Addressing Anemia Full Spectrum_Outterson_5.11.11


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  • Secondary schools will be the units - both control and intervention schools will be in Gangni. There was also the question about the schoolgoing girls who also go to the after school sessions-how do account for their "double exposure" of the message and possible taking iron pills twice? Answer: School girls will get peer/ teacher led sessions in schools and out of school girls will be in the community-based peer sessions - we have to ensure that there will be no duplication of sessions for girls. a) We are going with the WHO weekly iron-folic acid supplementation recommendation and Andrew's suggestion of 60 mg iron for adolescent girls/ week. b) To my understanding, the sponsorship program will take place in primary schools in Gangni as planned; however in secondary schools the activities will be limited to the study (Rupa and Shahana please correct if I am wrong). I don't see any problem with this. Over time we can expect the children entering secondary school to have lesser anemia as a result of the vitamin A and iron supplementation in primary schools; but that will be so for both intervention and control schools, so we can still measure the differences in hemoglobin between them. We can also study the long-term effect of supplements after the girls have left school, but Andrew, Shahana and I did not discuss the modality for it on our last call so I did not include it in the slides. You can mention it in your presentation; and ask for suggestions on how to look at sustainability of supplementation. c) We are not thinking of any after school sessions in the community for school going girls. The sessions will take place in schools, facilitated by teachers on a weekly basis. Andrew, Shahana and I didn't get a chance to discuss sessions for out-of-school girls (e.g. who will conduct the sessions, how will they be trained etc) in our last call. Therefore I did not include them in the powerpoint. Also because the goal of our study is to increase girls' retention in schools, I just focused on the schoolgoing children and their parents in the powerpoint. We can include out-of-school children after we have worked out the details of the study. Lastly, at the moment we are looking at retention in school, nutritional status (incl hemoglobin), delay in marriage, and pregnancy as the outcomes for the study. Longer-term reproductive health outcomes is not part of the study design but we may want to look at it in the long-term.
  • Addressing Anemia Full Spectrum_Outterson_5.11.11

    1. 1. <ul><li>Addressing the Factors Affecting Education of Adolescent Girls in Bangladesh </li></ul>
    2. 2. <ul><li>Some problems in Bangladesh: </li></ul><ul><ul><li>Early drop-out of adolescent girls in secondary schools </li></ul></ul><ul><ul><li>Poor nutritional status of adolescent girls </li></ul></ul><ul><ul><li>Eve-teasing and sexual harassment, a key reason for early drop out </li></ul></ul><ul><ul><li>Early marriage and pregnancy, other reasons for early drop out </li></ul></ul><ul><ul><li>Less dowry a reason for early marriage </li></ul></ul><ul><ul><li>Menstruation may also be a reason for absenteeism </li></ul></ul>BACKGROUND
    3. 3. STATISTICS ON THE PROBLEM <ul><li>Tertiary education ratio for female to males is 36:64 </li></ul><ul><li>Almost 1/3 rd adolescent girls are anemic </li></ul><ul><li>1/3 rd of women (20-24 years) married by 15 yrs, 80% married by 20 years </li></ul><ul><li>55% adolescent girls are mothers by 19 years, of which 50% are acutely malnourished </li></ul>1. Government of Bangladesh and UN ‘Millennium Development Goals, Bangladesh Progress Report,’ 2005. 2. Anaemia Prevalence Survey of Urban Bangladesh and Rural Chittagong Hill Tracts 2003, UNICEF 3. State of the World’s Children, 2011 4. The State of World Population 2005, UNFPA
    4. 4. <ul><li>Main goal : </li></ul><ul><li>Increasing the retention of adolescent girls in schools in Save the Children’s Sponsorship program area in Bangladesh </li></ul><ul><li>Also : </li></ul><ul><li>Delaying the marriage and first pregnancy of adolescent girls in Save the Children’s Sponsorship program area in Bangladesh </li></ul>PURPOSE OF THE STUDY
    5. 5. HYPOTHESES BEING TESTED <ul><li>Providing life-skills education package to boys and girls and their parents on social factors relating to girls’ education and health will positively effect the retention of girls in schools, their marriage and first pregnancy </li></ul><ul><li>Provision of iron-folic acid supplements with health education is more effective than health education alone </li></ul>
    6. 6. RELEVANCE OF SPONSORSHIP PROGRAM AREA <ul><li>Sponsorship programs are long-term programs, which typically run for 10-15 years </li></ul><ul><li>This allows for medium to long-term outcomes of programs such as school retention, marriage, pregnancy outcomes in adolescent girls study to be studied) </li></ul>
    7. 7. PROGRAM DESIGN: RANDOMIZED CLUSTER TRIAL <ul><li>Where : 52 schools in Gangni, Meherpur district, Bangladesh </li></ul><ul><li>Intervention schools : </li></ul><ul><ul><li>For school going girls and boys, weekly 30 minute peer group session on life skills, reproductive health, family planning, life planning, nutrition, rights, financial literacy and savings </li></ul></ul><ul><ul><li>For parents, every 2 months, education on adolescent girls’ nutrition, reproductive health and decisions. Sessions on agricultural issues related to nutrition sources and consumption (poultry, kitchen gardening etc.) added as a vocational incentive. </li></ul></ul><ul><ul><li>For drop-out girls and their parents, continued follow up to ensure they attend the above sessions </li></ul></ul><ul><ul><li>Provision of iron-folic acid and nutrition education to school-going and drop-out girls </li></ul></ul><ul><ul><li>Provision of adequate toilet facilities for girls in schools to ensure management of menstrual hygiene. </li></ul></ul>
    8. 8. <ul><li>Control Schools </li></ul><ul><ul><li>For school going boys and girls, general health education not related to the factors affecting girls’ education </li></ul></ul><ul><ul><li>For parents, general health education not related to the factors affecting girls’ education </li></ul></ul><ul><ul><li>For drop-out girls and their parents, continued follow up to ensure they attend the above sessions </li></ul></ul><ul><ul><li>Nutrition education to school-going and drop-out girls to encourage them to get micronutrient supplementation from health centers </li></ul></ul>PROGRAM DESIGN: RANDOMIZED CLUSTER TRIAL
    9. 9. QUESTIONS AND CHALLENGES <ul><li>Challenges: </li></ul><ul><li>Secondary schools are reached by children beyond the village catchment, therefore there is risk for contamination. </li></ul><ul><li>Girls who drop out may be hard to reach esp. in case of migration </li></ul><ul><li>Questions: </li></ul><ul><li>Are there other interventions we should provide in order to see a change in girls’ retention in schools, and their marriage/ pregnancy outcomes? </li></ul>