Dataset Information

School Feeding Reduces Anemia Prevalence in Adolescent Girls and Other Vulnerable Household Members in a Cluster Randomized Controlled Trial in Uganda.

ABSTRACT:

Background

Food for education (FFE) programs that include school meals are widely used to improve school participation and performance, but evidence on nutritional benefits is limited.

Objective

This study tested whether food fortified with multiple micronutrients provided in FFE programs reduced anemia prevalence of primary-school-age adolescent girls, adult women, and preschool children.

Methods

Through the use of a cluster randomized controlled trial with individual-level repeated cross-sectional data, we measured impacts on anemia prevalence from 2 FFE programs, a school feeding program (SFP) providing multiple-micronutrient-fortified meals and a nutritionally equivalent take-home ration (THR). Camps for internally displaced people (IDP) (n = 31) in Northern Uganda were randomly assigned to SFP, THR, or a control group with no FFE. Rations were provided for 15 mo at SFP and THR schools. A survey of households (n = 627) with children aged 6-17 y was conducted (baseline and 18 mo later). Analyses used difference-in-differences by intent to treat.

Results

Adolescent girls aged 10-13 y in FFE schools experienced a significant (P < 0.05) 25.7 percentage point reduction (95% CI: -0.43, -0.08) in prevalence of any anemia [hemoglobin (Hb) <11.5 g/dL, age 10-11 y; Hb <12 g/dL, age 12-13 y] and a significant 19.5 percentage point reduction (95% CI: -0.35, -0.04) in moderate-to-severe anemia (Hb <11 g/dL) relative to the control group, with no difference in impact between SFP and THR. The THR reduced moderate-to-severe anemia prevalence (Hb <11g/dL) of adult women aged ≥18 y (12.8 percentage points, 95% CI: -0.24, -0.02). All IDP camps initially received micronutrient-fortified rations through a separate humanitarian program; in one district where most households stopped receiving these rations, SFP reduced moderate-to-severe anemia of children aged 6-59 mo by 22.1 percentage points (95% CI: -0.42, -0.02).

Conclusions

FFE programs reduced any anemia and moderate-to-severe anemia in primary-school-age adolescent girls and reduced moderate-to-severe anemia for adult women and preschool children. This study was registered with clinicaltrials.gov as NCT01261182.

SUBMITTER: Adelman S

PROVIDER: S-EPMC6461720 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

School Feeding Reduces Anemia Prevalence in Adolescent Girls and Other Vulnerable Household Members in a Cluster Randomized Controlled Trial in Uganda.

Adelman Sarah S Gilligan Daniel O DO Konde-Lule Joseph J Alderman Harold H

The Journal of nutrition 20190401 4

<h4>Background</h4>Food for education (FFE) programs that include school meals are widely used to improve school participation and performance, but evidence on nutritional benefits is limited.<h4>Objective</h4>This study tested whether food fortified with multiple micronutrients provided in FFE programs reduced anemia prevalence of primary-school-age adolescent girls, adult women, and preschool children.<h4>Methods</h4>Through the use of a cluster randomized controlled trial with individual-leve ...[more]

PMID: 30926996

Similar Datasets

Project description:BackgroundSchool-based iron and folic acid (IFA) supplementation is recommended for adolescent girls in countries with high burdens of anemia.ObjectivesWe aimed to evaluate the context-specific effectiveness of a school-based, integrated anemia control program with IFA supplementation in Ghana.MethodsUsing data from a pre-post, longitudinal program evaluation, we evaluated the effectiveness of school-based weekly IFA supplementation in reducing the burden of anemia and increasing hemoglobin concentrations (Hb; primary outcomes) in 2 regions of Ghana. Generalized linear mixed effects models with schools (clusters) as random effects were used to quantify the change in the anemia prevalence and the mean Hb associated with cumulative IFA tablet consumption over 1 school year (30-36 weeks), controlling for participant-level potential confounders. A cut point for minimum effective cumulative IFA consumption that is reflective of adequate Hb was derived following logistic regression. This cut point was verified by a restricted cubic spline model of IFA consumption and Hb.ResultsThe analytical sample included 60 schools and 1387 girls ages 10-19 years. The prevalence of anemia declined during 1 school year of the intervention, from 25.1% to 19.6% (P = 0.001). Students consumed a mean of 16.4 IFA tablets (range, 0-36). IFA consumption was positively associated with Hb and negatively associated with anemia. Each additional IFA tablet consumed over the school year was associated with a 5% (95% CI, 1-10%) reduction in the adjusted odds of anemia at follow-up, though the relationship is nonlinear. The cut point for minimum effective consumption was 26.7 tablets over a 30-36-week school year, with tablets provided weekly.ConclusionsSchool-based weekly IFA supplementation is effective in improving Hb and reducing the anemia prevalence among schoolgirls in Ghana, though most participants consumed fewer than the minimum effective number of IFA tablets. Increasing intake adherence may further improve anemia outcomes in this population.

