Nutritional and health status of children 15 months after integrated school garden, nutrition, and water, sanitation and hygiene interventions: a cluster-randomised controlled trial in Nepal
Open accessAbstract
Background: It has been suggested that specific interventions delivered through the education sector in low- and middle-income countries might improve children’s health and wellbeing. This cluster-randomised controlled trial aimed to evaluate the effects of a school garden programme and complementary nutrition, and water, sanitation and hygiene (WASH) interventions on children’s health and nutritional status in two districts of Nepal. Methods: The trial included 682 children aged 8–17 years from 12 schools. The schools were randomly allocated to one of three interventions: (a) school garden programme (SG; 4 schools, n = 172 children); (b) school garden programme with complementary WASH, health and nutrition interventions (SG+; 4 schools, n = 197 children); and (c) no specific intervention (control; 4 schools, n = 313 children). The same field and laboratory procedures were employed at the baseline (March 2015) and end-line (June 2016) surveys. Questionnaires were administered to evaluate WASH conditions at schools and households. Water quality was assessed using a Delagua kit. Dietary intake was determined using food frequency and 24-h recall questionnaire. Haemoglobin levels were measured using HemoCue digital device and used as a proxy for anaemia. Stool samples were subjected to a suite of copro-microscopic diagnostic methods for detection of intestinal protozoa and helminths. The changes in key indicators between the baseline and end-line surveys were analysed by mixed logistic and linear regression models. Results: Stunting was slightly lowered in SG+ (19.9 to 18.3%; p = 0.92) and in the control (19.7 to 18.9%). Anaemia slightly decreased in SG+ (33.0 to 32.0%; p < 0.01) and markedly increased in the control (22.7 to 41.3%; p < 0.01), a minor decline was found in the control (43.9 to 42.4%). Handwashing with soap before eating strongly increased in SG+ (from 74.1 to 96.9%; p = 0.01, compared to control where only a slight increase was observed from 78.0 to 84.0%). A similar observation was made for handwashing after defecation (increase from 77.2 to 99.0% in SG+ versus 78.0 to 91.9% in control, p = 0.15). Conclusions: An integrated intervention consisting of school garden, WASH, nutrition and health components (SG+) increased children’s fruit and vegetable consumption, decreased intestinal parasitic infections and improved hygiene behaviours. Trial registration: ISRCTN17968589 (date assigned: 17 July 2015).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Improved school WASH conditions may reduce pupils' absenteeism by providing services and a learning environment that appeals to children, specifically girls who are menstruating without facilities for personal hygiene, and by reducing illness transmission.
“Improved school WASH conditions may reduce pupils' absenteeism by providing services and a learning environment that appeals to children, specifically girls who are menstruating without facilities for personal hygiene, and by reducing illness transmission (Shrestha et al. 2020).”
From The level of implementation of water, sanitation, and hygiene (WASH) practices among the public basic schools in Ghana (2024) · cites this paper as Shrestha et al. 2020
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 36 · Cited by 45
Research works printed but not linked: 30
- [1]Morgan PJ Warren JM Lubans DR Saunders KL Quick GI Collins CE The impact of nutrition education with and without a school garden on knowledge, vegetable intake and preferences and quality of school life among primary-school students Public Health Nutr 2010 13 1931 1940 10.1017/S1368980010000959 20441683 · DOI
