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Field
Secondary Outcomes (Explanation)
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Before
4. Index of health knowledge
A standardized index score derived from a maximum of 10 questions covering diarrhea, malaria prevention, hygiene, and questions aligned with the program curriculum.
[Time Frame: At point of endline]
5. Proportion of children with moderate or severe anaemia
Haemoglobin concentration measured using a HemoCue photometer in the sample of children taking part in the health diaries (testing will occur at the end of the period). Anemia severity categories will be based on the WHO classification which depends on the age and sex of the child.
[Time Frame: Half of the sample captured in term 1 2026 and half in term 2 2026]
6. Proportion of children who are underweight
Using height and weight measured for all learners surveyed at endline, we will construct weight-for-age z-scores and determine the proportion of children who are underweight.
[Time Frame: Endline]
7. Proportion of children who are overweight
Using height and weight measured for all learners surveyed at endline, we will construct weight-for-age z-scores and determine the proportion of children who are overweight.
[Time Frame: Endline]
8. Proportion of children with diarrhoea
Incidence of diarrhoea - carer report of the child experiencing three or more loose or watery stools.
[Time Frame: Over the eight week follow-up period across term 1 and 2 in 2026]
9. Proportion of children testing positive for malaria
Testing for the presence of P. falciparum. The tests are performed using a rapid diagnostic test (RDT) on the sample of children taking part in the health diaries (testing will occur at the end of the period).
[Time Frame: End of health diaries in term 1 and term 2 2026]
10. Menstrual hygiene management
We examine the impact of the programme across three domains: knowledge, practices, and stigma. For each domain, we draw on questions developed and validated in prior studies (Austrian, Kangwana et al. 2021, Kansiime, Hytti et al. 2022, Hennegan, Hasan et al. 2024, Macours, Vera et al. 2024). For each sub-scale, we will construct a summary index using principal component analysis, standardized as a z-score using the mean and standard deviation of the control group for ease of interpretation of the results. In analysis, we will look at the impact of the programme on each of these domains separately, as well as combined.
[Time Frame: Endline]
11. Combined measure of attendance and retention
Proportion of children confirmed present in class on the day of the visit, out of the total number of children enrolled at the school at baseline and still alive. In this measure, we effectively treat children who may have transferred to another study school as ‘absent’, dropped out, or temporarily relocated.
[Time Frame: Five random spot checks across 18 months]
12. Attendance rate including learners transfered to other study schools
Proportion of children confirmed present in class on the day of the visit either in their original school or in another school to which they have transferred if that school is one of the study schools, out of the total number of children enrolled at baseline and still alive. Following an Intention-to-Treat principle, we will analyse participants based on the arm they were originally assigned to, even if they moved to a different study arm school.
[Time Frame: Five unannounced spot checks across 18 months]
13. Cross-section attendance
Additional measure of attendance, focusing on students in grades 1, 3, 5, and 7 at the time of the spot check. This register-based measure is defined as the proportion of children on the register who are present on the day of the spot check. The denominator will be defined by the list of children in each of the four grades who are confirmed by a school staff member as enrolled in the school on the day of the visit.
[Time Frame: Four randomised spot checks conducted across 12 months]
14. Learning
Learning is measured using individually administered numeracy, literacy, and science examinations. Items for these exams are aligned with the Zambian Ministry of Education national curriculum for Grades 1 through 7. Each assessment will be conducted one-on-one by trained enumerators at the start of the learners’ interviews. Items are developed by local curriculum experts and calibrated through pilot testing to ensure grade-appropriate difficulty. We will also borrow items from international test banks (e.g., TIMSS, EGRA, EGMA). Finally, we will classify items using Bloom’s taxonomy to test for differences in effects across higher- and lower-order thinking skills. In analysis, we will look at each domain separately as well as a combined score.
[Time Frame: Endline]
15. Students' working memory and attention
We measure students’ working memory and attention using the Digit Span task, a widely used short-term memory and working memory assessment. Enumerators orally present a sequence of digits at a rate of one per second, and students are asked to repeat the digits in the same order (Digit Span Forward) and then in reverse order (Digit Span Backward). The task measures students’ auditory attention, concentration, and working memory capacity, which are foundational components of general cognitive functioning and predictive of academic achievement. Scores are recorded as the total number of correct sequences reproduced, following standard administration and scoring procedures. Additional cognitive and non-cognitive measures may be added depending upon validation during piloting. These include Raven's Progressive Matrices, Interactive Stroop Tests, and pattern recognition tasks.
