The impact of school feeding on nutrition, education, agriculture and other social outcomes: design of a randomised controlled trial of 'home-grown' school feeding in Ghana
Last registered on December 06, 2018

Pre-Trial

Trial Information
General Information
Title
The impact of school feeding on nutrition, education, agriculture and other social outcomes: design of a randomised controlled trial of 'home-grown' school feeding in Ghana
RCT ID
AEARCTR-0003629
Initial registration date
December 03, 2018
Last updated
December 06, 2018 8:24 AM EST
Location(s)
Primary Investigator
Affiliation
Imperial College London
Other Primary Investigator(s)
PI Affiliation
Imperial College London
Additional Trial Information
Status
Completed
Start date
2013-06-01
End date
2016-07-01
Secondary IDs
ISRCTN66918874
Abstract
School food programmes are a popular way to support the education, health and nutrition of school children. The Ghana School Feeding Programme (GSFP) reaches over 1.6 million primary school children across all regions of Ghana. Private caterers are awarded contracts by the GSFP to procure, prepare and serve food to pupils. The caterers are able to procure on a competitive basis without commitment to purchasing from small-scale farmers.

‘Home-grown’ school feeding aims to link the increased demand for school feeding goods and services to community stakeholders, including small-holder farmers (mainly subsistence farmers) and women groups. This study proposes a randomized control trial that aims to evaluate the impact of school feeding sourced from small-holder farmers on small-holder food security, and the overall effects of the GSFP on child nutrition and education in Ghana.

This study involves a field experiment around the scale-up of the GSFP, including 116 primary schools in 58 districts.
The randomly assigned interventions are:
1. School feeding programme, where the standard GSFP is implemented
2. 'Home-grown' school feeding (HGSF+) group, including schools and communities where the Ghana School Feeding Programme is implemented in addition to district-level training of community-based organizations and local government
3. Control group, including schools and household from communities where the intervention will be implemented at the end of the trial (preferably without informing schools and households of impending intervention).

A total of 2626 households in 116 school catchment areas were surveyed at baseline. Households are selected at random from village-level listings.

