School AttendancePeanut-SMARTNCT06397989
Peanut-based School Meals in Rural Ghana to Improve Attendance and Retention
A study testing Ready-to-use school food and Standard meal in people with School Attendance and School Dropouts, run by Washington University School of Medicine at 20 sites in Ghana.
Trial summary
The goal of this clinical trial is to test daily provision of peanut paste-based milk-containing ready-to-use school food (PM-RUF) in children 5-17 years of age in Ghana . The main question it aims to answer is: Will provision of PM-RUF as a daily school meal improve attendance, improve matriculation, and/or reduce… Read more about this study
- Who is it for?
- Ages 5 to 17 yearsHealthy volunteers can take part
- Conditions the study is for
- School Attendance, School Dropouts, School Enrollment
- What is being tested?
- Ready-to-use school food and Standard meal
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 5,731 participants
- Where
- 20 sitesGhana
- Study dates
- 7 May 2024to 31 Jul 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 5 to 17 years
- All sexes
- Healthy volunteers accepted
- Child
Who may be able to join
- Provision of signed (or thumb-printed) and dated informed consent form by parent/guardian
- Enrolled at level Basic 1 or higher in a participating school
- Parent/guardian stated willingness to comply with all study procedures and availability for the duration of the study, including no plan to move from the catchment area of a participating school
- 5 - 17 years of age
Who cannot join
- Known allergy to components of intervention or control study food or medications
- Condition requiring immediate hospitalization
Trial locations and contacts
20 sites in 1 country.
20 sites in 1 country
Ghana20 sites
Afayili Islamic primary school
Afayili
Bofoyili E/P JHS
Bofoyili
Bofoyili primary school
Bofoyili
Jimle AME Zion JHS
Jimile
Jimle/Guma R/C primary school
Jimile
Kanimo R/C JHS
Kanimo
Kpabia Islamic JHS
Kpabia
Kpuligini Islamic primary school
Kpuligini
Kusheli Islamic primary school
Kusheli
Mbatinga Islamic primary school
Mbatinga
St. Anthony primary school
Mion
Nadundo R/C JHS
Nadundo
Nalogno Methodist JHS
Nalogno
Salankpang A.M.E Zion primary school
Salankpang
Zakpalsi Issawiya E/A primary school
Salwelsi
Sambu Islamic JHS
Sambu
Sang Islamic JHS
Sang
Sang Zakaria Islamic JHS
Sang
Tuwua R/C JHS
Tuwua
Yabogu Islamic primary school
Yabogu
About this study
The goal of this clinical trial is to test daily provision of peanut paste-based milk-containing ready-to-use school food (PM-RUF) in children 5-17 years of age in Ghana . The main question it aims to answer is:
- Will provision of PM-RUF as a daily school meal improve attendance, improve matriculation, and/or reduce dropouts among Ghanaian schoolchildren 5-17 years of age in Mion District as compared with provision of a common local flour made of rice/millet?
Read the detailed description
School feeding programs offer an opportunity to advance individual and community health and well-being, especially in contexts of poverty and limited diet quality. When compared with no school feeding, school feeding has been shown to improve attendance, reduce dropouts, and strengthen household food security.
In many low- and middle-income countries (LMICs), a model called Home-Grown School Feeding (HGSF) has been employed in an effort to increase the coverage of school feeding programs. This model involves local growing, procurement, and cooking of school meals, thereby aiming to boost local economies and improve sustainability. A potential drawback of this approach is the nutritive quality of the school meals, which will depend on what is typically grown and procured in the program. In areas of higher food insecurity, such a program may largely provide the foods to which children already have access, rather than nutrients their diets may be missing. Additional concerns include costs related to decentralized procurement and cooking, as well as food safety, which is more challenging to monitor in such a program.
Peanut paste-based school meals might offer benefits as an alternative. Local production is possible, as is done for ready-to-use supplementary and therapeutic foods. Local ingredient sourcing could offer similar economic and sustainability advantages. Peanut pastes are food safe with long storage capabilities. They also provide a matrix into which varied ingredients can be added while maintaining organoleptic acceptability to children. Finally, in regions where current government-run HGSF programs suffer from inadequate funds and instability, local production and distribution of RUFs (ready to use foods) might improve reliability and impact school attendance, dropouts, and matriculation.
This study is a cluster-randomized, controlled, investigator-blinded superiority trial. Schools will be randomized to receive PM-RUF or local rice meal (rice delivered, cash provided for additional ingredient purchase). PM-RUF will contain peanut, palm oil, sugar, fat-free milk powder, and 0.5-1 RDA (recommended dietary allowances) of 14 micronutrients. Attendance will be tracked with the use of fingerprint biometric scanning each day.
