Behavioral Assessment of Children Clinical Trial
Official title:
School-based Interventions to Promote Personal and Environmental Hygiene Among Children in Pakistan: Protocol for a Mixed Methods Study
Background: Poor personal hygiene and inadequate sanitation practices among young children in
Low Middle Income Countries such as Pakistan can lead to critical, life-threatening illnesses
such as respiratory infections, diarrheal disease, malnutrition and developmental delays. An
intervention for personal/environmental hygiene practices for primary schoolchildren will be
implemented at schools in urban squatter settlements of Karachi, Pakistan, aiming to improve
the hygiene knowledge and practices (K&P) amongst primary schoolchildren and their mothers
(participants), while identifying facilitating and impeding factors in the adoption of
hygiene practices for children.
Methods: The study will be built on quasi-experimental design with mixed methods data
collection approaches. To assess primary grade children and their mothers' hygiene-status,
K&P survey will be held in the pre-intervention phase. This phase also includes qualitative
exploration of mothers' and teachers' perceptions about children's hygiene literacy, factors
facilitating and impeding the adoption of the same among school children, for which in-depth
guides and focus group discussion tools will be used with teachers and mothers respectively.
School physical environmental assessment will be carried out pre-post intervention. This will
be followed by multi-component intervention phase with behavior change strategies to improve
children's and mothers' hygiene K&P. The post-intervention phase will assess the intervention
effectiveness in terms of enhancing hygiene K&P among schoolchildren and mothers, alongside
exploration of mothers and teachers' insights into whether or not the intervention has
brought changes in improving hygiene practices among children.
Results: Paired T-test will be done pre-post intervention to measure the differences in
knowledge and practice scores between mothers' hygiene literacy and practices with their
child's knowledge and practices. Similar test will also be run to assess the differences in
children' hygiene knowledge and practice scores pre and post intervention. Thematic analysis
will be used for qualitative data.
Discussion: Multi-component intervention aimed at improving personal and environmental
hygiene among primary school children offers an opportunity to design and test various
behavioral change strategies at school and home setting. The study findings will be
significant in assessing the intervention effectiveness in improving children's overall
hygiene.
Background:
Globally, communicable diseases are prevalent among school age children and the exposure to
variety of pathogens causing preventable diseases in school population is inevitable.
Underlying factors mainly rests on poor personal hygiene and inadequate sanitation practices
leading to school absenteeism and life threatening illnesses among children (if continually
neglected in the long run). The situation is worse in low and middle income countries due to
inadequate health care facilities leading to compromised health status of school children.
Among communicable diseases, respiratory infections and diarrheal diseases are regarded as
the deadliest killers of young children. Incidence of diarrheal disease in the initial years
has been linked with impaired cognitive performance in the later childhood. In addition, in
developing countries intestinal helminthic infection is a commonly cited problem among
school-age children. Furthermore, oral health cavity infections are also commonly found in
school going children worldwide. Frequent attacks of infection predispose young children to
malnutrition and can form a vicious circle and retard children's physical and cognitive
development. Moreover, the contextual factors such as poor socio-economic environment further
deteriorate the health status of school children especially in low and middle income
countries.
In the Pakistani context, alongside pneumonia and diarrhea worm infestation and scabies among
school age children are the commonly reported health issues; manifesting poor personal
hygiene. An evaluation study on water, sanitation and hygiene intervention on school child
performance in two cities showed that almost 48% of government school children avoid going to
school toilets due to poor sanitary condition. In local context, studies are mostly focused
on oral hygiene assessment among children, showing satisfactory knowledge about using tooth
paste. Comprehensive assessment about personal and environmental hygiene assessment among
children, teachers and parents has remained a gap. Poor knowledge and practice of, and
attitudes to personal hygiene have negative consequences on their long term development. This
necessitates the designing and testing of school-based interventions aiming to improve
hygiene behaviors among children, thereby minimizing their potential to capture preventable
illnesses.
It is unfortunate that school health remains a neglected aspect of public health in Pakistan.
In 2005, School Health Program was launched in 17 districts of the country by Ministry of
Education, Pakistan in collaboration with United Nations Educational, Scientific and Cultural
Organization (UNESCO). The program focused on various components including personal hygiene
and environmental education but its impact was not determined . To the best of our knowledge,
there is paucity of studies in Pakistan on school-based interventions to promote personal and
environmental hygiene of school children, with child's parents and teachers' involvement.
Towards designing school based programs, role of parents and teachers must be considered as
they are the important role models for school going age children. And thus had detrimental
effects in shaping children's overall health and hygiene behavior.
In this paper, Investigators present a study protocol using mixed-methods study design to be
implemented in schools of a peri-urban community setting, Pakistan. The proposed study aims
to improve the knowledge and practices of school children towards personal and environmental
hygiene through school based intervention. To our knowledge, holistic assessment of hygiene
among school children has not been studied in the local context. And the intervention to be
implemented (with behavior change communication using adult to child and child to child
approach, assessment of education curriculum on hygiene concepts) has never been studied
before.
Primary research questions
1. Does school-based hygiene intervention facilitate improvement in knowledge and practices
among primary school children studying in semi urban schools, Pakistan?
2. What are the enablers and barriers towards the adoption of personal and environmental
hygiene practices by school children?
Secondary research questions Does improvement in knowledge and practices among the mothers of
primary school children studying in semi-urban schools contributes to improved knowledge and
practices of school children?
Methods Study design The study will employ a quasi-experimental design (pre-post intervention
without control arm). The proposed study design is chosen as it will facilitate in evaluating
school based interventions in the selected school settings without randomization. Similar to
the randomized trials, quasi-experiments (community based trial) aims to demonstrate
causality between an intervention and an outcome at the defined interval.
Study settings The study will be conducted in District Malir, Gaddap town in Karachi,
Pakistan
Data collection methods The study is built on mixed method data collection approaches to gain
insight of the hygiene literacy and practices among school children, teachers and child's
mothers. Table 1 lists different data collection methods with its purpose and interval.
Study phases The study has been structured into 3 phases - pre-intervention, intervention and
post-intervention.
;
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Active, not recruiting |
NCT03854734 -
Healthy, Immunized Communities Study
|
N/A |