Design, Methods, and Select Baseline Results from a School Nutrition Project for Adolescents in Bangladesh

Maku E Demuyakor; Chowdhury Jalal; Anne M Williams; Kimberley P Bouckaert; Ralph D Whitehead Jr; Muhammad M Bhuiyan; Saiqa Siraj; Riffat Ara; Vanessa Pike; Maria Elena D Jefferds

doi:10.1016/j.cdnut.2023.100070

Design, Methods, and Select Baseline Results from a School Nutrition Project for Adolescents in Bangladesh

Curr Dev Nutr. 2023 Mar 30;7(4):100070. doi: 10.1016/j.cdnut.2023.100070. eCollection 2023 Apr.

Authors

Maku E Demuyakor^{1

2}, Chowdhury Jalal³, Anne M Williams^{1

2}, Kimberley P Bouckaert^{1

2}, Ralph D Whitehead Jr¹, Muhammad M Bhuiyan^{4

5}, Saiqa Siraj^{4

6}, Riffat Ara⁶, Vanessa Pike³, Maria Elena D Jefferds¹

Affiliations

¹ Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States.
² McKing Consulting Corporation, Atlanta, GA, United States.
³ Nutrition International, Ottawa, Ontario, Canada.
⁴ Nutrition International, Gulshan 1, Dhaka, Bangladesh.
⁵ Centre for Qualitative Research, Ibrahimpur, Dhaka, Bangladesh.
⁶ BRAC Health, Nutrition and Population Program, Mohakhali BRAC Center, Dhaka, Bangladesh.

Abstract

Background: The School Nutrition for Adolescents Project (SNAP) provided weekly iron and folic acid (WIFA) supplementation and menstrual hygiene management (MHM) support for girls; actions to improve water, sanitation, and hygiene (WASH) practices; and behavior change interventions to adolescents aged 10-19 y in 65 intervention schools in 2 districts of Bangladesh.

Objectives: We aimed to describe the project design and select baseline results of students and school project implementers.

Methods: Girls (n = 2244) and boys (n = 773) in 74 schools (clusters) and project implementers [headteachers (n = 74), teachers (n = 96), and student leaders (n = 91)] participated in a survey assessing nutrition, MHM, and WASH knowledge and experience. Hemoglobin, inflammation-adjusted ferritin, retinol-binding protein, and serum and RBC folate (RBCF) levels in girls were measured. School WASH infrastructure was observed and drinking water was tested for E. coli.

Results: IFA and deworming tablet intake in the last 1 and 6 mo were 4% and 81% for girls and 1% and 86%, respectively. Applying the Minimum Dietary Diversity for Women (MDD-W) tool, most (63%-68%) girls and boys achieved minimum dietary diversity. Fewer adolescents (14%-52%) had ever heard of anemia, IFA tablets, or worm infestation than project implementers (47%-100%). Girls (35%) missed school during menstruation; 39% reported of ever leaving school due to unexpected menstruation. The micronutrient status and deficiency severity varied: anemia (25%), RBCF insufficiency (76%), risk of serum folate deficiency (10%), deficiencies of iron (9%), and vitamin A (3%). WASH in school sustainable development goal (SDG) indicators achievement varied: basic drinking water service (70%), basic sanitation service (42%), and basic hygiene service (3%); 59% of sampled drinking water access points complied with WHO E. coli standards.

Conclusions: There is room for improvement of nutrition and health awareness, practices, micronutrient status, SDG basic WASH in-school services, and E coli contamination in school drinking water.This trial was registered in clinicaltrials.gov as NCT05455073.

Keywords: Bangladesh; adolescent; anemia; hygiene; micronutrient status; sanitation; school nutrition intervention; water.

Associated data

ClinicalTrials.gov/NCT05455073