Assessing the Impact of Health Education on Physical Measurements of Children in Bangladesh: A Non-Randomized Controlled Trial

Abstract

Children remain vulnerable to several diseases posing a significant threat to their lives, while inequitable access to regular physical measurement, healthcare services and resources is unsteady. Therefore, this study aims to evaluate the physical measurements and effects of health education on changes in the physical measurements of children in Bangladesh. A non-randomized controlled trial and pre- and post-test design, conducted in Chandpur, Bangladesh, from September 2021 to September 2022. The school-aged children were enrolled and allocated into the intervention group (IG) and control group (CG), while the IG received 9 months of school nurse-based health education. Data were collected by a questionnaire and physical measurements such as vital signs, height, weight, body mass index, mid-upper arm circumference measurement, triceps and subscapular skinfold, vision screen, and blood test. A total of 455 children completed the study. Among them, 107 (53.2%) and 94 (46.8%) were 7 to 8 years old in IG and CG, respectively. In IG, 140 (53.2%) and in CG 123 (46.8%) children were female. Since several physical assessments differed at baseline, repeated measures ANCOVA was performed with endline data as the dependent variable, group as a fixed factor, and baseline data as a covariate. The mean of the participants’ body height, weight, BMI, MUAC and skinfolds were greater among IG than the CG, which were statistically significant (P < .001). Systolic blood pressure was significantly lower in the IG than in the CG (P = .023), while diastolic blood pressure did not differ significantly (P = .120). Integrating regular physical assessments and evidence-based health education by school nurses can reduce health challenges. For the sustainability of school-based health initiatives, establishing a continuous monitoring system and engaging parents, teachers, and local health authorities is needed to assess whether these health benefits persist over time.

Keywords

children health status school-based health service and school nurse

Introduction

Systematic physical assessments for children are a crucial part of early diagnosis and appropriate health care.¹ Children remain vulnerable to several diseases, posing a threat to their survival and contributing to the global health burden. According to the World Health Organization (WHO), approximately 7.4 million children aged 0 to 14 years are in life-threatening conditions annually due to mostly preventable and treatable illnesses.^2,3 Despite medical progressions, conditions such as pneumonia, diarrhea, malaria, measles, and malnutrition continue to be leading causes of rising child morbidity and mortality, particularly in low- and middle-income countries (LMICs).^4,5 Although developed countries have significantly reduced child mortality through vaccination programs, high-quality healthcare services, and effective public health policies, developed countries have ensured access to advanced care facilities for children. The significance of child-centered primary healthcare services emphasizes early intervention and preventive strategies, including immunization and proper nutrition.⁶ However, LMICs continue to face persistent disparities in addressing these challenges due to inadequate healthcare infrastructure, poverty, and limited public awareness.^7,8 Besides, ensuring equitable access to regular physical assessments and timely interventions remains a major challenge in resource-limited settings.

Bangladesh exemplifies the challenges LMICs face in addressing child health concerns, with a high prevalence of malnutrition, pneumonia, diarrhea, intestinal worm infestation, typhoid, and influenza.⁹ Malnutrition with anemia exacerbates these health issues, increasing susceptibility to infections and contributing to long-term developmental health challenges.¹⁰ Moreover, integrating health promotion and preventive measures into healthcare frameworks in developing regions remains limited.¹¹ Children suffer from silent health issues, and without timely interventions and routine monitoring, these conditions may go unnoticed, leading to severe or life-threatening conditions. Subsequently, regular physical assessments form the foundation of preventive healthcare and help track a child’s growth and development. Those supports identifying early signs of physical or developmental disorders, ensuring timely immunizations, and detecting underlying health problems for children. Similarly, schools are essential environments for childhood development, offer an ideal platform for implementing health assessments and education programs that improve public awareness and foster disease-prevention behaviors. Schools allow a large number of children to be reached efficiently. Thus, regular physical assessments not only support growth monitoring and outbreak prevention but are especially impactful when integrated into school settings. By embedding health services within schools, healthcare personnel such as school nurses can ensure consistent surveillance of child health, initiate early treatment, and promote sustained healthy habits among children and their families.

