Long-term Effectiveness and Implementation of the Meals, Education, and Gardens for In-School Adolescents Program

Summary

The overall objective of the proposed study is to determine the longer-term effectiveness and implementation of an updated school-based nutrition intervention package for reducing adolescent malnutrition. Aim 1 of the study is to determine the longer-term effectiveness of an updated intervention package on reducing adolescent malnutrition using a cluster randomized controlled trial in Dodoma, Tanzania. Four intervention schools and two control schools will be included. The intervention schools will receive an intervention package that includes school feeding, nutrition education, school vegetable garden, community workshops, and weekly iron and folic acid supplementation and annual deworming. The control schools will not receive any intervention. The intervention package will be implemented over one year. In each school, 125 adolescents aged between 14 and 17 and 125 mothers/female guardians will be enrolled. The primary outcomes will be moderate to severe anemia in adolescents and underweight in adolescents. The secondary outcomes will include anemia (any severity) and overweight/obesity in adolescents, diet quality in adolescents and mothers/female guardians, household food insecurity, and women's empowerment for mothers/female guardians. A baseline and an end-line evaluation of the outcomes will be implemented. Aim 2 of the study will be to assess the implementation of the updated intervention package by collecting quantitative and qualitative data from adolescents, mothers/female guardians, teachers, smallholder farmers, agricultural extension workers, school administrators, and governmental stakeholders. Using a convergent mixed methods approach, quantitative data (via questionnaires) and qualitative data (via semi-structured interviews and focus group discussions) will be analyzed to evaluate the implementation of the intervention package and identify its implementation barriers and facilitators.

Conditions

• Anemia
• Nutritional Status

Interventions

OTHER

School meals

Daily mid-day meals sourced locally and supplemented by school gardens.

OTHER

School gardens

A school vegetable garden to grow green leafy vegetables on school grounds.

DIETARY_SUPPLEMENT

IFA and Deworming

Weekly iron and folic acid supplements and annual deworming.

BEHAVIORAL

Nutrition education

Nutrition education, led by trained teachers, that will cover health, agriculture, and WASH topics.

BEHAVIORAL

Women's workshops

Community workshops that will engage mothers or female guardians in gardening, nutrition, and entrepreneurship, offering support and training for small businesses and homestead gardens.

Sponsors & Collaborators

• George Mason University

  collaborator OTHER

• Africa Academy for Public Health

  collaborator OTHER

• University of Dodoma

  collaborator OTHER

• Harvard School of Public Health (HSPH)

  lead OTHER

Principal Investigators

• Wafaie W Fawzi, MBBS, MPH, MS, DrPH · Harvard School of Public Health (HSPH)

• Dongqing Wang, PhD, MPH · George Mason University

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

14 Years

Max Age

17 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2026-01-19

Primary Completion

2027-06-30

Completion

2028-01-31

Countries

• Tanzania

Study Locations