NEW UPDATE: Completed trials may now upload and register supplementary documents (e.g. null results reports, populated pre-analysis plans, or post-trial results reports) in the Post Trial section under Reports, Papers, & Other Materials.
Anemia and School Participation
Initial registration date
July 21, 2016
July 21, 2016 3:12 PM EDT
University of California, Berkeley
Other Primary Investigator(s)
Director, Niramaya Health Foundation
Assistant Professor of Economics, University of Toronto
Additional Trial Information
Anemia is among the most widespread health problems for children in developing countries. This paper evaluates the impact of a randomized health intervention delivering iron supplementation and deworming drugs to Indian preschool children. At baseline, 69 percent were anemic and 30 percent had intestinal worm infections. Weight increased among assisted children, and preschool-participation rates rose by 5.8 percentage points, reducing absenteeism by one-fifth. Gains were especially pronounced for those most likely to be anemic at baseline. Results contribute to a growing view that school-based health programs are an effective way of promoting school attendance in less developed countries.
The preschool health intervention was carried out in Pratham’s preschools with children aged 2-6 years. Children were given iron supplementation (33.3 mg of elemental iron with folic acid) and deworming drugs (400 mg of albendazole) administered during “health camps” conducted three times a year in the preschools. Following WHO recommendations, teachers in treatment preschools administered daily iron doses for 3 school days following each health camp, to all children attending school that day. Treatment and control preschools both also received 200,000 I.U. of Vitamin A at the first health camp during the study period, and thus treatment effects should be interpreted as the impact of iron and deworming in addition to Vitamin A, relative to Vitamin A alone.
Intervention Start Date
Intervention End Date
Primary Outcomes (end points)
1) Pre-school attendance
2) Anthropometrics (weight-for-height z-score, weight-for-age z-score, weight, BMI, height, height-for-age z-score)
3) Hemoglobin levels
Primary Outcomes (explanation)
1) Pre-school attendance: Baseline enrollment rosters were collected before the intervention and subsequent participation data was collected through monthly, unannounced visits to all preschools. At each visit, enumerators determined whether each child from the baseline roster was present, absent, had left school, or had transferred to another school. Those present at school are counted as “participants” and those who had dropped out or were absent as “nonparticipants." Children who transferred to another NGO preschool were tracked at those schools during subsequent attendance checks. Children who moved away from the area or about whom the teacher did not have good information, are lost from the sample (until they return to an NGO preschool, if ever).
2) Anthropometrics: measured at health camps by enumerators.
3) Hemoglobin levels: The Hb test consisted of a finger prick blood draw conducted by professional laboratory staff and analyzed using the Cyanometh technique.
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
The study was conducted in a low-income urban resettlement area in Delhi. The NGO Pratham runs preschools for children aged 2-6 years. The pre-schools are divided into “clusters,” with each cluster containing one to three preschools, usually all located on the same city block. The clusters are randomly assigned to three groups, Groups I, II and III. Group I is the treatment, and Groups II and III are the controls, although they all received the treatment after the study was finished.
Experimental Design Details
Computer random number generator
Pre-school “cluster” where cluster means a group of pre-schools containing one to three pre-schools.
Was the treatment clustered?
Sample size: planned number of clusters
155 pre-school clusters
Sample size: planned number of observations
Sample size (or number of clusters) by treatment arms
Group 1 = Treatment; clusters = 59; preschools = 80; children = 930
Group 2 = Comparison; clusters = 51; preschools = 70; children = 782
Group 3 = Comparison; clusters = 45; preschools = 50; children = 680
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
INSTITUTIONAL REVIEW BOARDS (IRBs)
Study has received IRB approval. Details not available.
IRB Approval Date
Details not available
IRB Approval Number
Details not available
Post Trial Information
Is the intervention completed?
Intervention Completion Date
March 31, 2002, 12:00 AM +00:00
Is data collection complete?
Data Collection Completion Date
October 31, 2002, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
Approximately 1,794 children (this is based on an approximate attrition rate of 25% for all attendance checks)
Final Sample Size (or Number of Clusters) by Treatment Arms
Group 1 = Treatment; clusters = 59
Group 2 = Comparison; clusters = 51
Group 3 = Comparison; clusters = 45
Reports, Papers & Other Materials
ANEMIA AND SCHOOL PARTICIPATION
Anemia is among the most widespread health problems for children in developing countries. This paper evaluates the impact of a randomized health intervention delivering iron supplementation and deworming drugs to Indian preschool children. At baseline 69 percent were anemic and 30 percent had intestinal worm infections. Weight increased among assisted children, and preschool participation rates rose by 5.8 percentage points, reducing absenteeism by one fifth. Gains were especially pronounced for those most likely to be anemic at baseline. Results contribute to a growing view that school-based health programs are an effective way of promoting school attendance in less developed countries.
Bobonis, Gustavo, Edward Miguel, and Charu Puri-Sharma. 2006. "Anemia and School Participation." The Journal of Human Resources 41(4): 692-721.
REPORTS & OTHER MATERIALS