{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T18:08:52Z","timestamp":1772388532171,"version":"3.50.1"},"reference-count":56,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,4,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                  <jats:p>School health programs are frequently attempted in low- and\/or middle-income countries; however, programmatic scope and reach is limited by human resource constraints. We sought to determine if trained community members could implement a school health program that improved outcomes in rural primary schools in India.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>This was a mixed-methods, stepped-wedge, cluster-controlled study of schools pragmatically assigned to receive a multicomponent, comprehensive school health program delivered by lay field-workers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>All students in 22 primary schools (9 government schools and 13 low-cost private schools) participated in this study. A total of 3033 student-years were included in the analysis (2100 student-years in the intervention period and 933 student-years in the control period). Qualitative feedback was collected from 38 teachers, 49 parents, and 4 field-workers. In low-cost private schools, the diarrhea incidence was lower in students receiving the intervention (incidence rate ratio 0.58; 95% confidence interval [CI] 0.47 to 0.71; P &amp;lt; .001). There was no difference in diarrhea incidence for students in government schools (incidence rate ratio 0.87; 95% CI 0.68 to 1.12; P = .29). Health-knowledge acquisition was higher in intervention schools (mean difference 12.6%; 95% CI 8.8 to 16.4; P &amp;lt; .001) and similar in both school types. Intervention coverage rates were high (mean 93.9%; SD 2.0%), and performance assessment scores indicated fidelity (mean 3.45; SD 0.69). Stakeholders revealed favorable perceptions of the field-workers and high levels of perceived impact.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Lay field-worker\u2013led school health programs offer a promising alternative for improving school health delivery in resource-constrained settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2018-0975","type":"journal-article","created":{"date-parts":[[2019,3,14]],"date-time":"2019-03-14T12:25:47Z","timestamp":1552566347000},"source":"Crossref","is-referenced-by-count":14,"title":["Lay Field-worker\u2013Led School Health Program for Primary Schools in Low- and Middle-Income Countries"],"prefix":"10.1542","volume":"143","author":[{"given":"Michael","family":"Matergia","sequence":"first","affiliation":[{"name":"Center for Global Health, Colorado School of Public Health, Aurora, Colorado;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Ferrarone","sequence":"additional","affiliation":[{"name":"Division of Health Care Policy and Research, University of Colorado Denver, Denver, Colorado;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasin","family":"Khan","sequence":"additional","affiliation":[{"name":"American India Foundation, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denna Weiss","family":"Matergia","sequence":"additional","affiliation":[{"name":"Broadleaf Health and Education Alliance, Stroudsburg, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla","family":"Giri","sequence":"additional","affiliation":[{"name":"Darjeeling Ladenla Road Prerna, Darjeeling, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjeeta","family":"Thapa","sequence":"additional","affiliation":[{"name":"Darjeeling Ladenla Road Prerna, Darjeeling, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric A.F.","family":"Sim\u00f5es","sequence":"additional","affiliation":[{"name":"Center for Global Health, Colorado School of Public Health, Aurora, Colorado;"},{"name":"Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2019,4,1]]},"reference":[{"issue":"2","key":"2021120913202206800_B1","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.hoc.2015.11.002","article-title":"The global burden of anemia.","volume":"30","author":"Kassebaum","year":"2016","journal-title":"Hematol Oncol Clin North Am"},{"key":"2021120913202206800_B2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0065-308X(05)62007-6","article-title":"Global epidemiology, ecology and control of soil-transmitted helminth infections.","volume":"62","author":"Brooker","year":"2006","journal-title":"Adv Parasitol"},{"issue":"3","key":"2021120913202206800_B3","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/jcpp.12381","article-title":"Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents.","volume":"56","author":"Polanczyk","year":"2015","journal-title":"J Child Psychol Psychiatry"},{"issue":"6","key":"2021120913202206800_B4","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1001\/jamapediatrics.2017.0250","article-title":"Child and adolescent health from 1990 to 2015: findings from the global burden of diseases, injuries, and risk factors 2015 study.","volume":"171","author":"Kassebaum","year":"2017","journal-title":"JAMA Pediatr"},{"key":"2021120913202206800_B5","volume-title":"Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks","author":"Mathers","year":"2009"},{"key":"2021120913202206800_B6","volume-title":"Optimizing Education Outcomes: High-Return Investments in School Health for Increased Participation and Learning","author":"Bundy","year":"2018"},{"key":"2021120913202206800_B7","volume-title":"Health and Attainment: A Brief Review of Recent Literature","author":"Powney","year":"2000"},{"issue":"6","key":"2021120913202206800_B8","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/j.1746-1561.2005.00025.x","article-title":"Nutrition and student performance at school.","volume":"75","author":"Taras","year":"2005","journal-title":"J Sch Health"},{"key":"2021120913202206800_B9","unstructured":"Stewart-Brown\u2008S\n          . 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