ABSTRACT
Objective To evaluate the effectiveness of nutrition and food safety educational programs on primary students from grade 4 to 6 in impoverished areas of Western China,under a school-based cluster-randomized trial.Methods Twelve primary schools were selected from 2 impoverished counties in West China and assigned to intervention or control groups,randomly,with 6 schools in each group.Self-rating knowledge,attitude and practice questionnaires were used at both baseline and final stages.Textbooks and supportive materials were designed according to the characteristics of baseline data.All students in the intervention group were treated with targeted nutrition and food safety lectures of 0.5 hour per week for 2 semesters.Generalized linear mixedeffects model was applied to fit the random effects on individual and clusters as well as to fit the fixed effect of the programs.Results Three hundred seventy-eight students from grade 4 to 6 were randomly selected at the baseline study and the differences of scores on knowledge,attitude and practice between the 2 groups were statistically insignificant (P＞0.05).No cluster was lost during the trial.In the final investigation,478 students were randomly selected at the individual level.Scores on knowledge,attitude and practice among students in the intervention group were significantly higher,when comparing to the control group (P＜0.01).At the cluster level,more schools in the intervention group showed significant changes on knowledge and practice,yet the change in attitude was less obvious.Data from the mixed-effects model demonstrated that the program served as an influential factor on scores related to knowledge after the intervention (P=0.015) but did not affect the scores on related attitude or practice (P＞0.05).Conclusion Lectures seemed to have improved the cognition of nutrition and food safety among primary students from grade 4 to 6.However,long-term observation and larger sample size were needed to evaluate the changes on attitude and practice among the students.
ABSTRACT
A large proportion of four million neonatal deaths occur each year during the first 24 hours of life. Research is particularly needed to determine the efficacy of interventions during the first 24 hours. Large cadres of community-based workers are required in newborn-care research both to deliver these interventions in a standardized manner in the home and to measure the outcomes of the study. In a large-scale community-based efficacy trial of chlorhexidine for cleansing the cord in north-eastern rural Bangladesh, a two-tiered system of community-based workers was established to deliver a package of essential maternal and newborn-care interventions and one of three umbilical cord-care regimens. At any given time, the trial employed approximately 133 community health workers—each responsible for 4-5 village health workers and a population of approximately 4,000. Over the entire trial period, 29,760 neonates were enrolled, and 87% of them received the intervention (their assigned cord-care regimen) within 24 hours of birth. Approaches to recruitment, training, and supervision in the study are described. Key lessons included the importance of supportive processes for community-based workers, including a strong training and field supervisory system, community acceptance of the study, consideration of the setting, study objectives, and human resources available.