- Conditions
- School Attendance, School Dropouts, School Enrollment, School Feeding Programs, Child Nutrition
- Being tested
- Ready-to-use school food, Standard meal
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Ready-to-use school foodDietary supplement
80 grams of peanut paste-based food containing skim milk powder, cowpea, peanuts, vegetable oil, and multiple micronutrients
Standard mealDietary supplement
Meal made with rice (cooked ~300 g/d) + local ingredients purchased by school cooks
| Study group | Role | What they receive |
|---|---|---|
| Ready-to-use school food | Experimental | Provision of peanut paste-based, milk-containing ready-to-use school food (PM-RUF) Receives: Dietary Supplement: Ready-to-use school food |
| Standard school meal | Active comparator | Provision of rice + cash for cooks to purchase local ingredients to make a school meal Receives: Dietary Supplement: Standard meal |
What is being measured
The primary outcome is the main question the study is designed to answer.
Attendance percentage
Percent attendance will be compared between PM-RUF and rice/millet flour groups using ordinal logistic regression with school as a random effect to account for clustered randomization, and including the covariates used in stratified, covariate-constrained randomization. Odds ratios with 95% confidence interval (CI) will be reported as well as model-derived median of differences with 95% CI.. Higher numbers are better. Maximum is 100%.
Measured: 11-30 months from enrollment
Secondary outcomes (4)
Dropout from school
Dropout is a binary outcome, defined as no attendance for 3 consecutive months, and the time from enrollment to last day of school attended will define time-to-dropout. Dropouts will be analyzed using time-to-event analysis with Cox proportional hazards regression. A random effect for school will be included to account for clustered randomization. The reported effect measure will be a hazard ratio with 95% CI. Censoring will occur at graduation from the school and moving away from school's catchment area.
Measured: 11-30 months
Matriculation
Matriculation is a binary outcome defined by attendance at a subsequent grade after completing a school year. Logistic regression with a random effect for school will be used to analyze matriculation to subsequent school grade. This will be repeated for each school year included in the study. The reported effect measure will be an OR with 95% confidence interval.
Measured: 11-30 months
Afternoon attendance percentage
Defined as attendance registered following lunch break. Percent afternoon attendance will be compared between PM-RUF and rice/millet flour groups using ordinal logistic regression with school as a random effect to account for clustered randomization. Odds ratios with 95% CI will be reported as well as model-derived medians of difference with 95% CI. Higher numbers are better. Maximum is 100%.
Measured: 11-30 months
New Attendees
New attendees are defined as new enrollments in school after initiation of school feeding. The number of new attendees as a percent of the school population they join will be analyzed using ordinal logistic regression with school as random effect, and variables used in stratified, covariate-constrained randomization as covariates. Higher numbers are better.
Measured: 11-30 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 May 2024
- Study start7 May 2024
- Primary completion20 May 2026
- Study completion31 Jul 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for School AttendanceStudies of the same condition, open and under way.
- More trials run by Washington University School of MedicineThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Cluster-randomized, controlled, investigator-blinded superiority trial. Schools will be randomized to receive PM-RUF or local rice meal. Randomization will be stratified / covariate-constrained by primary vs. junior secondary school, school size, and distance from a main road.
- Masking
- Single blind
- Who is masked
- Investigator
- Enrolment
- 5,731 participants (actual)
Sponsor and investigators
- Lead sponsor
- Washington University School of Medicine
- Sponsor type
- University, hospital or other
- Collaborators
- University of Ghana, United States Agency for International Development (USAID), The Danish Dairy Research Foundation, Denmark
- Responsible party
- Sponsor
- Investigators
- Mark Manary, MD, Principal investigator, Washington University School of Medicine
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06397989
- Sponsor's protocol ID
- 202404055
- Acronym
- Peanut-SMART
- Status last verified
- Aug 2026
- First submitted
- 30 Apr 2024
- Last updated
- 13 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 13 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Peanut-based School Meals in Rural Ghana to Improve Attendance and Retention
- ClinicalTrials.gov ID
- NCT06397989
- Acronym / sponsor ID
- Peanut-SMART / 202404055
- Conditions
- School Attendance, School Dropouts, School Enrollment, School Feeding Programs, Child Nutrition
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 5,731 participants (actual)
- Lead sponsor
- Washington University School of MedicineUniversity, hospital or other
- Collaborators
- University of Ghana, United States Agency for International Development (USAID), The Danish Dairy Research Foundation, Denmark
- Study start
- 7 May 2024 (actual)
- Primary completion
- 20 May 2026 (actual)
- Study completion
- 31 Jul 2026 (actual)
- First posted
- 3 May 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical trial is to test daily provision of peanut paste-based milk-containing ready-to-use school food (PM-RUF) in children 5-17 years of age in Ghana . The main question it aims to answer is:
- Will provision of PM-RUF as a daily school meal improve attendance, improve matriculation, and/or reduce dropouts among Ghanaian schoolchildren 5-17 years of age in Mion District as compared with provision of a common local flour made of rice/millet?
