The Status of School Health Programme in Primary Schools in Nnewi North Local Government Area of Anambra State, Nigeria -A Comparative Survey
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The Status of School Health Programme in Primary Schools in Nnewi North Local Government Area of Anambra State, Nigeria -A Comparative Survey Donatus Ignatius Chidiebere OSUORAH Department of Paediatrics Nnamdi Azikiwe University Teaching Hospital, Nnewi A Dissertation Submitted to the National Post-Graduate Medical College In Partial Fulfillment of the Requirements for the Award of the Fellowship of the College May 2015 DECLARATION It is hereby declared that this work is original unless otherwise acknowledged. The work has not been presented to any other College for a fellowship, nor has it been submitted elsewhere for publication. ……… ……………………………………… Donatus Ignatius Chidiebere OSUORAH ii ATTESTATION We certify that this work was carried out by Osuorah Donatus Ignatius Chidiebere of the Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria. SUPERVISORS: Dr. Ulasi T. O FMCPaed, FWACP (Paed) Consultant Paediatrician/ Senior Lecturer Department of Paediatrics Nnamdi Azikiwe University Teaching Hospital Nnewi Anambra State Signature and date: ………………………………… Dr. Ebenebe Joy FWACP (Paed), MPH Consultant Paediatrician/ Senior Lecturer Department of Paediatrics Nnamdi Azikiwe University Teaching Hospital Nnewi Anambra State Signature and date: …………………………………… iii TABLE OF CONTENTS Title Page i Declaration ii Attestation iii Table of content iv Dedication vi Acknowledgement vii List of Abbreviations viii List of Appendices ix List of Tables x Summary xii INTRODUCTION 1 Overview of School Health Programme (SHP) 1 The Objectives of SHP 3 Justification of the Study 4 Aims and Objectives 6 LITERATURE REVIEW 7 Components of SHP 7 Historical perspective of SHP 14 Fundamental components of SHP 20 MATERIAL AND METHODS 35 Study area 35 iv Study population 35 Study design 36 Sample size determination 36 Sampling technique 37 Inclusion and Exclusion criteria 38 Ethical clearance and Permission 38 Pilot Testing 39 Data Collection 39 Data analysis Plan 41 Operational definition 41 RESULTS 43 DISCUSSION 65 CONCLUSION 73 RECOMMENDATION 74 LIMITATION 75 RECOMMENDATION FOR FUTURE RESEARCH 76 REFERENCES 77 APPENDICES 89 v DEDICATION This work is dedicated to the millions of primary school children in Nigeria and other developing countries of the world, who despite the poor and uninspiring learning environments coupled with unfavourable economic conditions, struggle to stay healthy and still get educated. To them I say that, very soon you shall all grow to excel and become the best among your peers in your chosen fields of endeavour and with an assurance that brings forth much brighter future. vi ACKNOWLEDGEMENTS First and foremost, I thank God for His grace to carry on in spite of all challenges. I wish to express my sincere gratitude to my supervisors; Drs T. O. Ulasi and Joy Ebenebe who graciously devoted their time and energy to supervise this work. My gratitude also goes to all other consultants in the Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital for their individual contributions during my residency training. I also would like to thank all my fellow residents for their support and constructive criticisms. I am particularly indebted to the proprietors, School heads, staff and pupils of all the schools that participated in this study. Lastly, my gratitude goes to my wife and daughter for their endurance and unceasing prayers all through the period of my residency training. vii LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome ASUBEB Anambra State Universal Basic Education Board CDC Center for Disease Control FRESH Focusing Resources on School Health Program FME Federal Ministry of Education FSS Full Service School IAQ Indoor Air Quality LGA Local Government Area MGD Millennium Development Goal NAHET Nigerian Association of Health Education Teachers NGO Non-Governmental Organization NSHA National School Health Association PAN Paediatric Association of Nigeria PHC Primary Health Care PTA Parents| Teachers Association SHC School Health Committee SHP School Health Programme STD Sexually Transmitted Disease UBE Universal Basic Education UPE Universal Primary Education UNICEF United Nations Children Fund UNESCO United Nation Education Scientific and Cultural Organization WHO World Health Organization viii APPENDICES I. SHP Evaluation Scale 89 II. Questionnaire 97 III. Collation of scores 102 IV. List of Registered Primary Schools in Nnewi North LGA 103 V. Teachers scores and summary statistics 106 VI. Approval Letter from the State Primary School Board 107 VII. Letter of Approval from Ethical Committee NAUTH 108 VIII. The Map of Nnewi North Local Government Area 109 ix LIST OF TABLES Table I