Outcomes
ADVERSE EVENTS, SECONDARY
The primary outcome of impact was dietary diversity, defined as the number of food groups out of ten (grains, white roots, and tubers; pulses such as beans, peas, and lentils; nuts and seeds; dairy; meat, poultry, and fish; eggs; dark green leafy vegetables; other vitamin A-rich fruits and vegetables; other vegetables; and other fruits) consumed by adolescent girls over the previous 24 h, and minimum dietary diversity.Secondary outcomes were meal frequency and consumption of junk foods. Meal frequency (score of 0–6) was calculated as the number of times meals and snacks were consumed during the day and night in the previous 24 h both before the last school day and the last non-school day. Adolescent girls were asked whether they consumed any food during six meal and snack times: breakfast, snacks after breakfast but before a mid-day meal, lunch, afternoon snacks, dinner, and after-dinner snacks. Junk food consumption included four categories: baked sweets, other sweets (eg, candy and chocolate), fried and salty foods, and soda and sugar-sweetened beverages.To assess feasibility, exposure to each of the six intervention components (flag ceremonies, classroom lessons, school club meetings, peer group mentoring, BMI measurement and counselling, and parent–teacher meetings) was calculated as the proportion of adolescent girls or parents who reported receiving or participating in the interventions in the past 3 months (secondary outcome). We identified barriers and opportunities related to intervention implementation based on the exposure results.The original protocol was amended (on March 9, 2021) to remove a quantitative 24 h recall dietary assessment, the corresponding outcome indicators on adequate intake of micronutrients and macronutrients, and a sub-sample panel of adolescent girls at endline due to budgetary and time constraints.No adverse events were anticipated or monitored actively, and none were reported by teachers or other school staff during routine supervision of intervention activities.