School-based interventions targeting double burden of malnutrition and educational outcomes of adolescents in low- and middle-income countries: protocol for a systematic review

Background: Adolescence is a period of rapid physical growth and transition between childhood to adulthood. However, in many developing countries, nutritional and epidemiological transitions are contributing to surging overnutrition, which, together with prevalent undernutrition, is resulting in the double burden of malnutrition (DBM) among adolescents. Schools as social systems have tremendous but mostly underutilized capacity to facilitate change and address a range of nutritional and associated educational concerns of adolescents and young people. The main objective of this systematic review will be to describe school-based interventions that address the multiple forms of malnutrition, and synthesize their effects on nutrition and educational outcomes among adolescents (10 - 19 - years - old) from low- and middle-income countries (LMICs).

Methods: Comprehensive literature searches will be conducted in multiple electronic databases, including Medline (through PubMed), Embase, CENTRAL (through Cochrane Library), CINAHL, and Google Scholar. We will include randomized controlled trials (RCTs), non-RCTs including controlled before-after studies, examining the effects of nutrition interventions on nutrition and educational outcomes among adolescents in LMICs. Two reviewers will independently screen all citations and full-text articles and abstract data. The quality of the included studies will be assessed with the Cochrane Collaboration's revised tool for assessing the risk of bias for RCTs and the Risk Of Bias In Non-randomized Studies of Interventions tool for controlled before-after studies and non-randomized controlled trials.

Discussion: To maximize the power of schools as a platform to reinforce the mutually beneficial relationship between adolescent nutrition and education, it is imperative to develop and implement integrated interventions connecting schools, adolescents, parents, communities, and the health care system. The results of this systematic review may provide a comprehensive state of current knowledge on the effectiveness of school-based interventions to enable future research that maximizes the impact and efficiency of integrated approaches to tackle multiple forms of malnutrition among school-going and out-of-school adolescents.

Systematic review registration: PROSPERO ID: CRD42020211109.