School nurses play a vital role in mitigating the burden of child diseases through health education and early intervention strategies.¹² In developed countries, school nurses actively engage in health education programs, conduct regular health screenings, administer immunizations, and provide immediate medical attention, significantly improving health outcomes.^13
-15 As a consequence, children can acquire crucial knowledge about hygiene, nutrition, and disease prevention, fostering lifelong health-related behaviors. Previous research in developing countries has shown that school-based health education and regular physical assessments can lead to measurable improvements in children’s physical health outcomes. For instance, a school-based nutritional and multicomponent intervention enhanced nutrition knowledge and food practices, which improved body mass index (BMI), hemoglobin levels, and reductions in helminth infections among children in India and Nepal.¹⁶ In rural West Bengal, primary school health-nutrition education programs, especially when actively delivered by motivated teachers and supported by health personnel, substantially reduced anemia prevalence.¹⁷ Similarly, school health programs in Africa have reported positive outcomes, including enhanced growth patterns, increased vaccination coverage, and decreased prevalence of preventable infectious diseases among school-aged children.¹⁸ Despite these encouraging findings, there remains a scarcity of evidence from Bangladesh and comparable low-resource settings where the burden of preventable childhood illnesses is particularly high. Most existing studies focus on disease-specific interventions such as deworming or micronutrient supplementation rather than structured, routine assessments embedded in school settings. This gap limits the understanding of how routine, structured physical assessments surrounded by school environments can support both early detection of health issues and long-term health behavior changes in children. Integrating health education into school curricula and strengthening the role of school nurses can enhance health literacy, encourage positive behavioral changes, and promote better overall health, thereby bridging this gap. This study underlines the urgent need to institutionalize regular physical assessments and support the long-term physical and mental development of future generations in Bangladeshi schools. Hypothesized that assessing yearly physical measurements of children, including health education, will lead to significant improvements to get better physical measurements of children compared to those who do not receive health education in Bangladesh. Thus, this study aims to evaluate the physical measurements and effects of health education on changes in the physical measurements of children in Bangladesh.

Methods

Study Design, Area and Duration

This is a non-randomized controlled trial and pre-test and post-test design, conducted in Chandpur, Bangladesh. The study continued for 13 months, starting in September 2021 and ending in September 2022. This study was registered in the Clinical Trial Registry (NCT05012592), and the secondary outcomes reported here correspond to this trial registration. The Transparent Reporting of Evaluations with Non-randomized Designs (TREND) checklist was used to report this study (Supplemental Multimedia Appendix 1).

Study Participants and Sample Size

The study participants were school-aged children. The sample size is estimated using G power software (Version 3.1.9.4) considering the effect size of 0.70 based on school health intervention, confidence level of 0.95, and assuming the statistical test for the difference between 2 independent means (2 groups). The sample size calculation details procedure was described elsewhere.¹⁹

Enrollment and Allocation

The children were enrolled according to the eligibility criteria. The community health workers (CHWs) assessed children for eligibility and explained the study’s purpose and objectives by visiting their homes. Children of both genders were included with parental consent and willingness to participate. Participants agreed to undergo health check-ups, provide samples for investigation, and respond to the questionnaire. Children absent from school during the baseline health check-up due to severe illness or other reasons were excluded from the study. After providing consent, the children and their parents were informed about the date, time and duration of data collection. Four government primary schools were included in the study. Following formal communication with school authorities by letter, informed them of the study’s objectives and granted permission for their students to participate. Next, 2 schools from the same union were purposively assigned to the intervention group (IG) and control group (CG). The detailed procedures of enrollment and allocation were described somewhere else.¹⁹ All the data were collected in the children’s school setting by the school nurses. The CHWs and school nurses were unaware of which schools were assigned to the IG and CG.

Health Assessment and Questionnaire Data

The school nurses conducted anthropometric physical measurements to evaluate height in cm, body weight in kg, BMI, and mid-upper arm circumference measurement (MUAC).^20,21 Body weight, height, and MUAC were measured by using a digital weight machine, an adhesive measuring scale, and MUAC tape, respectively. During weight measurement, school nurse confirmed that every child stood on the weighing machine wearing lightweight clothes and barefoot. Vision screening was conducted in accordance with standard guidelines and using the Snellen chart. Children able to read line 6/18 or smaller on the chart were considered to have normal vision. The triceps and subscapular skinfolds were measured on the right side of the body using a skinfold caliper, recorded to the nearest 0.1 mm.^21,22 Blood pressure, temperature, and pulse rate were measured using a digital blood pressure monitor and a digital thermometer, respectively. A small amount of blood sample from the tip of the children’s index or middle finger was collected to measure their hemoglobin (Hb) concentrations (g/dl) and random blood sugar (RBS) levels (mmol/l). For collecting blood from the children, a very small incision was made in their finger using a separate tiny needle for each participant and they experienced minimal, short-lasting pain at the puncture site. A small urine sample was collected from the children to measure the urine sugar and the presence of protein in the urine.²³ The blood test and urine tests were performed at the study site using strip tests.

