Effectiveness of School-Based Interventions on Risk Factors of Non-Communicable Diseases in Middle School Children of Hilly Urban Settings of Nepal

Purpose The study aimed to evaluate the effectiveness of a school-based health promotion program in reducing key risk factors for NCDs in Nepal. Design A repeated cross-sectional, quasi-experimental study design. Setting School. Sample The sample size for each of the intervention and control arms was 209. Intervention Health education intervention. Measures Measurement of change in metabolic equivalent of task (MET), body mass index, body fat percentage, fruit and vegetable servings per day, and other risk factors of non-communicable diseases. Analysis Data for both groups were summarized as frequencies and percentages at baseline (T0), after the first intervention (T1), and after the second intervention (T2). Intervention and control groups were compared using the Chi-square test, Mann–Whitney U test, independent-samples t-test, Mood’s median test, and Cluster-level Difference-in-Difference (DiD) analysis. Results A total of 423, 366, and 270 adolescents (intervention: 214, 176, 135; control: 209, 190, 125) from 9 schools (5 intervention, 4 control) participated at baseline, T1, and T2. Cluster-level DiD analysis to assess the effectiveness of the intervention found improvements in BMI, body fat percentage, fruit and vegetable purchase frequency, and school canteen fruit availability, but none were statistically significant. Conclusion Although not statistically significant, the intervention produced directionally favorable changes in physical activity, anthropometric measures, and dietary behaviors, suggesting potential public health benefits at the school level.