title: Child Centred Approach to Climate Change and Health Adaptation through Schools in Bangladesh: A Cluster Randomised Intervention Trial.
abstract: BACKGROUND
  Bangladesh is one of the most vulnerable countries to climate change. People are getting educated at different levels on how to deal with potential impacts. One such educational mode was the preparation of a school manual, for high school students on climate change and health protection endorsed by the National Curriculum and Textbook Board, which is based on a 2008 World Health Organization manual. The objective of this study was to test the effectiveness of the manual in increasing the knowledge level of the school children about climate change and health adaptation.
  
  
  METHODS
  This cluster randomized intervention trial involved 60 schools throughout Bangladesh, with 3293 secondary school students participating. School upazilas (sub-districts) were randomised into intervention and control groups, and two schools from each upazila were randomly selected. All year seven students from both groups of schools sat for a pre-test of 30 short questions of binary response. A total of 1515 students from 30 intervention schools received the intervention through classroom training based on the school manual and 1778 students of the 30 control schools did not get the manual but a leaflet on climate change and health issues. Six months later, a post-intervention test of the same questionnaire used in the pre-test was performed at both intervention and control schools. The pre and post test scores were analysed along with the demographic data by using random effects model.
  
  
  RESULTS
  None of the various school level and student level variables were significantly different between the control and intervention group. However, the intervention group had a 17.42% (95% CI: 14.45 to 20.38, P = <0.001) higher score in the post-test after adjusting for pre-test score and other covariates in a multi-level linear regression model.
  
  
  CONCLUSIONS
  These results suggest that school-based intervention for climate change and health adaptation is effective for increasing the knowledge level of school children on this topic.
authors.affiliation: Department of Community Medicine and Clinical Epidemiology, Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia; Department of Epidemiology, National Institute of Preventive and Social Medicine, Mohakhali, Dhaka, Bangladesh; Climate Change and Health Promotion Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh.
authors.forename: Md Iqbal
authors.initials: MI
authors.lastname: Kabir
authors.affiliation: Department of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Md Bayzidur
authors.initials: MB
authors.lastname: Rahman
authors.affiliation: Department of Community Medicine and Clinical Epidemiology, Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Wayne
authors.initials: W
authors.lastname: Smith
authors.affiliation: Climate Change and Health Promotion Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh.
authors.forename: Mirza Afreen Fatima
authors.initials: MA
authors.lastname: Lusha
authors.affiliation: Department of Community Medicine and Clinical Epidemiology, Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Abul Hasnat
authors.initials: AH
authors.lastname: Milton
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D001459:Bangladesh; D002648:Child; D057231:Climate Change; D005260:Female; D006801:Humans; D019359:Knowledge; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011634:Public Health; D012574:Schools; D011795:Surveys and Questionnaires