Assessing the Educational Impact of Malaria Prevention in Kenyan Schools 2010-2012
Impact Evaluation Study [ie/ies]
The Government of Kenya is interested in understanding how malaria prevention and treatment can improve the education of school children when it is combined with effective teaching. This project examines the impact of school-based malaria intermittent screening and treatment and enhanced literacy training and support for teachers on children's health and educational outcomes.
A cluster randomized trial was implemented with 5,233 children in 101 government primary schools on the south coast of Kenya in 2010-2012. The intervention was delivered to children randomly selected from classes 1 and 5 who were followed up for 24 months. Once a school term, children were screened by public health workers using malaria rapid diagnostic tests (RDTs), and children (with or without malaria symptoms) found to be RDT-positive were treated with a six dose regimen of artemether-lumefantrine (AL). Given the nature of the intervention, the trial was not blinded. The primary outcomes were anemia and sustained attention. Secondary outcomes were malaria parasitaemia and educational achievement. Data were analyzed on an intention to treat basis. The study is registered with ClinicalTrials.gov, NCT00878007.
The schools were randomly assigned to one of four experimental groups: some schools have been tested and treated for malaria; some schools have had extra support for teachers of English and Swahili; some schools have been both tested for malaria and received extra teacher support; and other schools have gotten neither of the two programs.
Following recruitment, baseline health and education surveys were undertaken in January-February 2010, which were followed by the first round of intermittent screening and treatment (IST) and the teacher training workshop. Classroom observations occurred in May 2010, followed by the second round of IST in June-July 2010. The third round of IST occurred in September 2010. The first follow-up education surveys were carried out in November 2010 and the first health surveys - in February and March 2011, followed by a round of IST as well as refresher teacher training for the literacy intervention. The final round of IST was conducted in September 2011 with the 24 months follow-up health and education survey in February-March 2012.
The data from the baseline and follow-up surveys is documented here.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Individuals, households, schools
The scope of the study includes:
- Household: languages spoken at home, reading ability, schooling, involvement in children's school, family composition, household construction, asset ownership, mosquito net ownership and use.
- School: water and sanitation facilities, health activities and educational materials, elevation of school in meters.
- Children: consent collected, height, weight, temperature, anemia, bodymass index, hemoglobin concentration, clinical malaria.
Kwale and Msambweni districts
The survey cover children in grades 1 and 5 in government schools in Kwale and Msambweni districts, their parents/guardians, head teaches of schools in above mentioned districts.
Producers and sponsors
London School of Hygiene and Tropical Medicine
International Initiative for Impact Evaluation (3ie)
Partnership for Child Development
Development Impact Evaluation Initiative (World Bank)
School selection was made from the 197 government primary schools in Kwale and Msambweni districts. In Kwale district, a separate study is evaluating the impact of an alternative literacy intervention in two of the four zones; therefore only 20 schools in this district were included in our study allowing the two interventions to proceed without leakage. In Msambweni district, 81 of 112 schools were selected; schools 70 km or further away from the project office, were excluded due to logistical constraints.
The randomization of the 101 schools into the four experimental groups was conducted in two stages, each involving public randomization ceremonies:
Stage 1 - Literacy intervention randomization
a) Clusters of schools (groups of between 3-6 schools that meet and share information) were randomised either to receive the literacy intervention or to serve as a control schools.
b) This randomization was stratified by (i) cluster size, to ensure equal numbers of schools in the experimental groups; and (ii) average primary school leaving exam scores across the cluster, to balance the two groups for school achievement.
c) District officials and representatives from all 26 school clusters were invited to a meeting. Volunteers were asked to randomly draw envelopes each containing a cluster name from 10 pre-stratified ballot boxes and to sequentially place the envelopes in group A and group B.
Stage 2 - Health intervention randomization
a) The health intervention was randomly allocated amongst the 51 schools assigned to the literacy intervention and the 50 schools allocated to serve as control schools during the first randomization.
b) Schools were stratified by average primary school leaving exam scores into 5 quintiles and by literacy intervention group, producing 10 strata overall.
c) Representatives from the 101 schools and local communities were invited to this randomization ceremony. Volunteers were asked to draw envelopes from the 10 pre-stratified ballot boxes and sequentially place the envelopes in group 1 and group 2.
During January and February 2010, schools were visited and a census of all children in classes 1 and 5 was conducted, including children absent on the day of visit. This census served as a basis for making a random selection of 25 children with consent from class 1 and 30 children with consent from class 5. Fewer children were selected from class 1 because of the extra educational assessments undertaken with these children and the practical feasibility of conducting the tests in a single day. Some of the classes were small, and this meant that in these classes all children with consent were recruited.
Of the 5,233 children enrolled initially, 4,446 (85.0%) were included in the 12 month follow-up health survey and 4201 (80.3%) were included in the 24 month health survey. Overall, 4,656 (89.0%) of children were included in the 9 month follow-up education survey and 4,106 (78.5%) in the 24 month follow-up survey.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The study was approved by the Kenya Medical Research Institute and National Ethics Review Committee (SSC No. 1543), the London School of Hygiene & Tropical Medicine Ethics Committee (5503), and the Harvard University Committee on the Use of Human Subjects in Research (F17578-101). Prior to the randomization, meetings were held with community and school leaders and parents/guardians in each school to explain the study objectives and procedures. Parents/guardians of all children in class 1 and 5 were requested to provide individual written informed consent and they were given the option to withdraw their child from the study at any time. Prior to every IST round or assessment the procedures were explained to the children and they were required to provide verbal assent. An independent data monitoring committee reviewed the trial protocol, data analysis plan and preliminary results.
