Margaret M. Dubeck

Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya.

BackgroundImproving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence on the benefits of school-based malaria prevention or how health interventions interact with other efforts to improve education quality. This study aims to evaluate the impact of school-based malaria prevention and enhanced literacy instruction on the health and educational achievement of school children in Kenya.DesignA factorial, cluster randomised trial is being implemented in 101 government primary schools on the coast of Kenya. The interventions are (i) intermittent screening and treatment of malaria in schools by public health workers and (ii) training workshops and support for teachers to promote explicit and systematic literacy instruction. Schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention is implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months. The primary outcomes are educational achievement and anaemia, the hypothesised mediating variables through which education is affected. Secondary outcomes include malaria parasitaemia, school attendance and school performance. A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions.DiscussionAcross Africa, governments are committed to improve health and education of school-aged children, but seek clear policy and technical guidance as to the optimal approach to address malaria and improved literacy. This evaluation will be one of the first to simultaneously evaluate the impact of health and education interventions in the improvement of educational achievement. Reflection is made on the practical issues encountered in conducting research in schools in Africa.Trial RegistrationNational Institutes of Health NCT00878007

Plasmodium falciparum, anaemia and cognitive and educational performance among school children in an area of moderate malaria transmission: Baseline results of a cluster randomized trial on the coast of Kenya:

Objectives  Studies have typically investigated health and educational consequences of malaria among school‐aged children in areas of high malaria transmission, but few have investigated these issues in moderate transmission settings. This study investigates the patterns of and risks for Plasmodium falciparum and anaemia and their association with cognitive and education outcomes on the Kenyan coast, an area of moderate malaria transmission.

Early Primary Literacy Instruction in Kenya

We report on a study that used observations, conversations, and formal interviews to explore literacy instruction in 24 lower-primary classrooms in coastal Kenya. Specifically, we report the ways literacy instruction is delivered and how that delivery aligns with practices understood to promote reading acquisition. We find (1) prioritization of developing oral language skills over teaching the relationships between sounds and symbols, (2) enablers to literacy instruction that are the result of teachers’ efforts, and (3) constraints to successful literacy instruction as perceived by the teachers. We identify challenges and opportunities to improve literacy instruction in English and Swahili.

Challenges for consent and community engagement in the conduct of cluster randomized trial among school children in low income settings: experiences from Kenya

BackgroundThere are a number of practical and ethical issues raised in school-based health research, particularly those related to obtaining consent from parents and assent from children. One approach to developing, strengthening, and supporting appropriate consent and assent processes is through community engagement. To date, much of the literature on community engagement in biomedical research has concentrated on community- or hospital-based research, with little documentation, if any, of community engagement in school-based health research. In this paper we discuss our experiences of consent, assent and community engagement in implementing a large school-based cluster randomized trial in rural Kenya.MethodsData collected as part of a qualitative study investigating the acceptability of the main trial, focus group discussions with field staff, observations of practice and authors’ experiences are used to: 1) highlight the challenges faced in obtaining assent/consent; and 2) strategies taken to try to both protect participant rights (including to refuse and to withdraw) and ensure the success of the trial.ResultsEarly meetings with national, district and local level stakeholders were important in establishing their co-operation and support for the project. Despite this support, both practical and ethical challenges were encountered during consenting and assenting procedures. Our strategy for addressing these challenges focused on improving communication and understanding of the trial, and maintaining dialogue with all the relevant stakeholders throughout the study period.ConclusionsA range of stakeholders within and beyond schools play a key role in school based health trials. Community entry and information dissemination strategies need careful planning from the outset, and with on-going consultation and feedback mechanisms established in order to identify and address concerns as they arise. We believe our experiences, and the ethical and practical issues and dilemmas encountered, will be of interest for others planning to conduct school-based research in Africa.Trial registrationNational Institute of Health NCT00878007

Assess Reading Early to Inform Instruction, Improve Quality, and Realize Possibilities

Abstract In the more than quarter century since commitments were made under Education for All, low- and middle-income countries have made considerable progress in ensuring that more students are enrolled in and completing primary schooling. However, despite lofty promises to improve literacy and numeracy for all, UNESCO estimates that more than 250 million children are not learning the basics. Currently, a limited number of practitioners and policy makers have access to information on how well students are learning to read and perform basic math. As access to technology and globalization continues to expand, we expect increased demand for and democratization of information on student learning, particularly in the Global South. This chapter describes the influence of reading assessments at the child level on the focus on quality education in low-resourced contexts. Over the past decade, child-level assessment data have contributed to modifications in classroom instruction, teacher support, community engagement, and language policy. These data have led to the refinement of additional child-level and classroom-based assessments to inform and reflect context. Ultimately, the initial questions about child-level learning have facilitated successive improvements in understanding and bettering the results. This chapter suggests a prospective direction that the international education community should take to continue improving child outcomes.