Meals, Education, and Gardens for In-School Adolescents (MEGA): study protocol for a cluster randomised trial of an integrated adolescent nutrition intervention in Dodoma, Tanzania

INTRODUCTION

Secondary schools have the transformative potential to advance adolescent nutrition and provide a unique entry point for nutrition interventions to reach adolescents and their families and communities. Integrated school nutrition interventions offer promising pathways towards improving adolescent nutrition status, food security and building sustainable skill sets.

METHODS AND ANALYSIS

The Meals, Education, and Gardens for In-School Adolescents (MEGA) project aims to implement and evaluate an integrated, school-based nutrition intervention package among secondary schools in the Chamwino District of Dodoma, Tanzania. MEGA is a cluster-randomised controlled trial, including six public secondary schools assigned to three different arms. Two schools will receive the full intervention package, including school meals, school gardens, nutrition education and community workshops. Two schools will receive the partial intervention package, including the school garden, nutrition education and community workshops. Two schools will serve as the controls and will not receive any intervention. The intervention will be implemented for one academic year. Baseline and end-line quantitative data collection will include 750 adolescents and 750 parents. The domains of outcomes for adolescents will include haemoglobin concentrations, anthropometry, educational outcomes and knowledge, attitudes and practices regarding nutrition, agriculture and health. The domains of outcomes for parents will include knowledge, attitudes and practices of nutrition, agriculture and health. End-line focus group discussions will be conducted among selected adolescents, parents and teachers to assess the facilitators and barriers associated with the intervention.

ETHICS AND DISSEMINATION

This study was approved by the Institutional Review Board at Harvard T.H. Chan School of Public Health (approval number: IRB20-1623), the Institutional Research Review Committee at the University of Dodoma (approval number: MA.84/261/02) and the Tanzania National Institute for Medical Research (approval number: NIMR/HO/R.8a/Vol. IX/3801). A manuscript with the research findings will be developed for publication. Local dissemination meetings will be held with key stakeholders.

TRIAL REGISTRATION NUMBER

NCT04788303.; ClinicalTrials.gov Identifier.

Biolarviciding for malaria vector control: Acceptance and associated factors in southern Tanzania

In the struggle towards malaria elimination, the government of Tanzania scaled up nationwide biolarviciding to supplement existing vector control measures. As with any community-based intervention, success of biolarviciding depends on acceptability to the community. This study sought to ascertain acceptance of biolarviciding among communities in southern Tanzania. A mixed-method study involved administration of questionnaires to 400 community members, with 32 key informant interviews and five in-depth interviews also held in selected councils of southern Tanzania. A multistage sampling method was employed in selecting community members, with purposive sampling used in selecting key informant and in-depth interviewees. The study found high community acceptance (80.3%) despite very low (19.3%) knowledge on biolarviciding. Community perception that biolarvicide is effective in reducing malaria infection was found to be a significant predictor of community acceptance to biolarviciding: those who perceived biolarvicide as effective in reducing malaria were five times more likely to accept biolarviciding compared to those with a negative perception (odds ratio = 4.67, 95% CI: 1.89-11.50, P = 0.001). We conclude that biolarviciding received high acceptance among community members in southern Tanzania and therefore the implementation is likely to get strong support from community members. To enhance and make community acceptance sustainable, heath education to enhance the level of community knowledge on biolarviciding is recommended.