Project description:BackgroundIn sub-Saharan Africa (SSA), adolescent girls and young women are three times more likely than boys to have depressive disorders. Understanding adolescents' unique and common vulnerabilities and protective factors is essential for the development of appropriate interventions and programming focused on child and adolescent mental health. This paper examines the prevalence and predictors of depressive symptoms among high school adolescent girls in southern Uganda.MethodsBaseline data from a longitudinal cluster randomized study involving 1260 adolescent girls (14-17 years), recruited from 47 secondary schools were utilized. Depressive symptoms were estimated using the 21-item Beck's Depression Inventory. Hierarchical linear regression modelling was utilized to estimate key predictors of depressive symptoms among adolescent girls.ResultsOf the total sample, 16.35% (n = 206) reported severe depressive symptoms and almost one in every three adolescent girls interviewed (29.68%, n = 374) reported moderate symptoms. These symptoms were more prevalent among older adolescents (16 years and above). In addition, family relationships, social support, as well as measures of psychological wellbeing (self-concept and self-esteem) were all associated with lower levels of depressive symptoms. Hopelessness was associated with higher levels of depressive symptoms among adolescent girls.ConclusionFindings from this study indicate a high prevalence of depressive symptoms, especially among older adolescent girls. In addition, family support factors and adolescents' psychological wellbeing were associated with low levels of depressive symptoms -pointing to the need to strengthen family functioning and adolescent's psychological wellbeing to mitigate risks. Taken together, findings support increasing calls for early screening and detection of depressive symptoms to facilitate timely referral to care and treatment. Findings may also inform the development and incorporation of gender-specific mental health components in programming targeting adolescent girls, in low-resource communities in SSA.Trial registrationThis trial was prospectively registered with ClinicalTrials.gov (registration number: NCT03307226 ) on 11 October 2017.

Project description:BackgroundThe rapid growth and changes that occur in adolescents increase the demand for macro and micronutrients and addressing their needs particularly in females would be an important step to break the vicious cycle of intergenerational malnutrition. Thus we evaluated the status of anemia and its anthropometric, dietary and socio demographic determinants in female adolescents, west Ethiopia.MethodsA school based cross-sectional study was conducted among school going adolescent girls of Wayu Tuqa district, south west Ethiopia and a 3-stage random sampling technique was used to select study participants. Data were entered into EpiData version 3.1 and analyzed using STATA version12. Haemoglobin was measured by HemoCue 301+ photometer and WHO Anthro-plus software Version 1.0.4 was used to calculate BMI for age z-score. Both bivariate and multivariate analyses were performed to check associations and control confounding. A p-value <0.05 was considered statistically.ResultThe overall prevalence of anemia was 27% (95% CI: 22.9-31%) of which 23, and 4% had mild and moderate anemia respectively. The proportion of thinness and overweight girls based on the BMI for age z-score was 33 and 3.6%, respectively. The odds of developing anemia were almost four times more likely among late adolescents as compared to early adolescents (AOR = 3.8 95%CI = 2.3 to 8.5).Adolescents from rural areas were 3.4 times more likely to have anemia as compared to their urban counterparts (AOR = 3.4 95%CI = 1.9 to7) and adolescents those who attained menarche were two times more likely to develop anemia compared to those who did not attained menarche (AOR = 2.3 95%CI = 1.34 to 4.2).ConclusionThe prevalence of anemia among adolescent girls was a moderate public health problem. To improve the prevailing nutritional problem, there must be inter-sectorial collaboration among health sectors and education sectors in providing nutritional education and counseling based on age and menarche status.

