The study titled 'Seeds of Prevention' investigates the health behaviors of young adolescent girls in Uttar Pradesh, India, focusing on anemia, nutrition, and reproductive health through a cluster randomized control trial. Implemented in 30 schools with 1,800 participants, the intervention showed significant improvements in health behaviors, including increased consumption of iron folic acid and better menstrual hygiene. However, the short duration of the study and the sustainability of behavioral changes were identified as limitations.

1. Journal club
Presenter-Dr Rajesh Nandi
Moderator-Dr Mamta
Facilitator-Dr Abhishek

2. Title of the article
Seeds of prevention: The impact on health behaviors
of young adolescent girls in Uttar Pradesh, India, a
cluster randomized control trial
Authors- Nandita Kapadia-Kundu & Geetali Trivedi
1
, Douglas Storey & Basil Safi2
, Rama Tupe3
, G.
Narayana 4

3. 1-Johns Hopkins Bloomberg School of Public Health, Center for
Communication Programs, Nehru Place, New Delhi, India
2- Johns Hopkins Bloomberg School of Public Health, Center for
Communication, Baltimore, USA
3- Genesis Research, Delhi, India
4- Futures International , Haryana, India

4. About the journal
Name – Social science and medicine
Impact factor- 5.4
Published – September 2014
Volume-120
Pages -169-179

5. Plan of presentation
 Introduction and Rationale
 Objective
 Methodology
 Results
 Discussion

6. Introduction and rationale
Early adolescent girls are vulnerable to health challenges
Effective health interventions were scarce
Intergenerational low birth weight , anemia and under
nutrition
Leads to “Cycle of failure”
Early adolescent is a gateway to build nutritional and health
reserves

7. Aim
To provide a foundation of healthy behavior that
will benefit two generations: young adults and
girls in their adulthood and their children

8. Methodology
Study design- Cluster randomised control trial
Study setting- Hardoi, district of Uttar Pradesh
Study participants- Adolescent girls (11-14
years)
Study period-January 2010 to October 2011

9. Sample size – For cluster RCT (ESS=mk/DE)
ESS =effective sample size
Number of schools/clusters (k) = 30
Number of girls per school (m) = 60
Total number =1800
Design effect = 1+ rho(m-1)
= 1+0.017(29)
=1.4
ESS=1800/1.4=1205 adolescents girls

10. Data collection- Face to face interviews were
conducted
Statistical analysis-Qualitative data was analysed in
proportion using chi square while quantitative data
was analysed using t test between intervention and
control groups

11. Hardoi district (19 blocks)
Stratification of blocks into 3 categories by distance
41-60 kms
from Hardoi
<20 kms
from Hardoi
21- 40 kms
from Hardoi
Randomly 2 blocks
selected from
which 5 schools
were randomly
selected
40 girls from each
school were
randomly selected
from class 7-8
Randomly 2 blocks
selected from
which 5 schools
were randomly
selected
40 girls from each
school were
randomly selected
from class 7-8
Randomly 2 blocks
selected from which 5
schools were
randomly selected
40 girls from each
school were randomly
selected from class 7-
8
Baseline survey of girls

12. Baseline survey
Random assignment
of blocks <20km
from Hardoi city
Random assignment
of blocks 20-40 kms
from Hardoi city
Random assignment
of blocks 41-60 kms
from Hardoi city
Intervention
block
Control
block
5 schools
40
girls/school
SSKY + Pilot
5 schools
40
girls/school
5 schools
40
girls/school
5 schools
40
girls/school
5 schools
40
girls/school
5 schools
40
girls/school
Intervention
block
Control
block
Control
block
Intervention
block
SSKY + Pilot SSKY + Pilot
SSKY SSKY SSKY

13. Saloni swasthya kishori yojana
 For school going adolescent girls (10-19 years)
 Address the problem of anemia
 Administration of weekly IFA tablets, bi annual
deworming and annual health check ups

14. Saloni pilot intervention
Addition to SSKY implemented in government schools
Promoted 19 health behaviors
5 health seeking ,6 nutrition,3 reproductive health and 5 hygiene
A structured teachers manual
A saloni diary for the girls