[Time Frame: Endline]
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After
4. Malaria prevalence: Proportion of children testing positive for malaria
Testing for the presence of P. falciparum. The tests are performed using a rapid diagnostic test (RDT) on the sample of children taking part in the health diaries (testing will occur at the end of the period).
[Time Frame: End of health diaries in term 1 and term 2 2026]
5. Proportion of children with moderate or severe anaemia
Haemoglobin concentration measured using a HemoCue photometer in the sample of children taking part in the health diaries (testing will occur at the end of the period). Anemia severity categories will be based on the WHO classification which depends on the age and sex of the child.
[Time Frame: Half of the sample captured in term 1 2026 and half in term 2 2026]
6. Proportion of children who are underweight
Using height and weight measured for all learners surveyed at endline, we will construct weight-for-age z-scores and determine the proportion of children who are underweight.
[Time Frame: Endline]
7. Proportion of children with diarrhoea
Incidence of diarrhoea - carer report of the child experiencing three or more loose or watery stools.
[Time Frame: Over the eight week follow-up period across term 1 and 2 in 2026]
8. Haematuria prevalence
An indicator for incidence of haematuria (blood in urine) reported by the caregiver.
[Time Frame: in the last 7 days, household survey]
9, 10 and 11: Menstrual health knowledge, management, and stigma
We examine the impact of the programme across three domains: knowledge, practices, and stigma. For each domain, we draw on questions developed and validated in prior studies (Austrian, Kangwana et al. 2021, Kansiime, Hytti et al. 2022, Hennegan, Hasan et al. 2024, Macours, Vera et al. 2024). For each sub-scale, we will construct a summary index using principal component analysis, standardized as a z-score using the mean and standard deviation of the control group for ease of interpretation of the results. In analysis, we will look at the impact of the programme on each of these domains separately, as well as combined.
[Time Frame: Endline]
12. Student learning (numeracy, literacy, science)
Learning is measured using individually administered numeracy, literacy, and science examinations. Items for these exams are aligned with the Zambian Ministry of Education national curriculum for Grades 1 through 7. Each assessment will be conducted one-on-one by trained enumerators at the start of the learners’ interviews. Items are developed by local curriculum experts and calibrated through pilot testing to ensure grade-appropriate difficulty. We will also borrow items from international test banks (e.g., TIMSS, EGRA, EGMA). Finally, we will classify items using Bloom’s taxonomy to test for differences in effects across higher- and lower-order thinking skills. In analysis, we will look at each domain separately as well as a combined score.
[Time Frame: Endline]
13. Students' working memory
We measure students’ working memory using the Digit Span task, a widely used short-term memory and working memory assessment. Enumerators orally present a sequence of digits at a rate of one per second, and students are asked to repeat the digits in the same order (Digit Span Forward) and then in reverse order (Digit Span Backward). The task measures students’ auditory attention, concentration, and working memory capacity, which are foundational components of general cognitive functioning and predictive of academic achievement. Scores are recorded as the total number of correct sequences reproduced, following standard administration and scoring procedures.
[Time Frame: Endline]
School attendance (complementary measures):
14. Combined measure of attendance and retention
Proportion of children confirmed present in class on the day of the visit, out of the total number of children enrolled at the school at baseline and still alive. In this measure, we effectively treat children who may have transferred to another study school as ‘absent’, dropped out, or temporarily relocated.
[Time Frame: Five random spot checks across 18 months]
15. Attendance rate including learners transfered to other study schools
Proportion of children confirmed present in class on the day of the visit either in their original school or in another school to which they have transferred if that school is one of the study schools, out of the total number of children enrolled at baseline and still alive. Following an Intention-to-Treat principle, we will analyse participants based on the arm they were originally assigned to, even if they moved to a different study arm school.
[Time Frame: Five unannounced spot checks across 18 months]
16. Cross-section attendance
Additional measure of attendance, focusing on students in grades 1, 3, 5, and 7 at the time of the spot check. This register-based measure is defined as the proportion of children on the register who are present on the day of the spot check.
[Time Frame: Four randomised spot checks conducted across 12 months]
17. Illness- or menstruation-related absence
From the diary's daily records, caregivers flag whether the child attended school each day and records the reason for each absent day. The reasons are: illness (1), was menstruating (2), farming (3), school closure or school event (4), bad weather (5), religious reasons (6), market day (7), public holiday (8), fishing (9), mining (10), working with parents (11), no uniform/shoes/books (12), and other (-97). We treat a day as an illness or menstruation-related absence when the reason is (1) or (2). We restrict the sample to school days by dropping weekends and public holidays. Our measure is the share of the child's school days in the diary window lost to health-related absence: health-related absence days divided by total school days observed.
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