Cross sectional health surveys were carried out at 12 and 24 months. During these surveys, temperature, weight and height were measured and a finger prick blood sample was collected for determination of malaria parasitaemia and Hb. Children with an axillary temperature =37.5°C were tested using a RDT, providing an on the spot diagnosis for malaria and treatment was administered as per national guidelines.
Hb was measured using a portable haemoglobinometer (Hemocue, Ängelholm, Sweden). Thick and thin blood films were stained with Giemsa, asexual parasites were counted against 200 white blood cells (WBC), and parasite density was estimated assuming an average WBC count of 8000 cells/µL. A smear was considered negative after reviewing 100 high-powered fields. Thin blood smears were reviewed for species identification. All blood slides were read independently by two microscopists who were blinded to group allocation. Discrepant results were resolved by a third microscopist.
Attention and educational achievement
Tests of sustained attention and educational achievement were administered at baseline, 9 months and 24 months. Sustained attention was a primary outcome. This was assessed through the code transmission test, adapted from the TEA-Ch (Tests of everyday attention for children) battery.
The secondary outcome of educational achievement was measured through tests of literacy and numeracy. Literacy was assessed through group administered English spelling tests, adapted from PALS (Phonological Awareness Literacy Screening), with the younger classes asked to spell five 3-letter words and credit given for phonetically acceptable choices for each letter and the older classes asked to spell 25 words with credit given for correctly spelling the features and sound combinations of the word. Numeracy assessments involved an oral test of basic arithmetic for younger children at baseline and 9 month follow-up and written arithmetic at 24 month follow-up and a written arithmetic test throughout for older children. All educational assessments were piloted prior to use in the baseline and follow-up evaluations.
Kenya Medical Research Institute
The following questionnaires and forms are available:
1) School Questionnaire
The school questionnaire is administered to the head teachers of each school during the initial school selection; if absent, the deputy head was interviewed. Information is collected on the characteristics of the school such as the number of boys and girls enrolled in each class, examination results in English, mathematics and Kiswahili, school features such as number of desks and teachers, facilities available such as latrines and the presence of school health activities and materials. Locations of each school were mapped using a handheld Global Positioning System (GPS) receiver, (eTrex Garmin Ltd., Olathe, KS).
2) Parent questionnaire for class 1 students
The parent questionnaire for class 1 students assesses the educational and socio-economic environment of the children's households. This is administered to the parent or guardian at the time of consent. Questions relate to their own reading ability, schooling, and involvement in their children's school, as well as questions on family composition, household construction, asset ownership and mosquito net ownership and use.
3) Parent questionnaire for class 5 students
The parent questionnaire for class 5 students assesses the educational and socio-economic environment of the children's households. This is administered to the parent or guardian at the time of consent. The section on education environment is reduced as the literacy intervention was focused on the class 1 children, so a less extensive knowledge of attitudes to education was required for parents of class 5 children. Questions relate to their schooling level achieved, as well as questions on family composition, household construction, asset ownership, and mosquito net ownership and use.
4) Nurse survey form for classes 1 and 5
The child ID, child name, and parent name of the randomly selected children are already entered on the form before arrival at the school. The nurse records the attendance of each child, completing the reasons using the codes at the bottom of the form. Height, weight and temperature of each child is recorded on the form. The child is also asked their age, which is recorded.
5) Health Technician survey form for classes 1 and 5
The child ID, child name, and parent name of the randomly selected children are already entered on the form before arrival at the school. The technician notes whether the child is present, and then records the hemoglobin reading, whether or not a blood slide has been taken, and the timing and result of the malaria rapid diagnostic test (RDT). This form is for assessment of children in the intervention schools where P falciparum infection is assessed.
Data were double-entered, consistency checks were performed and all analysis was conducted using Stata software version 12.1. The pre-specified primary outcome measure was the prevalence of anaemia, defined according to age and sex corrected World Health Organisation (WHO) thresholds: haemoglobin concentration <110g/l in children under 5 years; <115g/l in children 5 to 11 years; <120g/l in females 12 years and over and males 12 to 15 years old; and <130g/l in males over 15 years, with no adjustment made for altitude. The pre-specified secondary outcomes were the prevalence of P.falciparum, scores for code transmission, spelling and arithmetic. Reported information on ownership of household assets and household construction was used to construct wealth indices using principal component analysis  and resulting scores were divided into quintiles.
Anthropometric measurements were processed using the WHO Anthroplus Stata macro to derive indicators of stunting, wasting and underweight.
London School of Hygiene and Tropical Medicine
Researchers take strict precautions to safeguard children's personal information throughout the study. All research records are stored securely in locked cabinets and password protected computers. Only a few people who are closely concerned with the research are able to view information from participants.
The use of this dataset must be acknowledged using a citation which would include:
- the identification of the Primary Investigator(s) (including country name)
- the full title of the survey and its acronym (when available), and the year(s) of implementation
- the survey reference number
- the source and date of download (for datasets disseminated online).
Simon Brooker, London School of Hygiene and Tropical Medicine, Matthew Jukes, Harvard University. Assessing the Educational Impact of Malaria Prevention in Kenyan Schools (AEIMPBS) 2010-2012, Ref. KEN_2010-2012_AEIMPBS_v01_M. Dataset downloaded from [URL] on [date].
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
DDI Document ID
Development Data Group
Date of Metadata Production
DDI Document version
v01 (November 2013)
v02 (March 2014), Added: a report "Impact of intermittent screening and treatment for malaria among school children in Kenya: a cluster randomized trial."