- [2]Christian MS Evans CE Nykjaer C Hancock N Cade JE Evaluation of the impact of a school gardening intervention on children’s fruit and vegetable intake: a randomised controlled trial Int J Behav Nutr Phys Act 2014 11 99 10.1186/s12966-014-0099-7 25128211 PMC4142134 · DOI
- [3]Parmer SM Salisbury-Glennon J Shannon D Struempler B School gardens: an experiential learning approach for a nutrition education program to increase fruit and vegetable knowledge, preference, and consumption among second-grade students J Nutr Educ Behav 2009 41 212 217 10.1016/j.jneb.2008.06.002 19411056 · DOI · Paper page
- [5]McAleese JD Rankin LL Garden-based nutrition education affects fruit and vegetable consumption in sixth-grade adolescents J Am Diet Assoc 2007 107 662 665 10.1016/j.jada.2007.01.015 17383272 · DOI
- [6]Ozer EJ The effects of school gardens on students and schools: conceptualization and considerations for maximizing healthy development Health Educ Behav 2007 34 846 863 10.1177/1090198106289002 16861584 · DOI
- [7]Akhtar S Malnutrition in South Asia-a critical reappraisal Crit Rev Food Sci Nutr 2016 56 2320 2330 10.1080/10408398.2013.832143 25830938 · DOI
- [8]Schaible UE Kaufmann SHE Malnutrition and infection: complex mechanisms and global impacts PLoS Med 2007 4 e115 10.1371/journal.pmed.0040115 17472433 PMC1858706 · DOI
- [9]Victora CG Adair L Fall C Hallal PC Martorell R Richter L Maternal and child undernutrition: consequences for adult health and human capital Lancet 2008 371 340 357 10.1016/S0140-6736(07)61692-4 18206223 PMC2258311 · DOI
- [10]Alum A Rubino JR Ijaz MK The global war against intestinal parasites--should we use a holistic approach? Int J Infect Dis 2010 14 e732 e738 10.1016/j.ijid.2009.11.036 20399129 · DOI
- [11]Katona P Katona-Apte J The interaction between nutrition and infection Clin Infect Dis 2008 46 1582 1588 10.1086/587658 18419494 · DOI
- [12]Hall A Hewitt G Tuffrey V de Silva N A review and meta-analysis of the impact of intestinal worms on child growth and nutrition Matern Child Nutr 2008 4 Suppl 1 118 236 10.1111/j.1740-8709.2007.00127.x 18289159 PMC6860651 · DOI
- [15]Gunawardena K Kumarendran B Ebenezer R Gunasingha MS Pathmeswaran A de Silva N Soil-transmitted helminth infections among plantation sector schoolchildren in Sri Lanka: prevalence after ten years of preventive chemotherapy PLoS Negl Trop Dis 2011 5 e1341 10.1371/journal.pntd.0001341 21980549 PMC3181244 · DOI
- [16]Hotez PJ Mass drug administration and integrated control for the world’s high-prevalence neglected tropical diseases Clin Pharmacol Ther 2009 85 659 664 10.1038/clpt.2009.16 19322166 · DOI
- [17]Jia T-W Melville S Utzinger J King CH Zhou X-N Soil-transmitted helminth reinfection after drug treatment: a systematic review and meta-analysis PLoS Negl Trop Dis 2012 6 e1621 10.1371/journal.pntd.0001621 22590656 PMC3348161 · DOI
- [18]Black RE Victora CG Walker SP Bhutta ZA Christian P de Onis M Maternal and child undernutrition and overweight in low-income and middle-income countries Lancet 2013 382 427 451 10.1016/S0140-6736(13)60937-X 23746772 · DOI · Paper page
- [19]Erismann S Shrestha A Diagbouga S Knoblauch A Gerold J Herz R Complementary school garden, nutrition, water, sanitation and hygiene interventions to improve children’s nutrition and health status in Burkina Faso and Nepal: a study protocol BMC Public Health 2016 16 244 10.1186/s12889-016-2910-7 26957322 PMC4784388 · DOI
- [20]Schreinemachers P Bhattarai DR Subedi GD Acharya TP Chen H Yang R Impact of school gardens in Nepal: a cluster randomised controlled trial J Dev Eff 2017 9 329 343 10.1080/19439342.2017.1311356 · DOI
- [22]Shrestha A Sharma S Gerold J Erismann S Sagar S Koju R Water quality, sanitation, and hygiene conditions in schools and households in Dolakha and Ramechhap districts, Nepal: results from a cross-sectional survey Int J Environ Res Public Health 2017 14 1 10.3390/ijerph14010089 PMC5295339 28106779 · DOI
- [23]Erismann S Knoblauch AM Diagbouga S Odermatt P Gerold J Shrestha A Prevalence and risk factors of undernutrition among schoolchildren in the plateau central and Centre-Ouest regions of Burkina Faso Infect Dis Poverty 2017 6 17 10.1186/s40249-016-0230-x 28100278 PMC5244543 · DOI
