Promoting healthy practices among schools and children in rural bangladesh: a randomised controlled trial of skill-based health education

Poor child health and hygiene practices are persistent issues in resource-constrained settings, particularly in low-income countries. This study assessed the impact of skill-based health education (SBHE) on school and child hygiene practices in rural Bangladesh. A cluster-randomised-controlled intervention with cross-cutting/factorial design was conducted in 180 randomly selected primary schools, stratified by school type, in Jhenaidah District, Bangladesh. Weekly SBHE sessions were delivered to half of the schools by locally recruited para-teachers for one year. A cross-cutting soap provision treatment was given monthly to half of the SBHE-treatment schools and half of the SBHE-control schools. Treatment assignment was masked to all baseline and endline surveyors. Data were collected at both the school and child levels, with child-level data aggregated at the school level. Outcome measures were grouped into five thematic families. The primary outcome families were school hygiene practice & maintenance, school-aggregated child handwashing and school-aggregated child dentalcare. Utilising the difference-in-differences estimator with seemingly unrelated regression, we estimated the average treatment effect for each family of multiple outcomes. The intervention spillover effect to neighbouring schools along with the time-period effect were also evaluated. The project's cost-effectiveness was additionally assessed. Our findings revealed that SBHE had a positive impact on primary outcomes related to healthy practices and behavioural changes, resulting in a 0.32SD improvement in school hygiene practices and maintenance (p