Condition category
Nutritional, Metabolic, Endocrine
Date applied
05/11/2013
Date assigned
05/03/2015
Last edited
13/10/2016
Prospective/Retrospective
Retrospectively registered
Overall trial status
Completed
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
School food programmes are a popular way to support the education, health and nutrition of school children. As of 2011, the Ghana School Feeding Programme (GSFP) reaches over 1.6 million primary school children in all 170 districts in Ghana. Private caterers are awarded contracts by the GSFP to procure, prepare and serve food to pupils. The caterers are able to procure on a competitive basis without commitment to purchasing from small-scale farmers. ‘Home-grown’ school feeding aims to link the increased demand for school feeding goods and services to community stakeholders, including small-holder farmers (mainly subsistence farmers) and women groups. This study aims to evaluate the impact of school feeding sourced from small-holder (mainly subsistence) farmers on school children’s nutrition, health and education as well as on small holder food security in Ghana.

Who can participate?
Pre-primary and primary school age children (2-15 years of age) and their families, and small holder farmers.

What does the study involve?
Participating primary schools will be randomly allocated to one of the following three groups:
1. The school feeding programme group, where the standard GSFP is implemented.
2. The ‘home-grown’ school feeding (HGSF+) group, where the GSFP is implemented in addition to training of community-based organizations and local government.
3. The control group, where the intervention will be implemented two years later.
Half of the HGSF+ schools will also be randomly assigned to receive food fortification (the HGSF++ group). Data will be collected from children aged 5 to 15 in all of the groups, including blood samples, demographic and education characteristics of the children, and characteristics of the parents.

What are the possible benefits and risks of participating?
School feeding programmes have been shown to support the education, health and nutrition of school children. The Government of Ghana will benefit from the findings in terms of informing the scale-up of the national programme. The participants will find out about their hemoglobin levels and parasite infection status. Overall, the study involves very low risks for participants. The risks are related to the quality of the food service delivered by the national school feeding programme. Risks involve food hygiene, sanitation and preparation-related issues. The study will examine these risks in detail and also identify and test strategies to reduce these risks. The anemia measurement and blood film preparation will involve finger pricking that will cause some discomfort, but no major risks are associated with this procedure.

Where is the study run from?
Imperial College London (UK)

When is the study starting and how long is it expected to run for?
June 2013 to June 2015

Who is funding the study?
Bill and Melinda Gates Foundation (USA)

Who is the main contact?
1. Dr Lesley Drake (lesley.drake@imperial.ac.uk)
2. Dr Elisabetta Aurino (e.aurino@imperial.ac.uk)

Trial website

Contact information

Type

Scientific

Primary contact

Dr Lesley Drake

ORCID ID

Contact details

Partnership for Child Development
Department of Infectious Disease Epidemiology
Imperial College London
London
W2 1PG
United Kingdom

Type

Scientific

Additional contact

Dr Elisabetta Aurino

ORCID ID

http://orcid.org/0000-0001-5814-2704

Contact details

Partnership for Child Development
Department of Infectious Disease Epidemiology
Imperial College London
London
W2 1PG
United Kingdom

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

N/A

Study information

Scientific title

The impact of school feeding on nutrition, education, agriculture and other social outcomes: design of a randomised controlled trial of 'home-grown' school feeding in Ghana

Acronym

N/A

Study hypothesis

School feeding programmes provide well documented direct benefits to school children and their families. Emerging evidence also suggests that they can provide a stable market for goods and services. This study in Ghana and a study we have begun in Mali (http://www.controlled-trials.com/ISRCTN76705891) are the first randomised controlled trials that will examine this in detail.

The Ghana School Feeding Programme (GSFP) was piloted in 10 schools in late 2005. By the end of 2009, GSFP had progressively grown to serve 1,695 public schools with 656,624 pupils in all the 170 districts in Ghana. As of 2011, the Ghana School Feeding Programme (GSFP) reaches over 1.6 million primary school children in all 170 districts in Ghana. Co-ordination and implementation are undertaken by a National Secretariat, with programme oversight provided by the Ministry of Local Government and Rural Development (MoLGRD). Line Ministries offer technical support through the programme steering committee (PSC), although a number of NGOs and bilateral agencies are also involved with technical support. The GSFP has become a very popular programme with the Ghanaian public and enjoys solid commitment from the government who directly fund the programme, currently with a 4 year programme budget of over 200 million USD.

The GSFP service delivery is provided through private caterers who are awarded contracts by the GSFP to procure, prepare and serve food to pupils in targeted schools. Each caterer is responsible for procuring food items from the market, preparing school meals and distributing food to pupils. Cash transfers are made from the District Assemblies, under the supervision of the District Implementing Committees (DICs), to caterers based on 40 Ghana pesewas (circa US$0.33) per child per day. Caterers are not permitted to serve more than three schools each, and profit is derived from savings made after food has been procured, prepared and distributed. The caterers are not restricted or guided in their procurement and are able to procure on a competitive basis without commitment to purchasing from small-scale farmers even though the GSFP project document prioritises procurement from the community surrounding the assisted schools, broadening the focus to the district and national levels when food items are not available.

School food programmes are popular interventions to support the education, health and nutrition of school children. Home-grown school feeding has the potential to link the increased demand for school feeding goods and services to community stakeholders, including small-holder farmers (mainly subsistence farmers) and women groups. There is limited evidence however of the impact of providing a reliable market for small-holder farmers through “home-grown” school feeding approaches. The GSFP was designed as a strategy to increase domestic food production, household incomes and food security in deprived communities. Despite the large investment in the national programme, to date, there are no rigorous impact evaluations of the GSFP.

