Impact of Malaria Prevention on Health and Education in Kenyan Schoolchildren
Status:
Completed
Trial end date:
2012-04-01
Target enrollment:
Participant gender:
Summary
While malaria represents one of the main health problems afflicting schoolchildren, the
evidence base for policy development and programme implementation for school-based malaria
control remains inadequate. A recent study in western Kenya showed that delivering
intermittent preventive treatment (IPT) to schoolchildren improved rates of anaemia and
classroom concentration, but did not improve school performance. This study aims to (i)
investigate the impact of malaria prevention using a strategy of periodic screening using
malaria rapid diagnostic tests and treatment positives using artemether-lumefantrine (AL) on
health and education among schoolchildren and (ii) determine the interaction between health
and improved literacy instruction. The study hypothesis is that that school-based malaria
prevention will reduce rates of anaemia or improve educational outcomes in Kenyan
schoolchildren, when compared to comparison schools. In addition, a programme of training for
primary school teachers to improve literacy instruction will improve literacy rates and there
will be no interaction between the malaria intervention and the education intervention, such
that learning will not be improved when teaching is effective and children are healthy. The
study will be undertaken in 101 randomly selected primary schools in Kwale District. The
malaria intervention consists of screening all children using rapid diagnostic tests (RDTs)
for malaria. Children (with or without clinical malaria symptoms) found to be RDT-positive
will be treated with AL according to national guidelines. Screening and treatment will be
administered by district public health staff once a school term, observed by the evaluation
research team. This intervention has been changed from IPT due to the withdrawal of
amodiaquine in Kenya. The education intervention includes a programme of training for primary
school teachers to improve literacy instruction. The study is designed to detect a 25%
reduction in anaemia and an improvement of 0.2 standard deviations in mathematics and
literacy tests. Additional outcomes will also be measured including malaria parasitaemia,
classroom attention and school attendance. Cost-effectiveness and community acceptability of
the interventions will be assessed. Anaemia and educational outcomes will be assessed before
interventions and 12 and 24 months later. Malaria parasitaemia using blood slides will only
be assessed at follow-up.