School based clustered randomised intervention trial to climate change adaptation in Bangladesh

Bangladesh is one of the most vulnerable countries to climate change (1,2) where children and women are at higher risk (3,4). A school manual, based on a 2008 WHO manual(5), was developed for high school students on climate change and health protection by the Ministry of Health, Bangladesh in collaboration with the National Curriculum and Textbook Board (6). The objective of this study was to test the effectiveness of the manual in increasing the knowledge level of the school children on climate change and health adaptation. Thirty upazilas (sub-district) from seven coastal districts that are most vulnerable to climate change in Bangladesh were randomly allocated in this cluster randomised controlled trial. Among the 30 upazilas, 15 were randomly allocated to the control group and 15 to the intervention group. From each upazila, two high schools were randomly selected to include in the study. All the year seven students from both group of schools sat for a pre-test of 30 uniform short questions of binary response. Total of 1515 students from 30 intervention schools received the intervention through training based on the school manual. Contents of the manual include essential knowledge about climate change and health issues, do's and don'ts during extreme weather events, and adaptation activities. At the same time a leaflet containing general message on climate change and health was distributed among 1778 students of the 30 control schools. Six months later, a post-intervention test of the same questionnaire was taken for both intervention and control schools. The pre and post test scores were analysed along with the demographic data by using random effects model to determine the effect of the manual based training program on increasing the knowledge of school children on climate change. None of the school level and student level variables was significantly different between the control and intervention group. The intervention group had 17.42% (95% CI: 14.45% to 20.38%, P=0.000) higher score in the post-test after adjusting for pre-test score and other covariates in a multi-level linear regression model. Students whose family head is house wife had lowest score compared to other occupation and the population density at home had an inverse association with post-test score in the multivariable model. Analyses of scores from individual questions demonstrated significantly higher score among the intervention group. Thus, the school manual was very effective in increasing the knowledge level of students on climate change.

Key References:

1. McMichael AJ, Lindgren E. Climate change: present and future risks to health, and necessary responses. J Intern Med. 2011 Nov;270(5):401-13. 2. Shahid S. Probable impacts of climate change on public health in Bangladesh. Asia Pac J Public Health. 2010 Jul;22(3):310-9 3. Campbell-Lendrum D, Bertollini R, Neira M, Ebi K, McMichael A. Health and climate change: a roadmap for applied research. Lancet. 2009 May 16;373(9676):1663-5. 4. Ebi KL, Semenza JC. Community-based adaptation to the health impacts of climate change. Am J Prev Med. 2008 Nov;35(5):501-7. 5. Climate Change and Health Manual for kids and families, developed by WHO-SEARO and available in Hindi, Bengali, and several local languages. http://www.who.int/globalchange/training/en/ 6. Chapter 10: Community-Based Adaptation to Climate Change Scaling it up,Edited by E. Lisa F. Schipper, Jessica Ayers, Hannah Reid, Saleemul Huq, Atiq Rahman; http://www.routledge.com/books/details/9780415623704/