School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines

Sangalang, Stephanie O.; Lemence, Allen Lemuel G.; Ottong, Zheina J.; Valencia, John Cedrick; Olaguera, Mikaela; Canja, Rovin James F.; Mariano, Shyrill Mae F.; Prado, Nelissa O.; Ocaña, Roezel Mari Z.; Singson, Patricia Andrea A.; Cumagun, Ma. Lourdes; Liao, Janine; Anglo, Maria Vianca Jasmin C.; Borgemeister, Christian; Kistemann, Thomas

doi:10.1186/s12889-022-14398-w

Table 3 Effect of intervention on children’s growth and malnutrition status

From: School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines

Outcome	Study arm	Baseline		Endline		Effect of intervention (95% CI)	p-value
Outcome	Study arm	Mean	±SD	Mean	±SD	Effect of intervention (95% CI)	p-value
Continuous outcomes*
HAZ	Control	-0.07	1.3	-0.15	1.1
	Low-intensity education	-0.59	1.4	-0.57	1.3	0.22 (-0.26, 0.70)	0.36
	Medium-intensity education	-0.85	1.1	-0.61	3.3	0.28 (-0.19, 0.75)	0.24
	High-intensity education	-0.75	1.1	-0.82	1	0.21 (-0.17, 0.58)	0.28
BAZ	Control	0.31	1.7	0.64	1.5
	Low-intensity education	0.24	1.9	0.23	1.5	-0.18 (-0.57, 0.21)	0.37
	Medium-intensity education	-0.15	1.5	-0.12	1.5	-0.06 (-0.38, 0.26)	0.72
	High-intensity education	-0.15	1.4	-0.16	1.4	-0.10 (-0.41, 0.21)	0.53
BMI	Control	18.8	4.5	20.2	4.7
	Low-intensity education	19	6.9	19.2	4.4	-0.78 (-1.54, -0.01)	0.05
	Medium-intensity education	18.5	3.8	18.9	3.8	-0.28 (-0.95, 0.39)	0.41
	High-intensity education	17.7	3.3	18.1	3.4	-0.33 (-0.94, 0.28)	0.29
Height (cm)	Control	143.5	11.2	147.1	9
	Low-intensity education	140.3	10.6	145.2	9.6	0.46 (0.30, 0.63)	p < 0.01
	Medium-intensity education	145.5	11.2	149.1	11.2	0.98 (-0.06, 2.02)	0.07
	High-intensity education	140.5	9.3	143.8	8.6	0.57 (0.05, 1.10)	0.03
Weight (kg)	Control	39.2	12.1	44.2	12.7
	Low-intensity education	37.5	12.6	41.3	13.2	0.08 (-0.17, 0.33)	0.53
	Medium-intensity education	39.8	11.7	42.6	11.8	0.24 (0.07, 0.41)	0.01
	High-intensity education	35.4	9.9	38	10	0.14 (-0.29, 0.57)	0.53
Binary outcomes**		n	%	n	%
Stunting	Control	4	5.1	4	4.9
	Low-intensity education	14	13.5	11	10.6	0.95 (0.93, 0.96)	p < 0.01
	Medium-intensity education	47	13.3	41	13.2	1.04 (0.96, 1.13)	0.29
	High-intensity education	24	11.7	19	10.5	1 (0.80, 1.25)	1
Undernutrition	Control	6	7.7	3	3.7
	Low-intensity education	8	7.7	6	5.8	0.77 (0.09, 6.52)	0.81
	Medium-intensity education	31	8.8	24	7.7	0.93 (0.16, 5.67)	0.94
	High-intensity education	13	6.3	13	7.2	1 (0.19, 5.26)	1
Overnutrition	Control	27	34.6	36	44.4
	Low-intensity education	32	30.8	31	29.8	0.57 (0.34, 0.96)	0.04
	Medium-intensity education	76	21.5	68	21.9	0.68 (0.37, 1.26)	0.22
	High-intensity education	44	21.4	38	21	0.63 (0.42, 0.93)	0.02

BAZ = body mass index-for-age Z score. BMI = body mass index. CG = control group. CI = confidence interval. cm = centimetre. HAZ = height-for-age Z score. IG = intervention group. kg = kilogram. SD = standard deviation
The p-value refers to the difference in intervention effect between the respective intervention group (IG) and the control group (CG). We classified nutrition status using the 2007 WHO Growth Reference. Stunting = HAZ < − 2 SD. Undernutrition = composite variable comprised of thinness (− 3 < BAZ < − 2) and severe thinness (BAZ < − 3). Overnutrition = composite variable comprised of overweight (1 < BAZ < 2) and obesity (BAZ > 2).
*We used a multilevel mixed-effects linear regression model to estimate intervention effects, which can be interpreted as the adjusted differences in the mean changes of the desired follow-up outcome between the respective IG and the CG. The model included the respective IG, random intercept for the city, and robust standard errors. We adjusted for the child’s sex and age and the parent/caregiver’s education level and socioeconomic status (SES).
**We used a multilevel mixed-effects logistic regression model to estimate intervention effects, which can be expressed as the odds ratio (OR) of change in prevalence of a desired follow-up outcome between the respective IG and the CG. The model included the respective IG, random intercept for the city, and robust standard errors. We adjusted for the child’s sex and age, and the parent/caregiver’s education level and socioeconomic status SES.

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