Researcher developed a questionnaire survey that was used for the children and their parents regarding socio-demographic information and the previous health history of the children.^17,24,25 Content validity was confirmed by expert researchers, and the tool was pre-tested among 20 children from different schools. It took 10 min for the child’s parents to fill up (Supplemental Multimedia Appendix 2).

Health Education

After baseline data collection, children in the IG received face-to-face school-based health education once per week for 9 months in their school area by the school nurse, with weekly 45-min interactive sessions. Similar data were collected at the endline (after 12 months from baseline). In each session, the children received a healthy food snack such as a boiled egg, apple/banana, including educational materials. During holidays, school nurses provided education via phone. Sessions were interactive, utilizing play, hands-on activities and supported by researcher-developed educational materials such as booklets, posters, food models, and leaflets. The contents covered healthy eating, the food pyramid, balanced meals, and risks of unhealthy food, with picture-based tools. Parents also received health education twice in the first month and monthly subsequently in the community setting. The details of health education and its implementation were described somewhere else.^7,19 Parents in both groups received their children’s baseline health reports as feedback. However, the control group did not receive the health education except for a health checkup.

Data Analysis

The data was analyzed using per-protocol analysis and descriptive statistics. The categorical and continuous variables were analyzed using the chi-square test. The socio-demographic data were illustrated using frequencies and percentages, while baseline physical assessment data were presented as means and standard deviations. The Shapiro-Wilk Test was performed to assess the normality of the baseline physical assessment variables. Next, the distribution of physical assessment (blood pressure, Hb, and blood glucose) data compared with the Japanese normal reference value was explored in frequency and percentage among all participants.^26
-29 Considering the primary outcome of this study, the distribution of physical measurement findings of each time period and the effects of health education on changes in the physical measurements of children were demonstrated using mean and standard deviation (SD) for both groups. Then, data were analyzed using repeated measures ANCOVA, with endline physical assessment variables as the dependent measures, group (intervention vs. control) as the fixed factor, and baseline physical assessment variables as covariates. The homogeneity of regression slopes assumption was examined by including the group × baseline physical assessment interaction term. As this interaction was not significant, the final model included the main effects. Adjusted means (estimated marginal means) were reported for each group while controlling for baseline physical assessments, and pairwise comparisons were adjusted using the Bonferroni method with confidence interval adjustment. All analyses were performed using SPSS for Windows, version 28.0 (IBM Corp., Armonk, NY, USA). Statistical significance was set at P < .05.

Outcome

The outcome of this study, the distribution of physical measurement findings of each time period and the effects of health education on changes in the physical measurements of children.

Results

Out of 604 children, 455 completed the whole study and their data were included in the analysis. Among them, 235 and 220 children were allocated to the IG and CG, respectively. The children’s health history in the past 6 months was presented in Table 1, and an incomplete immunization history (2.4%), based on the Expanded Program on Immunization (EPI) in Bangladesh, was observed.

Table 1.

Frequency of the Participants’ Health History in the Past 6 months (n = 455).

