Modelling the Long-Term Effects of School-Based Health Education on Adult Non-Communicable Disease Incidence in Nigeria: A Simulation Study

The long-term preventive potential of school-based health education in reducing adult non-communicable disease incidence in Nigeria has not been rigorously modelled, limiting the evidence base for national health education investment decisions. This study developed and applied a system dynamics simulation model to estimate the long-term effects of school-based health education on adult non-communicable disease incidence in Nigeria over a 30-year horizon. Model structure and parameters were derived from a systematic review of 64 empirical studies on school-based health education and non-communicable disease risk factors in sub-Saharan Africa, supplemented by primary data from a cross-sectional survey of 340 secondary school students and 20 expert consultations with public health economists and health education specialists. The model simulated outcomes under three policy scenarios: status quo, scaled national school health education programme, and integrated school and community health education. Simulation results indicated that a scaled national school health education programme scenario would reduce adult hypertension incidence by 18 percent, type 2 diabetes by 14 percent, and obesity by 22 percent over 30 years compared to status quo, with a benefit-cost ratio of 3.8. The study makes a significant methodological contribution to health education research through the first Nigeria-specific simulation model for non-communicable disease prevention. Keywords: school-based health education, non-communicable disease, simulation modelling, Nigeria, system dynamics