Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi
Introduction Evidence indicates children who suffer from ill-health are less likely to attend or complete schooling. Malaria is an important cause of morbidity and mortality in school-age children. However, they are less likely to receive malaria treatment at health facilities and evidence for how t...
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2020-01-01
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| author | Elizabeth Allen Charles Opondo Katherine E Halliday Stefan S Witek-McManus Austin Mtali Andrew Bauleni Saidi Ndau Emmanuel Phondiwa Doreen Ali Virginia Kachigunda John H Sande Mpumulo Jawati Allison Verney Tiyese Chimuna David Melody Helen Moestue Natalie Roschnik Simon J Brooker Don P Mathanga |
| author_facet | Elizabeth Allen Charles Opondo Katherine E Halliday Stefan S Witek-McManus Austin Mtali Andrew Bauleni Saidi Ndau Emmanuel Phondiwa Doreen Ali Virginia Kachigunda John H Sande Mpumulo Jawati Allison Verney Tiyese Chimuna David Melody Helen Moestue Natalie Roschnik Simon J Brooker Don P Mathanga |
| author_sort | Elizabeth Allen |
| collection | DOAJ |
| description | Introduction Evidence indicates children who suffer from ill-health are less likely to attend or complete schooling. Malaria is an important cause of morbidity and mortality in school-age children. However, they are less likely to receive malaria treatment at health facilities and evidence for how to improve schoolchildren’s access to care is limited. This study aimed to evaluate the impact of a programme of school-based malaria case management on schoolchildren’s attendance, health and education.Methods A cluster randomised controlled trial was conducted in 58 primary schools in Zomba District, Malawi, 2011–2015. The intervention, implemented in 29 randomly selected schools, provided malaria rapid diagnostic tests and artemisinin-based combination therapy to diagnose and treat uncomplicated malaria as part of basic first aid kits known as ‘Learner Treatment Kits’ (LTK). The primary outcome was school attendance, assessed through teacher-recorded daily attendance registers and independent periodic attendance spot checks. Secondary outcomes included prevalence of Plasmodium spp infection, anaemia, educational performance, self-reported child well-being and health-seeking behaviour. A total of 9571 children from standards 1–7 were randomly selected for assessment of school attendance, with subsamples assessed for the secondary outcomes.Results Between November 2013 and March 2015, 97 trained teachers in 29 schools provided 32 685 unique consultations. Female schoolchildren were significantly more likely than male to seek a consultation (unadjusted OR=1.78 (95% CI 1.58 to 2.00). No significant intervention effect was observed on the proportion of child-days recorded as absent in teacher registers (n=9017 OR=0.90 (95% CI 0.77 to 1.05), p=0.173) or of children absent during random school visits—spot checks (n=5791 OR=1.09 (95% CI 0.87 to 1.36), p=0.474). There was no significant impact on child-reported well-being, prevalence of Plasmodium spp, anaemia or education scores.Conclusion Despite high community demand, the LTK programme did not reduce schoolchildren’s absenteeism or improve health or education outcomes in this study setting.Trial registration number ClinicalTrials.gov NCT02213211. |
| format | Article |
| id | doaj-art-77971df8e73c42a6bbe916e6b5c3381d |
| institution | OA Journals |
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| language | English |
| publishDate | 2020-01-01 |
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| spelling | doaj-art-77971df8e73c42a6bbe916e6b5c3381d2025-08-20T01:58:55ZengBMJ Publishing GroupBMJ Global Health2059-79082020-01-015110.1136/bmjgh-2019-001666Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern MalawiElizabeth Allen0Charles Opondo1Katherine E Halliday2Stefan S Witek-McManus3Austin Mtali4Andrew Bauleni5Saidi Ndau6Emmanuel Phondiwa7Doreen Ali8Virginia Kachigunda9John H Sande10Mpumulo Jawati11Allison Verney12Tiyese Chimuna13David Melody14Helen Moestue15Natalie Roschnik16Simon J Brooker17Don P Mathanga18Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK3 Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UKDepartment of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UKDepartment of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UKSave the Children Malawi, Zomba, MalawiMalaria Alert Centre, College of Medicine, University of Malawi, Blantyre, MalawiZomba District Health Office, Ministry of Health, Zomba, MalawiDistrict Education Office, Ministry of Education, Science and Technology, Zomba, MalawiNational Malaria Control Programme, Ministry of Health, Lilongwe, MalawiDepartment of School Health, Nutrition, HIV & AIDS, Ministry of Education, Science and Technology, Lilongwe, MalawiNational Malaria Control Programme, Ministry of Health, Lilongwe, MalawiSave the Children International, Blantyre, MalawiSave the Children International, Blantyre, MalawiSave the Children International, Lilongwe, MalawiSave the Children International, Lilongwe, MalawiSave the Children, Washington, Washington DC, USASave the Children, Washington, Washington DC, USADepartment of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK3University of Malawi, College of Medicine, MalawiIntroduction Evidence indicates children who suffer from ill-health are less likely to attend or complete schooling. Malaria is an important cause of morbidity and mortality in school-age children. However, they are less likely to receive malaria treatment at health facilities and evidence for how to improve schoolchildren’s access to care is limited. This study aimed to evaluate the impact of a programme of school-based malaria case management on schoolchildren’s attendance, health and education.Methods A cluster randomised controlled trial was conducted in 58 primary schools in Zomba District, Malawi, 2011–2015. The intervention, implemented in 29 randomly selected schools, provided malaria rapid diagnostic tests and artemisinin-based combination therapy to diagnose and treat uncomplicated malaria as part of basic first aid kits known as ‘Learner Treatment Kits’ (LTK). The primary outcome was school attendance, assessed through teacher-recorded daily attendance registers and independent periodic attendance spot checks. Secondary outcomes included prevalence of Plasmodium spp infection, anaemia, educational performance, self-reported child well-being and health-seeking behaviour. A total of 9571 children from standards 1–7 were randomly selected for assessment of school attendance, with subsamples assessed for the secondary outcomes.Results Between November 2013 and March 2015, 97 trained teachers in 29 schools provided 32 685 unique consultations. Female schoolchildren were significantly more likely than male to seek a consultation (unadjusted OR=1.78 (95% CI 1.58 to 2.00). No significant intervention effect was observed on the proportion of child-days recorded as absent in teacher registers (n=9017 OR=0.90 (95% CI 0.77 to 1.05), p=0.173) or of children absent during random school visits—spot checks (n=5791 OR=1.09 (95% CI 0.87 to 1.36), p=0.474). There was no significant impact on child-reported well-being, prevalence of Plasmodium spp, anaemia or education scores.Conclusion Despite high community demand, the LTK programme did not reduce schoolchildren’s absenteeism or improve health or education outcomes in this study setting.Trial registration number ClinicalTrials.gov NCT02213211.https://gh.bmj.com/content/5/1/e001666.full |
| spellingShingle | Elizabeth Allen Charles Opondo Katherine E Halliday Stefan S Witek-McManus Austin Mtali Andrew Bauleni Saidi Ndau Emmanuel Phondiwa Doreen Ali Virginia Kachigunda John H Sande Mpumulo Jawati Allison Verney Tiyese Chimuna David Melody Helen Moestue Natalie Roschnik Simon J Brooker Don P Mathanga Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi BMJ Global Health |
| title | Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi |
| title_full | Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi |
| title_fullStr | Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi |
| title_full_unstemmed | Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi |
| title_short | Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi |
| title_sort | impact of school based malaria case management on school attendance health and education outcomes a cluster randomised trial in southern malawi |
| url | https://gh.bmj.com/content/5/1/e001666.full |
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