Detailed description
School feeding programs offer an opportunity to advance individual and community health and well-being, especially in contexts of poverty and limited diet quality. When compared with no school feeding, school feeding has been shown to improve attendance, reduce dropouts, and strengthen household food security.
In many low- and middle-income countries (LMICs), a model called Home-Grown School Feeding (HGSF) has been employed in an effort to increase the coverage of school feeding programs. This model involves local growing, procurement, and cooking of school meals, thereby aiming to boost local economies and improve sustainability. A potential drawback of this approach is the nutritive quality of the school meals, which will depend on what is typically grown and procured in the program. In areas of higher food insecurity, such a program may largely provide the foods to which children already have access, rather than nutrients their diets may be missing. Additional concerns include costs related to decentralized procurement and cooking, as well as food safety, which is more challenging to monitor in such a program.
Peanut paste-based school meals might offer benefits as an alternative. Local production is possible, as is done for ready-to-use supplementary and therapeutic foods. Local ingredient sourcing could offer similar economic and sustainability advantages. Peanut pastes are food safe with long storage capabilities. They also provide a matrix into which varied ingredients can be added while maintaining organoleptic acceptability to children. Finally, in regions where current government-run HGSF programs suffer from inadequate funds and instability, local production and distribution of RUFs (ready to use foods) might improve reliability and impact school attendance, dropouts, and matriculation.
This study is a cluster-randomized, controlled, investigator-blinded superiority trial. Schools will be randomized to receive PM-RUF or local rice meal (rice delivered, cash provided for additional ingredient purchase). PM-RUF will contain peanut, palm oil, sugar, fat-free milk powder, and 0.5-1 RDA (recommended dietary allowances) of 14 micronutrients. Attendance will be tracked with the use of fingerprint biometric scanning each day.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (investigator)
- Number of arms
- 2
- Model description
- Cluster-randomized, controlled, investigator-blinded superiority trial. Schools will be randomized to receive PM-RUF or local rice meal. Randomization will be stratified / covariate-constrained by primary vs. junior secondary school, school size, and distance from a main road.
| Arm | Type | Receives |
|---|---|---|
| Ready-to-use school food | Experimental | Dietary Supplement: Ready-to-use school foodProvision of peanut paste-based, milk-containing ready-to-use school food (PM-RUF) |
| Standard school meal | Active comparator | Dietary Supplement: Standard mealProvision of rice + cash for cooks to purchase local ingredients to make a school meal |
Who may qualify
- Ages
- 5 to 17 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child
Key inclusion criteria (4 listed)
- Provision of signed (or thumb-printed) and dated informed consent form by parent/guardian
- Enrolled at level Basic 1 or higher in a participating school
- Parent/guardian stated willingness to comply with all study procedures and availability for the duration of the study, including no plan to move from the catchment area of a participating school
- 5 - 17 years of age
Key exclusion criteria (2 listed)
- Known allergy to components of intervention or control study food or medications
- Condition requiring immediate hospitalization
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Ready-to-use school food80 grams of peanut paste-based food containing skim milk powder, cowpea, peanuts, vegetable oil, and multiple micronutrients | Dietary supplement | Ready-to-use school food |
| Standard mealMeal made with rice (cooked ~300 g/d) + local ingredients purchased by school cooks | Dietary supplement | Standard school meal |
Primary outcome
Attendance percentage
Time frame: 11-30 months from enrollment
Percent attendance will be compared between PM-RUF and rice/millet flour groups using ordinal logistic regression with school as a random effect to account for clustered randomization, and including the covariates used in stratified, covariate-constrained randomization. Odds ratios with 95% confidence interval (CI) will be reported as well as model-derived median of differences with 95% CI.. Higher numbers are better. Maximum is 100%.
4 secondary outcomes
Dropout from school
Time frame: 11-30 months
Matriculation
Time frame: 11-30 months
Afternoon attendance percentage
Time frame: 11-30 months
New Attendees
Time frame: 11-30 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 13 Aug 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mark Manary, MD principal investigator
Washington University School of Medicine
20 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Ready-to-use school food and Standard meal in people with School Attendance and School Dropouts, run by Washington University School of Medicine at 20 sites in Ghana.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 13 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 20 sites in Ghana. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Attendance percentage (time frame: 11-30 months from enrollment). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Aug 2026.