This study proposes a randomized control trial which aims to evaluate the impact of school feeding sourced from small-holder (mainly subsistence) farmers on school children’s nutrition, health and education as well as on small-holder food security in Ghana.

Ethics approval

Ethical clearance was obtained from the appropriate boards in Ghana and at Imperial College London. Meetings were held from early stages in the study development with relevant Government Ministries both at central and decentralised levels to discuss the
purpose, procedures and risks involved in the study. Informed consent was obtained from parents/guardians of children through written and verbal information provided before interviews.

Study design

Randomised controlled trial

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Community

Trial type

Quality of life

Patient information sheet

Not available in web format, please use contact details to request a participant information sheet

Condition

School health and nutrition

Intervention

This study involves a field experiment around the scale-up of the national Ghana School Feeding Programme, including 120 primary schools in 58 Districts. The randomly assigned interventions are:
1. School feeding programme group, where the standard Ghana School Feeding Programme is implemented
2. 'Home-grown' school feeding (HGSF+) group, including schools and communities where the Ghana School Feeding Programme is implemented in addition to training of community based organizations and local government
3. Control group, including schools and household from communities where the intervention will be implemented in two years (preferably without informing schools and households of impending intervention).

The pilot project will be implemented within the existing structure of the GSFP. By using the pre-existing programme structure, the pilot will complement the current programme by delivering a number of district and community level activities aimed at enhancing the GSFP impact. In brief, these activities comprise:
1. Enhancing the linkage between school feeding and smallholder agriculture production
2. Enhanced nutrition service.

The impact evaluation will include a sub-study focusing on nutrition in school feeding with and without fortification. A sub-group of 15 of the 30 HGSF+ will be randomly assigned to receive food fortification (the HGSF++ group) in addition to training and sensitization activities that are part of the HGSF+ pilot. Data will be collected from children aged 5 to 15 in the HGSF++, HGSF+, GSFP and control villages. Data to be collected includes blood samples, demographic and education characteristics of the child, and characteristics of the parents.

The expected impact of the intervention relate to education, nutrition and social protection. The findings of this study will provide policy and programme level guidance to inform the scale-up of the Government programme. This project will be a first of its kind and aim to fill the gap in the evidence base on HGSF programmes and provide measures of cost-effectiveness of two different implementation modalities.

The study population includes approximately 5000 children, 2400 households and 120 schools. Households will be selected at random from community level listings.

The study is integrated within the monitoring and evaluation of the national school feeding programme. Local Government Authorities, the Ghana Education Service, and local chiefs will be sensitized on the project activities and asked to give their consent. Informed consent will be requested from the each of the household heads, parents and School Principals prior to the interviews using a standardized form. All the survey tools are written in English, and the enumerators will speak both English and the local language.

Participants will be free to withdraw at any stage of the process by informing the survey enumerators, Local Government Authority, programme or Ghana Education Service staff. During the data processing stages the data set will be anonymized to ensure confidentiality of the respondents. All published data sets will include no personal references to individuals.

Intervention type

Other

Phase

Drug names

Primary outcome measures

Small-holder farmer income, school participation and learning, and community involvement in
the programme. Baseline was conducted between 22/06/2013 and 02/09/2013. Follow-up planned for November 2015.

Secondary outcome measures

Nutritional status (anthropometry and anaemia) and diet diversity. Baseline was conducted between 22/06/2013 and 02/09/2013. Follow-up planned for November 2015.

Overall trial start date

01/06/2013

Overall trial end date

01/06/2015

Reason abandoned

Eligibility

Participant inclusion criteria

1. Pre-primary and primary school age children (2-15 years of age) and their families
2. Small-holder farmers

Participant type

Mixed

Age group

Mixed

Gender

Both

Target number of participants

The study population includes 5300 children, 1800 households, and 120 schools. Households will be selected at random from village level listings.

Participant exclusion criteria

Households with children not of primary school age

Recruitment start date

12/06/2013

Recruitment end date

02/09/2013

Locations

Countries of recruitment

Ghana

Trial participating centre

Imperial College of Science, Technology and Medicine
Exhibition Road South Kensington
London
SW7 2AZ
United Kingdom

Trial participating centre

Noguchi Memorial Institute for Medical Research
Box LG 581 University of Ghana
Legon
-
Ghana

Sponsor information

Organisation

Imperial College London (UK)

Sponsor details

c/o Elio Riboli
School of Public Health
St Mary's Campus
London
W2 1PG
United Kingdom

Sponsor type

University/education

Website

http://www3.imperial.ac.uk/

Funders

Funder type

Charity

Funder name

Bill and Melinda Gates Foundation

Alternative name(s)

Bill & Melinda Gates Foundation

Funding Body Type

private sector organisation

Funding Body Subtype

foundation

Location

United States of America

Results and Publications

Publication and dissemination plan

A series of papers related to baseline data, including the one on design and analysis of baseline data, are currently being drafted. These relate to education, nutrition and food security/agricultural linkages. Additional papers using the follow-up data are planned.

Intention to publish date

Participant level data

Available on request

Results - basic reporting

Publication summary

2016 results in: https://www.ncbi.nlm.nih.gov/pubmed/26792672

Publication citations

Additional files

Editorial Notes

13/10/2016: Publication reference added.