Primary outcomes include: child health and nutritional status (BMI-for-age and height-for-age z-scores); school participation; learning (maths and literacy); cognition (raven and digit span); and smallholder farmer income, sales and production. Intermediate outcomes along the agriculture. nutrition and education pathways are also measured. The evaluation follows a mixed-method approach, including child-, household-, school- and community-level surveys as well as focus group discussions with project stakeholders.
Registration Citation
Citation
Aurino, Elisabetta and Lesley Drake. 2018. "The impact of school feeding on nutrition, education, agriculture and other social outcomes: design of a randomised controlled trial of 'home-grown' school feeding in Ghana." AEA RCT Registry. December 06. https://www.socialscienceregistry.org/trials/3629/history/38405
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Experimental Details
Interventions
Intervention(s)
The randomly assigned interventions are:
1. School feeding programme, where the standard Ghana School Feeding Programme is implemented
2. 'Home-grown' school feeding (HGSF+) group, including schools and communities where the Ghana School Feeding Programme is implemented in addition to district-level training of community based organizations and local government
3. Control group, including schools and household from communities where the intervention will be implemented at the end of the trial (preferably without informing schools and households of impending intervention).
Intervention Start Date
2013-09-01
Intervention End Date
2016-06-01
Primary Outcomes
Primary Outcomes (end points)
Agriculture: Household income, production, sales.
Education: Child enrolment, attendance, completion, maths and literacy scores (5–15 year old).
Cognition: Raven’s test and forward/backward digit span scores (5–15 year old).
Physical health/Nutrition :Anthropometry (height-for-age, BMI-for-age, 2–15 year old,
haemoglobin levels (5–15 year old)
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The selection of the study areas involved two key steps. I) Selecting 58 districts at random within Ghana from a sample frame including all districts in the country. The sample frame was stratified by region and district inclusion was prioritised using data from the GSFP retargeting exercise including data on the prevalence of poverty and food insecurity. II) Identifying 2 comparable schools within each of the 58 selected districts. A protocol was designed to ensure that the schools were comparable based on data from the Education Management Information system (EMIS) and that potential for contamination and crossover between the schools and pupils in each district was minimised. This step utilized a list from the GSFP secretariat of schools not currently covered by GSFP in each district. Data from the annual school census from 2011-2012 was then used to match schools not receiving the GSFP and identify “best matched” pair. The allocation into school feeding and control schools was then randomised within each pair. The 58 schools assigned to the intervention were then randomly assigned to regular GSFP and HGSF+. In this way the randomisation of the HGSF+ intervention occurs at the district level. The number of 58 schools is based on power calculations determined with the objective of achieving statistical validity and representativeness for the main outcomes of interest.
Experimental Design Details
Randomization Method
Lottery style
Randomization Unit
Selection of the target areas involved three key steps: 1) the first step involved selecting 58 districts at random
within Ghana from a sample frame including all districts in the country. The sample frame was stratified by region, and district inclusion was prioritised using data from the GSFP retargeting exercise including data on
the prevalence of poverty and food insecurity; 2) the second step involved identifying 2 comparable schools
within each of the 58 selected districts. A list was obtained through the GSFP secretariat including schools
not currently covered by the GSFP in each district. Data from the annual school census from 2011 to 2012 were
then used to match schools not receiving the GSFP and identify ‘ best matched’ pair. The allocation of school
feeding and control was then randomised (lottery style) within each pair; 3) the third step in the site selection
protocol involved the random allocation of districts to the HGSF+/GSFP groups by modelling pilot selection
using a set of community- and district-level variables and selecting the permutation of allocation that minimises
the R-squared for the predicted selection
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
58 districts, 116 schools
Sample size: planned number of observations
A total of 2626 households in 116 communities were surveyed at baseline
Sample size (or number of clusters) by treatment arms
58
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
For the impact evaluation, power calculations and resource availability suggested the adoption of a sample of 25 households from the communities in the areas of the 58 schools receiving the intervention and of 20 households in the communities of the 58 control schools. Households were randomly selected from household listings in the catchment areas of the selected schools for the survey interviews. The household listings were stratified into farmer/non-farmer households, based on agriculture classification data from the national census. Farmer households were sampled in both areas in the following way: 10 out of the 25 households in the 60 intervention communities were farmer households and 5 out of the 20 households in the 60 control communities were farmer households. Non-farmer households with children in the 5– 15 years age group were randomly selected from the household listings. This distribution of the sample between farmer and non-farmer households and between project control groups allows the construction of comparable samples. Power calculations for the following outcomes were computed: a. School attendance: we used the rural sample of the Ghana DHS data of 2008 to estimate attendance rates of children in the age group 6 to 14 and we found rates of 79% for boys and 81% for girls. A sample of 60 clusters and collecting data on 40 children is sufficient to detect such an impact with 80% statistical power. b. Cognitive tests: we obtained data on outcomes of cognitive tests from a sample of rural children tested in 2003 using Raven’s matrices. The average score on the test was 15.3 out of 36 questions with a standard deviation of 5.9 and an intracluster correlation coefficient of 0.14. We assumed a number of 40 children per cluster considering 20 households interviewed in each cluster and an average of 2.3 children in the relevant age group per each household with children. c. Child nutrition: we used data of DHS Ghana 2008 to estimate mean and standard deviation of height-for-age Z-scores of rural children and we found these to be -1.03 and 1.57 respectively. The intracluster correlation coefficient is 0.08. d. Farm income: we used data from GLSS4 of 1998/99 to estimate average farm income of rural households (1,200 thousands Cedis) and relative standard deviation (1,400 Cedis). We found an extremely high intracluster correlation coefficient. Income is the most difficult outcome to estimate with sufficient precision.
Supporting Documents and Materials

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IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
THE NOGUCHI MEMORIAL INSTITUTE FOR MEDICAL RESEARCH INSTITUTIONAL REVIEW BOARD (NMIMR-IRB)
IRB Approval Date
2013-07-03
IRB Approval Number
N/A
Analysis Plan
Analysis Plan Documents
Design and analysis plan

MD5: d91d6f71eed99995228371f8282c19b9

SHA1: 44f442460fc751cb1667fdbc81adb81b941d41ad

Uploaded At: December 03, 2018

Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
June 01, 2016, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
April 01, 2016, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
91 school catchment areas
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
1668 households
Final Sample Size (or Number of Clusters) by Treatment Arms
At district level, 58 districts in both treatment and control arms. At school catchment areas: the final number of schools is 91 (45 schools in treatment and 46 schools in control arms, respectively). The discrepancy from original sample size is due to the discovery of GSFP already running in 13 and 12 schools in the treatment and control arms respectively. These schools were therefore dropped.
Data Publication
Data Publication
Is public data available?
No

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Program Files
Program Files
No
Reports and Papers
Preliminary Reports
Relevant Papers