Effect of egg powder-fortified Tom Brown on nutritional and academic performance among school-aged children in Wa Municipality, Ghana: a parallel-group randomised controlled trial

Abstract

Objective: This study investigated the impact of egg powder-fortified Tom Brown on classroom scores among resource-poor school-aged children aged between 5 and 12 years in the Wa Municipality, Ghana.
Design: A 24-week parallel-group randomised controlled trial was conducted with 136 primary school children from low-income communities. Participants were individually randomised within schools into intervention (n = 68) and control (n = 68) arms.
Setting: Wa Municipality, Ghana.
Participants: School-aged children in primary four in public primary schools in Wa Municipality.
Intervention and outcome measures: The intervention group received egg powder-fortified Tom Brown three times per week, while controls received the standard porridge. Academic performance was assessed pre/post-intervention using Ghana Education Service validated standardised tests in English and mathematics using linear mixed-effects models (LMM) to analyse scores, controlling for time, treatment, their interaction (fixed effects) and school-level clustering (random effects).
Results: The intervention group demonstrated significant improvement in test scores. English scores increased by 19.3 points at endline (vs. 3.8-point gain in controls; Time × Treatment interaction: b = 15.46, p < 0.001). Mathematics scores also improved by 18.8 points (41.5% improvement; interaction: b = 19.91, p < 0.001), while controls declined marginally. Baseline equivalence confirmed successful randomisation (English: p = 0.935 and mathematics: p = 0.715). Between-school heterogeneity was moderate with a variance partition coefficient of 9.6–10.7%.
Conclusion: Fortifying Tom Brown with egg powder is an effective and potentially scalable intervention to boost academic scores among Ghanaian schoolchildren. Integrating it into national programmes could help combat malnutrition and advance educational achievement in children.
Trial design: Parallel-group randomised controlled trial (allocation ratio 1:1)
Trial registration: Pan African Clinical Trial Registry, pactr.samrc.ac.za, identifier: PACTR202408897182810.

Keywords: school feeding, egg fortification, academic performance, malnutrition, Ghana, linear mixed-effects model