Variables	Yes	No
Visited physician for treatment	108 (23.7)	347 (76.3)
Scabies	161 (35.4)	294 (64.6)
Fever	392 (86.2)	63 (13.8)
Immunization	444 (97.6)	11 (2.4)

In the sociodemographic data, mostly the children were aged 7 to 8 years (IG = 53.2%, CG = 46.8%), female (IG = 53.2%, CG = 46.8%) and had a monthly family income of approximately 200 USD or above in both groups. Considering the children’s parental educational level, 117 (50.9%) and 113 (49.1%) of their fathers were educated in CG and IG, respectively (Table 2). Further, the data was illustrated in Table 2 considering the distribution of physical assessment findings of the children during baseline in both groups. In the baseline, statistically significant differences were observed across most anthropometric indicators. The mean scores of the participants’ height (IG, 128.77 ± 9.74 cm; CG, 125.35 ± 8.88 cm), body weight (IG, 25.52 ± 7.14 kg; CG 23.03 ± 5.11 kg), BMI (IG, 15.15 ± 2.63; CG, 14.51 ± 1.82), and MUAC (IG, 18.80 ± 2.85 cm; CG, 17.76 ± 1.91 cm) were greater among IG than the CG, which were statistically significant (P < .001). Although for blood pressure systolic values were slightly lower in the IG (92.37 ± 10.57 mmHg) compared with the CG (94.73 ± 11.48 mmHg), it was nonetheless statistically significant (P = .023). However, diastolic blood pressure did not differ significantly between the groups (IG, 61.10 ± 10.52 mmHg vs. CG, 62.58 ± 9.70 mmHg; P = .120). Skinfold thickness measurements also revealed significant group differences; for triceps (IG, 8.57 ± 3.22 mm; CG, 7.67 ± 2.72 mm) and subscapular (IG, 6.14 ± 2.55 mm vs. CG, 5.01 ± 1.98 mm) skinfolds were likewise greater in the IG than the CG (P < .001). Regarding RBS levels were slightly lower in the IG (5.51 ± 0.72 mmol/L) than in the CG (5.63 ± 0.78 mmol/L); however, there was no significant (P = .088) difference observed. Similarly, mean Hb concentrations were comparable between groups (IG, 12.47 ± 1.34 g/dL vs. CG, 12.41 ± 1.31 g/dL; P = .647).

Table 2.

Socio-Demographic Characteristics and the Baseline Physical Assessments of the Children in Both Groups (n = 455).

Variables	Intervention group, n (%)	Control group, n (%)	P-value^a
Sociodemographic	—	—	—
Gender	—	—	.429
Male	95 (49.5)	97 (50.5)	—
Female	140 (53.2)	123 (46.8)	—
Age	—	—	.017*
5-6 years	15 (30.6)	34 (69.4)	—
7-8 years	107 (53.2)	94 (46.8)	—
9-10 years	100 (55.9)	79 (44.1)	—
11-12 years	13 (50.0)	13 (50.0)	—
Family income	—	—	.400
100-<200 USD	101 (54.0)	86 (46.0)	—
200 USD or above	134 (50.0)	134 (50.0)	—
Father education level	—	—	.277
Non educated	122 (54.2)	103 (45.8)	—
Educated	113 (49.1)	117 (50.9)	—
Mother education level	—	—	.319
Non educated	73 (55.3)	59 (44.7)	—
Educated	162 (50.2)	161 (49.8)	—
Physical measurements	Intervention group mean (SD)	Control group mean (SD)	P-value^b
Height (cm)	128.77 (9.74)	125.35 (8.88)	<.001***
Weight (kg)	25.52 (7.14)	23.03 (5.11)	<.001***
BMI	15.15 (2.63)	14.51 (1.82)	<.005**
MUAC (cm)	18.80 (2.85)	17.76 (1.91)	<.001***
Blood pressure, systolic (mmHg)	92.37 (10.57)	94.73 (11.48)	.023**
Blood pressure, diastolic (mmHg)	61.10 (10.52)	62.58 (9.70)	.120
Tricep (mm)	8.57 (3.22)	7.67 (2.72)	<.001***
Subscapular (mm)	6.14 (2.55)	5.01 (1.98)	<.001***
Random blood glucose (mmol/L)	5.51 (0.72)	5.63 (0.78)	.088
Hemoglobin (g/dL)	12.47 (1.34)	12.41 (1.31)	.647

SD = standard deviation.

χ² test

Shapiro-Wilk test.

P < .05, **P < .005, ***P < .001.

Next, Figure 1 shows the comparison of the baseline data distribution of children’s physical assessment with the Japanese normal reference value. Among all the participants, 39 (20.3%) boys and 54 (20.5%) girls had poor hemoglobin levels. Subsequently, 1.1% of the participants had abnormal blood glucose levels. Although most children were aligned within the normal range regarding systolic, diastolic blood pressure, and RBS, no statistically significant differences were observed. However, the total number of low systolic (59.6%) and diastolic blood pressure (24.2%) still raises concerns, while the 20.4% of the children ranged under a normal Hb level is highly noticeable (Figure 2).

Figure 1.

The distribution of blood test (hemoglobin and glucose) data compared with the Japanese normal referencevalue (n = 455).

Figure 2.

The distribution of health assessment (systolic and diastolic blood pressure) data compared with the Japanese normal reference value (n = 455).

The ANCOVA analysis was used to compare means across groups while statistically controlling for the influence of baseline physical assessment data. Notably, no significant group × baseline interaction effects were detected for all the outcome variables (P > .05), confirming that baseline adjustments were effective and the group differences reported reflect true endline effects. After adjusting for baseline data, significant group differences were observed among several anthropometric and physical measures at endline (Table 3). Thus, pairwise comparisons (Bonferroni-adjusted) revealed that the IG had significantly lower adjusted means for most of the physical assessments compared with the CG. Children from IG demonstrated significantly higher BMI (F(df) = 6.87 (1), P = .009, partial η² = 0.015), MUAC (F(df) = 10.86 (1), P = .001, partial η² = 0.023), triceps (F(df) = 9.68 (1), P < .002, partial η² = 0.021), and subscapular skinfold thickness (F(df) = 27.69 (1), P < .001, partial η² = 0.058) compared with the CG, indicating improved nutritional status. Next, the IG showed significantly higher systolic blood pressure (F(df) = 12.74 (1), P < .001, partial η² = 0.027) and lower random blood glucose levels (F(df) = 5.07 (1), P = .025, partial η² = 0.011). However, the CG maintained significantly greater height (F(df) = 12.34 (1), P < .001, partial η² = 0.027) and diastolic blood pressure (F(df) = 4.68 (1), P = .031, partial η² = 0.010). Hemoglobin concentration showed a borderline difference between groups (F(df) = 3.72 (1), P = .054, partial η² = 0.008), with higher levels in the CG, although this did not reach statistical significance. Next, there were no significant differences observed in body weight between groups (P = .286). During baseline, the urine glucose test showed 1 child in the CG had a positive test report; however, no cases were observed in the endline. Furthermore, this study’s vision screen test results did not find any abnormalities in the children’s vision which is not included in the tables.

Table 3.

Changes in the Study Outcomes Between the Groups Over Time (n = 455).

Variables for each group	Adjusted mean	Std. error	df	F	Partial η2	P-value	Interaction (group × BL)
Height (cm)	—	—	—	—	—	—	—
Control	132.95	0.15	1	12.34	0.027	<.001***	0.443
Intervention	132.19	0.14	—	—	—	—	—
Weight (kg)	—	—	—	—	—	—	—
Control	26.53	0.21	1	1.14	0.003	.286	0.676
Intervention	26.84	0.20	—	—	—	—	—
BMI	—	—	—	—	—	—	—
Control	14.77	0.11	1	6.87	0.015	.009**	0.286
Intervention	15.15	0.10	—	—	—	—	—
MUAC (cm)	—	—	—	—	—	—	—
Control	17.79	0.09	1	10.86	0.023	.001**	0.375
Intervention	18.22	0.09	—	—	—	—	—
Blood pressure, systolic (mmHg)	—	—	—	—	—	—	—
Control	93.51	0.83	1	12.74	0.027	<.001***	0.225
Intervention	97.64	0.80	—	—	—	—	—
Blood pressure, diastolic (mmHg)	—	—	—	—	—	—	—
Control	63.97	0.71	1	4.68	0.010	.031*	0.497
Intervention	61.83	0.68	—	—	—	—	—
Tricep (mm)	—	—	—	—	—	—	—
Control	7.97	0.29	1	9.68	0.021	<.002**	0.828
Intervention	9.26	0.28	—	—	—	—	—
Subscapular (mm)	—	—	—	—	—	—	—
Control	5.13	0.27	1	27.69	0.058	<.001***	0.826
Intervention	7.14	0.26	—	—	—	—	—
Random blood glucose (mmol/L)	—	—	—	—	—	—	—
Control	5.39	0.054	1	5.07	0.011	.025*	0.711
Intervention	5.23	0.052	—	—	—	—	—
Hemoglobin (g/dL)	—	—	—	—	—	—	—
Control	13.46	0.122	1	3.72	0.008	.054	0.085
Intervention	13.14	0.118	—	—	—	—	—

Note. Repeated measures ANCOVA, adjustment for multiple comparison: Bonferroni.

Std. = standard, df = degrees of freedom.

P < .05, **P < .005, ***P < .001.

Discussion

This study explored the physical measurements and effects of health education on changes in the physical measurements of children through a first-time school nurse-led health education program in Bangladesh. The findings contribute to the significance of regular physical measurements and preventive health interventions in resource-limited settings, particularly in LMICs, where child morbidity remains a significant concern. Subsequently, the results highlight the effectiveness of the combined health education and school-based interventions in improving children’s health outcomes.

The sociodemographic characteristics were relatively similar between the 2 groups, ensuring comparability in the analysis. Most children belonged to families with a monthly income of around USD 200, suggesting that economic disparities may still exist. The total educated parents in both groups was similar; however, parents’ educational level influenced their health knowledge during their children’s care.³⁰ Additionally, in many developing countries like Bangladesh, ensuring complete immunization according to the EPI remains a challenge, reflecting gaps in health communication and primary care access.^24,31 Although a few baseline physical measurements showed statistically significant differences; however, differences in children’s age distribution between the groups may have influenced the non-normal data distribution. Physical growth indicators vary with age; thus, minor differences in age distribution may affect baseline measures, although perfect age-matching is rarely feasible in school-based studies. Nevertheless, from baseline to endline, the IG demonstrated partial improvements with the low effect sizes in anthropometric and blood test measures compared with the CG. The IG received targeted health education and school-based interventions, which contributed to the improvements.³¹ Although height, gained in the IG, was lower than expected, this encouraged further exploration. However, variations in nutritional intake, age distribution, growth trajectories, and several biological determinants such as genetic predispositions and hormonal influences may have affected the study outcomes. Previous studies have shown that nutritional diversity plays a critical role in children’s physical growth and cognitive development, while genetic factors are well-documented contributors to individual differences in height and growth potential.^32,33 Likewise, age-related growth patterns and puberty-associated hormonal changes can substantially modify anthropometric measures, thereby influencing intervention effects.³⁴ Moreover, the collaboration among parents, school authorities, and CHWs appeared to enhance engagement and adherence, thereby amplifying intervention effects.^35
-37 Furthermore, according to researchers, anemia remains a dominant issue among school-aged children in Bangladesh, principally led by nutritional deficiencies and frequent infections.³⁸ In this study, changes in Hb and RBS were statistically significant; only a small proportion of children reached clinically normal thresholds (Hb ≥ 11.5 g/dL; RBS < 140 mg/dL), suggesting modest clinical improvements.³⁹ The study highlighted significant differences in systolic blood pressure between baseline and endline in the IG, reinforcing the effectiveness of school-based health education in promoting healthier behaviors. These findings align with global evidence that nutritional and lifestyle interventions in school settings can improve children’s cardiovascular and metabolic outcomes.^40,41

In many developing countries, including Bangladesh, access to healthcare services is limited, and most people seek medical attention only during emergencies, rather than through regular check-ups.⁴² In contrast, a notable methodological consideration was the absence of nationally established growth standards for Bangladeshi children, which limits the ability to interpret anthropometric measurements accurately within the local context. Previous studies often rely on WHO or CDC (Centers for Disease Control and Prevention) references, which may not fully reflect the accurate findings and report a high prevalence of malnutrition.^43,44 In this study, with Institutional Review Board (IRB) approval, we applied Japanese cut-off values as a reference, given their availability of age-specific cut-offs comparable to our study population and large-scale, nationally representative data with robust methodology.⁴⁵ This approach allowed objective evaluation of children’s growth and nutritional status, while highlighting the urgent need to develop Bangladeshi-specific reference standards.

The findings of this study provide important implications for national school health programs in Bangladesh. Integrating routine health checkups, targeted nutritional education, and parental engagement into school-based programs could improve children’s health outcomes in LMIC contexts. Given the limited healthcare access and the need to establish standardized growth references, such interventions may serve as a feasible strategy to address health risks among school-aged children. Integrating health education and engaging parents helps children gain lifelong health knowledge that benefits both families and communities.

Limitations

This study had a few limitations as listed below-

The study area was selected from a rural and specific geographical area in Bangladesh, which does not represent the children’s growth pattern and physical assessment in the overall country. This was a non-randomized controlled trial, the possibility of selection bias cannot be ruled out, which may affect the internal validity of the findings. The questionnaire used in this study was developed by the researcher based on the previous articles, which may influence the study findings. A few physical measurements were statistically significant during the baseline data collection; this might be due to the different age groups of children being enrolled in different proportions and led to possible bias. The health assessment data were compared only with the Japanese cut-off values, which may have influenced the generalizability of our findings to Bangladeshi children. Although the intervention targeted physical improvements, annual data collection may have overlooked the rapid growth typical of this age group. Furthermore, nutritional intake was not observed, which may lead to potential bias in this study.

Conclusion

In conclusion, this study provides valuable insights into the impact of health education on child health outcomes in Bangladesh. The findings suggest that school-based interventions can play a crucial role in addressing common health issues among children, particularly in LMICs where healthcare access remains a challenge. Strengthening school health programs and integrating preventive strategies into educational settings may help policymakers promote child well-being, reduce the health burden, and foster a healthier future.

Supplemental Material

sj-pdf-1-inq-10.1177_00469580251382037 – Supplemental material for Assessing the Impact of Health Education on Physical Measurements of Children in Bangladesh: A Non-Randomized Controlled Trial

Supplemental material, sj-pdf-1-inq-10.1177_00469580251382037 for Assessing the Impact of Health Education on Physical Measurements of Children in Bangladesh: A Non-Randomized Controlled Trial by Aivey Sadia Alam, Rahman Md Moshiur, Ahmed Ashir, Hawlader Mohammad Delwer Hossain and Moriyama Michiko in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material

sj-pdf-2-inq-10.1177_00469580251382037 – Supplemental material for Assessing the Impact of Health Education on Physical Measurements of Children in Bangladesh: A Non-Randomized Controlled Trial

Supplemental material, sj-pdf-2-inq-10.1177_00469580251382037 for Assessing the Impact of Health Education on Physical Measurements of Children in Bangladesh: A Non-Randomized Controlled Trial by Aivey Sadia Alam, Rahman Md Moshiur, Ahmed Ashir, Hawlader Mohammad Delwer Hossain and Moriyama Michiko in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Footnotes

Acknowledgements

The author is sincerely grateful to the participants, coworkers, and organizations for their support in completing this study.

ORCID iDs

Aivey Sadia Alam

Rahman Md Moshiur

Hawlader Mohammad Delwer Hossain

Ethical Policy and Institutional Review Board Statement

This study adhered to the ethical standards of the Helsinki Declaration (2013 revision) and was approved by the Institutional Review Board of North South University, Bangladesh (2021/OR-NSU/IRB/0701). Written parental consent and children’s verbal assent were obtained after explaining the study’s purpose, privacy, anonymity, minimal risk, and right to withdraw. Participant data were coded with unique identifiers to ensure confidentiality.

Consent to Participate

All the children provided verbal assent, and written informed consent was obtained from their parents (or legal guardians) before participating in the study.

Consent for Publication

Written informed consent to publish this study was obtained from the children’s parents (or legal guardians) to publish this paper. Data were recorded anonymously and no personal information was disclosed.

Author Contributions

Aivey Sadia Alam: Conceptualization, Investigation, Methodology, Formal analysis, Writing Original Draft, Writing – Review & Editing.

Rahman Md Moshiur: Conceptualization, Methodology, Writing – Review & Editing, Funding acquisition.

Ahmed Ashir: Investigation, Methodology, Funding acquisition, Project administration.

Hawlader Mohammad Delwer Hossain: Investigation, Writing – Review & Editing, Project administration.

Moriyama Michiko: Conceptualization, Methodology, Formal analysis, Writing – Original Draft, Writing – Review & Editing, Funding acquisition, Project administration.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Grants-in-Aid for Scientific Research Program (KAKENHI), Japan (Kiban B, N0.21H03250).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Clinical Trial Registration

The Clinical Trial Registry number NCT05012592.

Data Availability Statement

Data will be available upon the corresponding author’s request.

Supplementary Material

Supplemental material for this article is available online.

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