Remedial after-school support classes offered in rural Gambia (The SCORE trial): study protocol for a cluster randomized controlled trial.

BACKGROUND: Low education levels are endemic in much of the developing world, particularly in rural areas where traditional government-provided public services often have difficulty reaching beneficiaries. Providing trained para-teachers to teach regular after-school remedial education classes has been shown to improve literacy and numeracy in children of primary school age residing in such areas in India. This trial investigates whether such an intervention can also be effective in a West African setting with similarly low learning levels and difficult geographic access. METHODS/DESIGN: DESIGN: cluster-randomized controlled trial. Clusters: villages or groups of villages with 15-300 households and at least 15 eligible children in the Lower River and North Bank Regions of The Gambia. PARTICIPANTS: children born between 1 September 2007 and 31 August 2009 planning to enter the first grade, for the first time, in the 2015-2016 school year in eligible villages. We anticipate enrolling approximately 150 clusters of villages with approximately 6000 children as participants. INTERVENTION: a program providing remedial after-school lessons, focusing on literacy and numeracy, 5 to 6 days a week for 3 years to eligible children, based on the intervention evaluated in the Support To Rural India's Public Education System (STRIPES) trial (PLoS ONE 8(7):e65775). CONTROL: both the intervention and control groups will receive small bundles of useful materials during annual data collection as recompense for their time. If the education intervention is shown to be cost-effective at raising learning levels, it is expected that the control group villages will receive the intervention for several years after the trial results are available. OUTCOMES: the primary outcome of the trial is a composite mathematics and language test score. Secondary outcomes include school attendance, enrollment, performance on nationally administered exams, parents' spending on education, spillover learning to siblings and family members, and school-related time use of parents and children. Subgroup analyses of the primary outcome will also be carried out based on ethnic group, gender, distance from the main highway, parents' education level, and school type. The trial will run by independent research and implementation teams and supervised by a Trial Steering Committee. DISCUSSION: Along with the overall impact of the intervention, we will conduct a cost-effectiveness analysis. There are no major ethical issues for this study. TRIAL REGISTRATION: Current controlled trials ISRCTN12500245 . 1 May 2015

Community health and medical provision: impact on neonates (the CHAMPION trial)

BACKGROUND: The trial aims to evaluate whether neonatal mortality can be reduced through systemic changes to the provision and promotion of healthcare. Neonatal mortality rates in India are high compared to other low income countries, and there is a wide variation of rates across regions. There is evidence that relatively inexpensive interventions may be able to prevent up to 75% of these deaths. One area with a particularly high rate is Mahabubnagar District in Andhra Pradesh, where neonatal mortality is estimated to be in the region of 4-9%. The area suffers from a vicious cycle of both poor supply of and small demand for health care services. The trial will assess whether a package of interventions to facilitate systemic changes to the provision and promotion of healthcare may be able to substantially reduce neonatal mortality in this area and be cost-effective. If successful, the trial is designed so that it should be possible to substantially scale up the project in regions with similarly high neonatal mortality throughout Andhra Pradesh and elsewhere. METHODS/DESIGN: This trial will be a cluster-randomised controlled trial involving 464 villages in Mahabubnagar District. The package of interventions will first be introduced in half of the villages with the others serving as controls. The trial will run for a period of three years. The intervention in the trial has two key elements: a community health promotion campaign and a system to contract out healthcare to non-public institutions. The health promotion campaign will include a health education campaign, participatory discussion groups, training of village health workers and midwives, and improved coordination of antenatal services. The intervention group will also have subsidized access to pregnancy-related healthcare services at non-public lth centres (NPHCs). The primary outcome of the trial will be neonatal mortality. Secondary outcomes will include age at and cause of neonatal death, neonatal morbidity, maternal mortality and morbidity, health service usage, costs and several process and knowledge outcomes. DISCUSSION: The trial will be run by independent research and service delivery arms and supervised by a trial steering committee. A data monitoring committee will be put in place to monitor the trial and recommend stopping/continuation according to a Peto-Haybittle rule. The primary publication for the trial will follow CONSORT guidelines for cluster randomised controlled trials. Criteria for authorship of all papers, presentations and reports resulting from the study will conform to ICMJE standards

The surprisingly dire situation of children's education in rural west Africa: results from the CREO study in Guinea-Bissau

We conducted a survey covering 20% of villages with 200-1000 population in rural Guinea-Bissau. We interviewed household heads, care-givers of children, and their teachers and schools. We analysed results from 9,947 children, aged 7-17, tested for literacy and numeracy competency. Only 27% of children were able to add two single digits, and just 19% were able to read and comprehend a simple word. Our unannounced school checks found 72% of enrolled children in grades 1-4 attending their schools, but the schools were poorly equipped. Teachers were present at 86% of schools visited. Despite surveying 351 schools, we found no examples of successful schools where children reached reasonable levels of literacy and numeracy for age. Our evidence suggests that interventions that raise school quality in these villages, rather than those which target enrolment, may be most important to generate very sharp improvements in children’s educational outcomes

How much can we remedy very low learning levels in rural parts of low-income countries? Impact and generalizability of a multi-pronged para-teacher intervention from a cluster-randomized trial in the Gambia

Despite large schooling and learning gains in many developing countries, children in highly deprived areas are often unlikely to achieve even basic literacy and numeracy. We study how much of this problem can be resolved using a multi-pronged intervention combining three interventions known to be separately effective. We conducted a cluster-randomized trial in The Gambia evaluating a literacy and numeracy intervention designed for primary-aged children in remote parts of poor countries. The intervention combines para teachers delivering after-school supplementary classes, scripted lesson plans, and frequent monitoring focusing on improving teacher practice (coaching). A similar intervention previously demonstrated large learning gains in rural India. After three academic years, Gambian children allocated to the intervention scored 46 percentage points (3.2 SD) better on a combined literacy and numeracy test than control children. Our results demonstrate that, in this type of area, aggressive interventions can yield far greater learning gains than previously shown

Antenatal, delivery, and postnatal care experience of women with pregnancies with estimated delivery date on or after the assessment start date.

<p>Antenatal, delivery, and postnatal care experience of women with pregnancies with estimated delivery date on or after the assessment start date.</p

Comparability between trial arms.

<p>Comparability between trial arms.</p

Costs by category (calculated in May 2011 US dollars).

<p>Costs by category (calculated in May 2011 US dollars).</p

Neonatal mortality according to characteristics of villages/women for births with expected delivery date after the assessment start date.

<p>Neonatal mortality according to characteristics of villages/women for births with expected delivery date after the assessment start date.</p