Delivery strategies supporting school-age child health: A systematic review

Context: School-aged children (SAC; 5-9 years) remain understudied in global efforts to examine intervention effectiveness and scale up evidence-based interventions. Objective: This review summarizes the available evidence describing the effectiveness of key strategies to deliver school-age interventions. Data sources: We searched Medline, PsycINFO, Campbell Collaboration, and The Cochrane Library during November 2020. Study selection: Systematic reviews and meta-analyses that: target SAC, examine effective delivery of well-established interventions, focus on low- and middle-income countries (LMICs), were published after 2010, and focus on generalizable, rather than special, populations.Data extraction: Two reviewers conducted title and abstract screening, full-text screening, data extraction, and quality assessments.Results: Sixty reviews met the selection criteria, with 35 containing evidence from LMICs. The outcomes assessed and the reported effectiveness of interventions varied within and across delivery strategies. Overall, community, school, and financial strategies improved several child health outcomes. The greatest evidence was found for the use of community-based interventions to improve infectious disease outcomes, such as malaria control and prevention. School-based interventions improved child development and infectious disease-related outcomes. Financial strategies improved school enrollment, food security, and dietary diversity.Limitations: Relatively few LMIC studies examined facility, digital, and self-management strategies. Additionally, we found considerable heterogeneity within and across delivery strategies and review authors reported methodological limitations within the studies.Conclusions: Despite limited research, available information suggests community-based strategies can be effective for the introduction of a range of interventions to support healthy growth and development in SAC. These also have the potential to reduce disparities and reach at-risk and marginalized populations