A randomized-controlled intervention and evaluation of an innovative school health education (ISHE) project for primary schools in rural Bangladesh

INTERVENTION: The proposed project applied a treatment‐control pre‐post evaluation based on a cross‐cutting randomisation design of SBHE (HE) and a soap‐provision (SP) intervention. The unit of intervention was school, and 180 randomly chosen schools out of total of 204 primary schools were stratified according to the school type—government primary school (GPS) and registered non‐government primary school (RNGPS). A cross‐cutting HE‐ SP treatments were then randomly assigned to 180 schools stratified by two school‐type stratified. Thus, four groups (HE, SP, HESP, and control) with 45 school each were randomly chosen using Excel random classification formula by the author who was also the principal investigator. The process was repeated until statistical nondifference of baseline school characteristics between the groups was ensured. Children surveyed were chosen randomly using seat placement based on the pre‐determined randomly selected seat numbers prescribed by the author. Surveyors were masked about the treatment status in both baseline and endline surveys. The baseline survey was conducted before the intervention in September–December 2011, and the endline data were collected in April–August 2013, after the completion of the intervention (March 2012–March 2013). The randomisation was done in January 2012 after the beginning of academic year in Bangladesh, thus the treatment status should not have affected the choice of school by the children and their families. Treatment randomisation ensured statistical nondifference between treatment and control schools at school level variables. We collected data from 180 schools, with 45 each randomly assigned for a cross‐cutting HE‐SP treatments. Data collection was done by the Dhaka based survey institute S CONDITION: Healthy and hygiene behaviour: cold‐related symptoms; other infectious disease (diarrhoea; scabbies); other health symptoms (stomachache; dizziness; fatigue; appetite loss) ; Not Applicable PRIMARY OUTCOME: ; 1. Handwashing practice: handwashing habit index (frequency and used materials before eating, after defecation, and after playing), frequency of handwashing with soap on each occasion, washing under running water, and correct handwashing procedure.; 2. Dental‐care practice: dentalcare index (frequency); tooth‐brushing frequency using brush/branch; combination of used materials such as fingers, branch to brush, with ash, coal, powder and/or paste.; 3. Oher hygiene practice: shoe‐wearing habits at school; shoe‐wearing habits at home (inside latrine and in courtyard).; 4. Hand cleanliness: clean hands, trimmed nails, and clean nails; adenosine triphosphate (ATP): ATP improvement rate comparing before and after handwashing.; 5. Nutrition practice: breakfast taken, and food taken for the past three days, ordered by the richness of the nutrition score and categorised into three categories (none; carbohydrate and vitamins; carbohydrate, protein and plus).; 6. Health/hygiene knowledge: handwashing procedure; breakfast important; putting water in latrine before defecating (endline only), oral rehydration solution (ORS) making (endline only), food pyramid (endline only).; INCLUSION CRITERIA: School children attending the selected schools SECONDARY OUTCOME: ; 1. nthropometry: height‐, weight‐ (net of clothes) and BMI‐for‐age‐z‐score.; * Given the fact that WHO Growth Chart for weight is only available for 5‐10 years, while that for height and BMI is available for 5‐19 years, the British 1990 Growth Charts available for 0‐20 years were utilised to calculate the z‐scores.; 2. Cold‐related symptoms: cough, breathing difficulty, sore throat, fever, running nose, and congested nose at present and in the past two‐weeks.; 3. Other illness: diarrhoea, stomachache, scabies in the past two‐weeks, fatigue, dizziness, and appetite loss.;