Features of the traditional SHP Component model Table II Features of the four (fresh) components model Table III Features of eight (CDC) components model Table IV Features of the full services model Table V Scoring system for school health programme Table VI General Characteristics of the Schools Surveyed Table VII Frequency distribution of Health Personnel in the Schools Table VIII Health Appraisal Implemented in the Schools Surveyed Table IX Availability of Health Services and Facilities by School Type Table X Drugs and Treatment Materials Available in First-Aid Box Table XI Emergency Care Services Delivery Accessible to School Pupils Table XII Time Allocated for Health Instructions According in schools Table XIII Level of Contents of Health Instruction taught in Schools Table XIV Teaching Methods in use in the Schools Surveyed Table XV Proportion of Health Instructors in Schools Surveyed Table XVI Distribution of the School Surveyed by Area of Locations Table XVII Condition of School Buildings and Premises by School Type Table XVIII Seat Availability for Teachers and Pupils by School Type Table XIX Provision of Food Service Area and Selected Variables in Schools x Table XX Distribution of Toilet Facilities in the Schools Surveyed Table XXI Healthful Living Practices According to Schools Type Table XXII Level of Interactions between the Schools and Communities Table XXIII Score Summary for Components of SHP in Assessed Schools Table XXIV Teacher’s Score Summary for SHP knowledge Assessment Table XXV Association between Teacher’s Highest Qualifications and Scores Obtained xi SUMMARY Background: The school health programme (SHP) is an important aspect of health delivery system essential for monitoring the health of school children in order to keep them healthy and optimize their learning potentials and capacities. Aim and Methods: This cross-sectional, descriptive study aimed at determining the status of the SHP programme in 56 randomly selected private and public schools using, as an assessment tool, four of the eight components in the Center for Disease Control (CDC) model for SHP. The study also aimed at comparing the extent of implementation of SHP in both private and public primary schools as well as to assess the level of knowledge of SHP among 426 randomly selected teachers in Nnewi North Local Government Area of Anambra State. Result: Of the 4 components of SHP assessed, the minimum requirement for acceptable school health service implementation was not achieved in either private or public schools. The elements for healthful school environment were present but public schools were found to be less capable in implementing these elements than private schools. Similarly the elements for assessing community involvement were present but it was observed that public schools were more likely to benefit from community participation than private schools. When criteria for assessing school health services and healthful school environment were compared, private schools had significantly higher mean scores (13.6±4.3 vs. 8.8±2.5; p=0.001) and (37.7±4.4 vs. 31.2±6.4) (p=0.002). Public schools, on the other hand, had a higher score (8.1±2.1 vs. 5.9±0.9; p=0.002) when criteria xii for assessing community participation were compared (p=0.001). There was no significant difference in scores for school health instruction between private and public schools (17.6±4.4 vs. 17.6±3.6; p=0.939). One hundred and sixty (37.5%) of the 426 teachers surveyed had adequate knowledge of SHP but when stratified by the school types, the proportion of teachers in private and public schools that had adequate knowledge (37.5% vs. 36.2%; p=0.630) were comparable (mean score (42.9±12.8 vs. 43.8±13.2; p=0.810). The linear regression analysis showed that teachers with higher educational qualifications were more likely to have better knowledge of SHP than those with lower qualifications (OR 5.90; CI 3.13-11.05) and (NCE OR 11.55; CI 5.89- 22.65). The views of the teachers were that adequate funding, training and retraining, supervision and monitoring of the program implementation would have a positive impact on the status and implementation of SHP in the LGA. Conclusions and recommendations: The status of School Health Program activities is present in Nnewi North LGA but the implementation of some of the essential elements and components were below standard. Training and retraining of primary school teachers coupled with effective school health policies would be essential in ensuring adequate and optimal implementation of SHP in primary schools in Nnewi. xiii INTRODUCTION Overview of School Health Programme According to the Institute of Medicine USA, the school health programme (SHP) is a coordinated and integrated set of planned, sequential school affiliated strategies, activities and services designed to promote