16. Saloni diary – provided to girls with aim to promote healthy
behaviors in a more interactive way (colourful pictorial
representations)
Contents
 Personal information
 Family details
 Daily activities
Daily food intake
 Health behaviors (reproductive health, nutrition and hygiene)
 Intergenerational communication – sharing learning with parents

17. Delivery of interventions
Saloni diary
Education on inter generational communication(with mothers,
fathers and other family members)
Role plays and posters promoting intergenerational communication
and enforcing healthy behaviors
Community support ( school teachers)
Ten monthly education sessions one hour each ( by the teachers)

18. Consent for participation was taken from their guardians or parents
and from the girls themselves
Face to face interviews were conducted at the end of the
intervention

20. Only 11.4 – 9.5% girls live in brick houses- indicative of high level of poverty
Increase in number of nuclear families in the endline is not explained

21. Results
Significant increase in consumption of iron folic acid tablets after the intervention

22. The above table shows significant increase in having 3 meals + snack in both the groups but more in intervention
group

23. There was an improvement in menstrual hygiene in both the groups but due to some social
constraints the improvement was limited

26. Discussion
 Seeds of prevention need to be sown in early ages
 Saloni intervention focused on early adolescence as gateway moment
 Early adolescence girls are potentially receptive
 Integrated intervention on reproductive and sexual health ,nutrition and
hygiene
 Evidence of concurrent changes in more than one behavior across
different health issues
 Findings can be applied to the target population

27. Limitations
 Short duration of study
 Sustainability of behavioral changes unknown

28. CONSORT checklist
28
Content Recommendation Report
Title Identification as a randomized trial in the title Yes
Abstract
Structured summary of trial design, methods,
results, and conclusions
Mentioned but not in a structured format
Introduction Scientific background and explanation of rationale
Background and problem statement
explained
Objectives Specific objectives or hypotheses
Not clearly stated under a separate
heading
Trial design
Description of trial design
Important changes to methods after trial
commenced
No changes were made to protocol after
commencing the study

29. CONSORT checklist (cont.)
Content Recommendation Report
Participants
Eligibility criteria
Settings and locations where the data were collected Mentioned
Interventions
Interventions for each group with sufficient details to allow
replication
Mentioned but in detailed
delivery of interventions not
given
Outcomes
Completely defined pre-specified outcome measures, including
how and when they were assessed
Any changes to outcomes after the trial commenced
Primary outcome and
secondary outcome not
mentioned under separate
heading , analysis of results
not mentioned clearly
Sample size How sample size was determined Explained.

30. CONSORT checklist (cont.)
Content Recommendation Report
Random sequence
generation
Method, type of randomization, details of any restriction Not mentioned
Allocation
concealment
Mechanism used, describing any steps taken to conceal
the sequence until interventions Not mentioned
Implementation
Who generated the random allocation sequence, who
enrolled and assigned interventions Not mentioned
Blinding
If done, who was blinded after assignment to interventions
and how
Not mentioned clearly
Statistical methods Methods used to compare groups for outcomes
Methods for additional analyses Mentioned.

31. CONSORT checklist (cont.)
Content Recommendation Report
Outcomes and
estimation
For each primary and secondary outcome, results for
each group, and estimated effect size and precision
For binary outcomes, presentation of both absolute and
relative effect sizes is recommended
No primary and secondary
outcomes mentioned
seperately
Ancillary
analyses
Results of any other analyses performed, including
subgroup analyses and adjusted analyses,
distinguishing pre-specified from exploratory
Not done
Harms Important harms or unintended effects in each group No harm
Limitations
Trial limitations, addressing sources of potential bias,
imprecision, and, if relevant, multiplicity of analyses
short duration
Sustainability of changes
unknown

32. CONSORT checklist (cont.)
Content Recommendation Report
Generalizability External validity & applicability of the trial findings
Generalizable only to target
population
Registration Registration number and name of trial registry Not mentioned
Protocol Where the full trial protocol can be accessed Could not be accessed
Funding
Sources of funding and other support, role of
funders
Not mentioned