- [25]Bosch AM Baqui AH van Ginneken JK Early-life determinants of stunted adolescent girls and boys in Matlab, Bangladesh J Health Popul Nutr 2008 26 189 199 18686552 PMC2740662
- [26]Lautenschlager L Smith C Understanding gardening and dietary habits among youth garden program participants using the theory of planned behavior Appetite 2007 49 122 130 10.1016/j.appet.2007.01.002 17336424 · DOI
- [27]Ratcliffe MM Merrigan KA Rogers BL Goldberg JP The effects of school garden experiences on middle school-aged students’ knowledge, attitudes, and behaviors associated with vegetable consumption Health Promot Pract 2011 12 36 43 10.1177/1524839909349182 19846682 · DOI
- [28]Wang MC Rauzon S Studer N Martin AC Craig L Merlo C Exposure to a comprehensive school intervention increases vegetable consumption J Adolesc Health 2010 47 74 82 10.1016/j.jadohealth.2009.12.014 20547295 · DOI
- [29]Lautenschlager L Smith C Beliefs, knowledge, and values held by inner-city youth about gardening, nutrition, and cooking Agric Hum Values 2007 24 245 10.1007/s10460-006-9051-z · DOI
- [30]Aryal J Gautam B Sapkota N Drinking water quality assessment J Nepal Health Res Counc 2012 10 192 196 23281449
- [31]Rai SK Ono K Yanagida JI Kurokawa M Rai CK Status of drinking water contamination in mountain region, Nepal Nepal Med Coll J 2009 11 281 283 20635611
- [32]Utter J Denny S Dyson B School gardens and adolescent nutrition and BMI: results from a national, multilevel study Prev Med 2016 83 1 4 10.1016/j.ypmed.2015.11.022 26657347 · DOI
- [33]Shrestha A Koju RP Beresford SAA Gary Chan KC Karmacharya BM Fitzpatrick AL Food patterns measured by principal component analysis and obesity in the Nepalese adult Heart Asia 2016 8 46 53 10.1136/heartasia-2015-010666 PMC4898623 27326232 · DOI
- [34]Sayasone S Utzinger J Akkhavong K Odermatt P Multiparasitism and intensity of helminth infections in relation to symptoms and nutritional status among children: a cross-sectional study in southern Lao People’s Democratic Republic Acta Trop 2015 141 322 331 10.1016/j.actatropica.2014.09.015 25291046 · DOI
- [35]Righetti AA Koua A-YG Adiossan LG Glinz D Hurrell RF N’Goran EK Etiology of anemia among infants, school-aged children, and young non-pregnant women in different settings of south-central Côte d’Ivoire Am J Trop Med Hyg 2012 87 425 434 10.4269/ajtmh.2012.11-0788 22848097 PMC3435343 · DOI
- Authors
- Shrestha, A., Schindler, C., Odermatt, P., Gerold, J., Erismann, S., Sharma, S., Koju, R., Utzinger, J., & Cissé, G.
- Affiliations
- Swiss Tropical and Public Health Institute (CH)
- Kathmandu University (NP)
- Corresponding author
- Cissé, Guéladio
- ORCID
- Venue
- BMC Public Health
- Published
- 2020-02-03
- Volume
- 20
- Issue
- 1
- Pages
- 158-158
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC6998817
- OpenAlex
- W3005153908
- Cited by
- 45
- References
- 36
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 4 · 2023: 12 · 2022: 7 · 2021: 6 · 2020: 1
- FWCI
- 4.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Swiss Agency for Development and Cooperation (81024052 (project 7F-08511.01))
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
- Social Sciences › Safety Research › Poverty, Education, and Child Welfare
- Keywords
- school-based nutrition intervention, water, sanitation and hygiene, complementary feeding, child nutritional status, stunting, anemia, handwashing with soap, intestinal protozoa, helminths, dietary intake, school-based health education, Nepal, school clusters, low- and middle-income countries, school-based deworming
- MeSH terms
- Gardens, Adolescent, Child, Diet, Female, Health Status, Humans, Hygiene, Male, Nepal, Nutritional Status, Sanitation, School Health Services, Water Supply, Program Evaluation, Water Quality
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
