Demonstrating the impact of de worming and micronutrients on cognitive ability
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Demonstrating the impact of de-worming and micronutrients on cognitive ability. Ministry of Education CHANGES Program In collaboration with Creative Associates and funded by USAID Carried out by the Partnership for Child Development and Successful Intelligence. Presented by Anthi Patrikios

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Demonstrating the impact of de-worming and micronutrients on cognitive ability

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Demonstrating the impact of de-worming and micronutrients on cognitive ability

Ministry of Education CHANGES Program

In collaboration with Creative Associates and funded by USAID

Carried out by the Partnership for Child Development and Successful Intelligence

Presented by Anthi Patrikios

Partnership for Child Development

CIES Meeting, Stanford University, 22nd March 2005

Talk structure

  • Background

  • Study design

    • Collecting biomedical data

    • Treatment

  • Cognitive assessment

  • Impact

    • On health and nutrition

    • On educational ability

  • Conclusions

  • Reality for the Education Sector

In recent years, studies have shown that interventions of de-worming and micronutrient supplementation can improve both children’s health and cognition

Increasing realisation that interventions can affect their ability to learn and their educational outcomes

Why should the MoE invest in School Health?

  • School Health Programs are amongst the most cost-effective and simplest to deliver of all public health strategies

  • They are becoming increasingly viewed by MoEs as essential education interventions because of the potential benefits

  • Thus…the Zambian MoE decided to conduct a large scale study of the impact of school health interventions on the health and educational ability of Zambian children

Study Design

3 year longitudinal study following a cohort of children in grades 1-7

  • YEAR 2

  • 20 Yr2 Control

  • 20 Yr2 Interventions (Yr1 Control)

  • 20 Yr 1 Intervention Schools

  • (n = 3800)

  • YEAR 3

  • 20 Yr3 Interventions (Yr2 Control)

  • 20 Yr 2 Interventions

  • 20 Yr1 Interventions

  • (n = 3200)

  • YEAR 1

  • 20 Yr1 Control

  • 20 Yr1 Intervention

  • (n = 2800)

NB 5 girls and 5 boys from each year 1-7

Intervention Group data:

Anthropometric indicators

Iron status (Haemoglobin, serum ferritin, transferrin receptor)

Vitamin A status (serum retinol)

Parasite infections (geohelminths and schistosomes)

Control Group data:

Anthropometric indicators

Children’s health and nutrition were measured during the study using a number of established indicators


Children enrolled in intervention groups received the following by trained teachers:

  • Treatment for intestinal worms

    • Albendazole

  • Treatment for schistosomiasis

    • Praziquantel

  • Annual vitamin A supplementation

  • Weekly iron supplementation

  • Health education

    (children in control groups received health education only)

Cognitive Assessment

Tools used to measure educational ability

  • Zambian Grade 5 National Assessment tests (English, Mathematics and Nyanja)

  • Mill Hill Vocabulary Test

  • Zambian Cognitive Assessment Instrument (Z-CAI)

Measuring improvements in educational ability

AIM: To develop a test of ability that can measure the impact of interventions on health and that can be delivered by a teacher to a class

RESULT: Development of the Zambian Cognitive Assessment Instrument (Z-CAI)


  • Measures cognitive function by assessing children’s ability to follow increasingly complex oral, written and pictorial instructions

  • The ability to follow instructions is an implicit part of the educational process: the more complex the instructions a child can follow, the more she or he will be able to learn in the classroom

Unlike other cognitive tests, which are time consuming and difficult to administer, the Z-CAI can be delivered to classes of children by teachers under exam conditions

The Impact of Interventions

Health and Nutrition

During the 3 years of the study, there was a decrease in prevalence and intensity of helminth infections

The benefit of repeated treatment

During the 3 years of the study, interventions were not found to have an impact, at the population level, on any of the indicators of health and nutrition employed. In addition, cases of malnutrition and anaemia were comparatively few

Educational Ability

There was a dramatic improvement in educational ability in the intervention groups

  • At baseline (2001), the overall Z-CAI scores of children in the control and intervention groups were much the same

  • After one year (2002), children who received interventions performed significantly better than those who did not (p<0.001)

  • In 2003, children who had received interventions for two years were found to perform better than those who received only one (2002 only)

The study also showed that cognitive gains in girls were significantly stronger than gains in boys


  • While the interventions had no observable impact on children’s health and nutrition, their impact on children’s educational ability was dramatic

  • Even “light” infections can have an impact on children’s performance

  • Regular interventions have a greater impact on children’s educational ability than “one off” activities. Children benefit most when interventions are sustained

  • Interventions benefit girls more than boys

    • Suggesting that de-worming not only has a beneficial impact on educational ability, it can also have a positive impact on gender equity

Reality of the situation for the Education Sector

  • School health interventions (de-worming, iron and vit. A supplementation) cost ~$0.50 per child per annum in SSA

  • As such, they are amongst the least expensive public health interventions available

  • Tools used in this impact assessment are particularly geared towards taking School Health and Nutrition Programs to scale

Happy, healthy children do better in school and are more likely to reach their maximum PERSONAL potential

Enabling partnerships

  • Community Partnerships

  • WASHE and other community groups (esp. small grants support)

  • Ministry of Education

  • Ministry of Health

  • Ministry of Community Development

  • International and local NGOs

  • UTH

  • UNZA

  • Tropical Disease Research Centre

  • Creative Associates

  • Partnership for Child Development (Imperial College)

  • Successful Intelligence (Yale)

  • London School of Hygiene and Tropical Medicine (UK)

  • Schistosomiasis Control Initiative (Imperial College)

  • Development Partners

  • EduAction (Durban, South Africa)

  • Glaxo SmithKline

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