Project description:BackgroundAnemia is a significant public health challenge that affects the population of all nations. Anemia among adolescents emerged as an alarming public health issue as it harms an individual's physical capacity and cognitive and work performance. The study aims to determine the effect of changes in individual and household level factors on the prevalence of anemia among adolescent boys and girls.MethodThe study utilized data from two waves of the "Understanding the lives of adolescent and young adults" (UDAYA) survey, conducted in Bihar and Uttar Pradesh during 2015-16 (wave-1) and 2018-19 (wave-2). The sample size for the present study was 4216 and 5974 unmarried adolescent boys and girls aged 10-19 years in both waves. We performed descriptive analysis to observe the characteristics of adolescents during 2015-16. Further, changes in selected independent variables from wave-1 to wave-2 were examined using the proportion test. Moreover, random-effect regression models were employed to examine the association of changes in individual and household level factors with anemia prevalence among adolescents.ResultsThe prevalence of anemia decreased over time among adolescent boys (33 to 30%), whereas it increased among adolescent girls (59 to 63%). The results from the random-effect model show that adolescent boys who used shared toilets were more anemic than those who used a private restroom [β:0.05, 95% CI:(0.01, 0.08)]. Moreover, underweight [β:0.05, CI:(0.01, 0.09)] and thin [β:0.04, CI:(0.00, 0.07)] adolescent boys were more likely to be anemic compared to their normal counterparts. Additionally, boys who belonged to the poorest [β:0.08, CI:(0.02, 0.14)] households had a higher risk of anemia than the richest household.ConclusionThe anemia prevalence was higher among adolescents aged 10-19 years in Uttar Pradesh and Bihar. This study has filled an information gap by providing state-level representative estimates indicating underweight status and thinness as the common factors behind the anemia prevalence among adolescent boys than in girls. Iron deficiency anemia is the most prevalent in certain age groups in India. Hence, Anemia prevention efforts and iron-folic acid (IFA) supplementation programs are currently being strengthened in India, targeting the high-risk population.

Project description:BackgroundAnemia is a major public health concern; however, research on anemia and its contributing variables is scarce. To address the gap, we investigated the prevalence and associated factors of anemia in school-aged adolescent girls in rural Bangladesh.MethodsWe conducted a cross-sectional study in two secondary schools at Chandpur, Bangladesh, from January to April 2022. We randomly selected 422 adolescent girls based on prevalence rates from existing research to ensure reliable estimates and a robust study representation. We performed interviews with a semi-structured questionnaire after receiving ethical permission and written informed consent. In addition, physical examination and anthropometric measurements were done, followed by blood testing to identify anemia. Blood hemoglobin was measured using a spectrophotometric method, and quality control was ensured by validated results with control samples. Univariate with multiple logistic regression was employed for analysis to find the association between anemia and all other variables that were adjusted to control the potential effect of confounding variables.ResultsThe overall prevalence of anemia was 37.7% (mild- 33.8% and moderate- 3.9%). In the univariate analysis having a working mother (OR 3.84; 95% CI 1.31-11.26), undernutrition (OR 2.40; 95% CI 1.27-4.52), and irregular lunch consumption (OR 2.15; 95% CI 1.00-4.60) were associated with anemia. Conversely, being a user of a slab latrine (OR 0.61; 95% CI 0.40-0.93) and not weekly consumption of pure milk (OR 0.62; 95% CI 0.41-0.92) were negatively associated with anemia. In multivariate logistic regression analysis, associated factors for prevalent anemia were working mother [adjusted odds ratio (aOR) 7.65; 95% CI 1.97-29.50], slab latrine user (aOR 0.46; 95% CI 0.26-0.79), and irregular lunch consumption (aOR 2.92; 95% CI 1.21-7.03).ConclusionThe prevalence of anemia among adolescent girls in rural Bangladesh remains high with undernutrition. Anemia is associated with working mothers, slab latrine users, and irregular lunch consumers within the studied population.' Thus, policymakers may promote school-based nutritional education and lunch programs with iron supplementation and improve sanitary facilities.

Project description:BackgroundAnemia defined as a low blood hemoglobin concentration is public health importance. The adolescence age group is the most neglected in public health and nutrition research as priorities are usually given to pregnant women, lactating mothers, and their children less than 2 years. Current Ethiopian Food and Nutrition policy included adolescent girls in the most at-risk group for nutritional demands; however, only a few published studies have assessed a deficiency of anemia and associated factors to tackle the intergenerational cycle of malnutrition.ObjectiveTo assess the prevalence of anemia and associated factors among high school adolescent girls in Jimma town.MethodsData were collected from 528 secondary school adolescent girls by a school-based cross-sectional study design in Jimma town from 1/1/2019 to 1/2/2019, southwest Ethiopia. A multistage sampling technique was used to select the study participants. A portable battery-operated HemoCue Hb 301+ analyzer was used to measure the hemoglobin level, and then reading was classified as normal Hb ≥ 12 g\dl and anemic if the hemoglobin value <12 g/dl based on the WHO 2011 recommended cutoff points after adjustments to altitude was made. Bivariate analysis at p value ≤0.25 was considered as a candidate for multivariable logistic regression. Multivariable logistic regression was done to control for confounders and to identify factors independently associated with anemia. Level of statistical significance was declared at p < 0.05.ResultsA total of 528 adolescent girls were included in the study yielding a response rate of 95.8%. The prevalence of anemia was found to be 26.7%, 95% CI (22.7, 30.50). In multivariate logistic regression analysis, those living separately from their family (AOR = 4.430, 95% CI (2.20, 8.90)), low dietary diversity score (AOR = 3.57, 95% CI (1.88, 6.75)), menstrual bleeding more than 5 days (AOR = 2.25, 95% CI (1.17, 4.33)), and low economic status (AOR = 2.16, 95% CI (1.17, 4.33)) were positively associated factors with anemia and only having at least a secondary school in mother's educational status AOR = 0.43, 95% CI (0.18, 0.97) was negatively associated with anemia in the study area.ConclusionPrevalence of anemia among school adolescent girls was moderate public health importance according to the World Health Organization prevalence estimation of anemia. The living condition of the adolescent girls, dietary diversity score, duration of menses, and low economic status were positive predictor variables, whereas mothers who are being secondary school and above was a protective factor for anemia. Therefore, iron-rich and diversified food consumption should be given attention.

