Effect of double duty interventions on the frequency of morbidity among adolescents in Debre Berhan Regiopolitan City, Ethiopia: a cluster randomized controlled trial

Abstract

BACKGROUND: Morbidity is an immediate predictor of malnutrition. However, nutritional interventions to reduce frequent morbidities in adolescents were not conducted well based on behavioral models in low-income countries like Ethiopia. Hence, the aim of this study was to examine the effect of selected double-duty interventions on frequency of morbidities among adolescents based on health belief model in Debre Berhan Regiopolitan City, Central Ethiopia. METHODS: A two-arm parallel cluster randomized controlled trial was conducted from October 13, 2022, to June 30, 2023, involving 356 adolescents in the intervention group (IG) and 352 adolescents in the control group (CG). The frequency of morbidity (FoM) was assessed through self-reported responses provided by the adolescents. To evaluate the impact of the intervention, a difference-in-differences analysis was employed along with a Generalized Estimating Equation (GEE) model using a Negative Binomial regression approach, which is suitable for analyzing count data with overdispersion. The statistical significance of the study was determined by setting a threshold of p-value less than 0.05. RESULTS: The mean (± SD) score of FoM among IG and CG was - 4.5 (-1.82) and - 1.0 (-0.12), respectively. After the intervention had implemented, the IG had better reduction of mean score of FoM than CG. Moreover, adolescents in the endline measurements had 68% less likely to have higher FoM compared to the baseline measurements [IRR = 0.32, 95% CI (0.27, 0.37)]. Similarly, adolescents in the IG had 82.6% less likely to have higher FoM than CG [IRR = 0.72, 95% CI (0.12, 0.14)]. Likewise, adolescents in the time and treatment interaction category had 24.6% less likely to have higher FoM than adolescents who were not in the interaction category [IRR = 0.75, 95% CI (0.73, 0.78)]. CONCLUSION: The results showed that selected double-duty intervention packages based on the health belief model are effective in reducing FoM among adolescents. The findings suggest the need for integrating the double-duty intervention packages accompanied with behavioral models to the adolescent nutrition guideline and food and nutrition policy and strategy.