glob Health Action 5: 14870.
  53. Freeman MC, Clasen T, , 2011. Assessing the impact of a school-based safe water intervention on household adoption of point-of-use water treatment practices in southern India. Am J Trop Med Hyg 84: 370378.
  54. Hubbard B, Sarisky J, Gelting R, Baffigo V, Seminario R, Centurion C, , 2011. A community demand-driven approach toward sustainable water and sanitation infrastructure development. Int J Hyg Environ Health 214: 326334.
  55. McMichael C, Robinson P, , 2016. Drivers of sustained hygiene behaviour change: a case study from mid-western Nepal. Soc Sci Med 163: 2836.
  56. Onyango-Ouma W, Aagaard-Hansen J, Jensen BB, , 2005. The potential of schoolchildren as health change agents in rural western Kenya. Soc Sci Med 61: 17111722.
  57. Sànchez Garrido E, Suàrez Sànchez I, , 2015. Protection Sociale et Securité Alimentaire au Burkina Faso. Les Cantines Scolaires. Oxford, United Kingdom: Oxfam.
  58. Olney DK, Pedehombga A, Ruel MT, Dillon A, , 2015. A 2-year integrated agriculture and nutrition and health behavior change communication program targeted to women in Burkina Faso reduces anemia, wasting, and diarrhea in children 3–12.9 months of age at baseline: a cluster-randomized controlled trial. J Nutr 145: 13171324.
  59. Mukoma W, Flisher AJ, , 2004. Evaluations of health promoting schools: a review of nine studies. Health Promot Int 19: 357368.
  60. Delisle HF, Receveur O, Agueh V, Nishida C, , 2013. Pilot project of the Nutrition-Friendly School Initiative (NFSI) in Ouagadougou, Burkina Faso and Cotonou, Benin, in West Africa. Glob Health Promot Educ 20: 3949.
  61. Hall A, Hewitt G, Tuffrey V, de Silva N, , 2008. A review and meta‐analysis of the impact of intestinal worms on child growth and nutrition. Matern Child Nutr 4: 118236.
  62. Vivas A, Gelaye B, Aboset N, Kumie A, Berhane Y, Williams MA, , 2010. Knowledge, attitudes, and practices (KAP) of hygiene among school children in Angolela, Ethiopia. J Prev Med Hyg 51: 73.
  63. Sayasone S, Utzinger J, Akkhavong K, Odermatt P, , 2015. Repeated stool sampling and use of multiple techniques enhance the sensitivity of helminth diagnosis: a cross-sectional survey in southern Lao People’s Democratic Republic. Acta Trop 141: 315321.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.16-0964
Loading
/content/journals/10.4269/ajtmh.16-0964
Loading

Data & Media loading...

Supplementary Data

Supplemental Table

  • Received : 09 Dec 2016
  • Accepted : 22 May 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error