Project description:BackgroundThe age-specific epidemiology of child and adolescent tuberculosis (TB) is poorly understood, especially in rural areas of East Africa. We sought to characterize the age-specific prevalence and predictors of TB infection among children and adolescents living in rural Uganda, and to explore the contribution of household TB exposure on TB infection.MethodsFrom 2015-2016 we placed and read 3,121 tuberculin skin tests (TST) in children (5-11 years old) and adolescents (12-19 years old) participating in a nested household survey in 9 rural Eastern Ugandan communities. TB infection was defined as a positive TST (induration ≥10mm or ≥5mm if living with HIV). Age-specific prevalence was estimated using inverse probability weighting to adjust for incomplete measurement. Generalized estimating equations were used to assess the association between TB infection and multi-level predictors.ResultsThe adjusted prevalence of TB infection was 8.5% (95%CI: 6.9-10.4) in children and 16.7% (95% CI:14.0-19.7) in adolescents. Nine percent of children and adolescents with a prevalent TB infection had a household TB contact. Among children, having a household TB contact was strongly associated with TB infection (aOR 5.5, 95% CI: 1.7-16.9), but the strength of this association declined among adolescents and did not meet significance (aOR 2.3, 95% CI: 0.8-7.0). The population attributable faction of TB infection due to a household TB contact was 8% for children and 4% among adolescents. Mobile children and adolescents who travel outside of their community for school had a 1.7 (95% CI 1.0-2.9) fold higher odds of TB infection than those who attended school in the community.ConclusionChildren and adolescents in this area of rural eastern Uganda suffer a significant burden of TB. The majority of TB infections are not explained by a known household TB contact. Our findings underscore the need for community-based TB prevention interventions, especially among mobile youth.

Project description:BackgroundAdolescent girls are more likely to develop anemia as a result of physical and physiological changes that place a greater strain on their nutritional needs. Primary studies, on the other hand, may not be sufficient to provide a complete picture of anemia in adolescent girls and its major risk factors.ObjectiveThe study aimed to describe the pooled prevalence of adolescent girls' anemia and the factors that contribute.MethodsWe conducted a systematic review of observational studies using the databases CINAHL (EBSCO), PubMed, Science Direct, Cochrane Library, and Google Scholar. The Newcastle-Ottawa Scale was used to assess the quality of the articles, and studies of fair to good quality were included. We pooled anemia prevalence among adolescents and odds ratio estimates for risk factors. Subgroup analysis employing sample size and study setup was computed to determine the source of heterogeneity, and the I2 test was used to identify the existence or absence of substantial heterogeneity during subgroup analysis. The pooled prevalence of adolescent girls' anemia was calculated using a random-effects meta-analysis model.ResultsThe overall pooled prevalence of anemia among adolescent girls in Ethiopia was 23.03% (95% confidence interval: 17.07, 28.98). Low dietary diversity (odds ratio: 1.56; 95% confidence interval: 1.05, 2.32), illiterate mothers (odds ratio: 1.45; 95% confidence interval: 1.13, 1.86), household size greater than five (odds ratio: 1.65; 95% confidence interval: 1.14, 2.38), food-insecure households (odds ratio: 1.48; 95% confidence interval: 1.21, 1.82), and menstrual blood flow more than 5 days (odds ratio: 6.21; 95% confidence interval: 1.67, 23.12) were the identified factors associated with anemia among adolescent girls.ConclusionThe pooled prevalence of anemia among adolescent girls in Ethiopia was moderately high. Therefore, to combat the burden of anemia among adolescent girls offering nutritional education is crucial. Iron supplementation is also recommended for adolescent females who have a menstrual cycle that lasts longer than 5 days.

Dataset Information

School Feeding Reduces Anemia Prevalence in Adolescent Girls and Other Vulnerable Household Members in a Cluster Randomized Controlled Trial in Uganda.

Background

Objective

Methods

Results

Conclusions

Publications

School Feeding Reduces Anemia Prevalence in Adolescent Girls and Other Vulnerable Household Members in a Cluster Randomized Controlled Trial in Uganda.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets