Strengths and limitations
One of the major strengths of the study was the co-development of the education materials and the implementation plan with relevant local stakeholders including teachers and health and nutrition experts to ensure acceptability and viability.28 Based on repeated discussions with stakeholders, a few key decisions were made. These included incorporating information on balanced diet and health and hygiene in addition to topics related to anaemia, contextual adaptation of existing BCC (Behaviour Change Communication materials), implementation of the intervention among grade six and seven students, and involvement of teachers as educators.
The study was designed to measure changes in knowledge, not in behaviour. However, several studies in India have reported a change in behaviour after the implementation of school-based nutrition education interventions. Due to planned school closures because of the Covid-19 pandemic, the post-intervention test was carried out after a gap of only 1-2 weeks, and retention in knowledge was not studied. Also, to sustainably enhance knowledge, the education intervention would need to be repeatedly implemented.