A COMPARATIVE STUDY OF THE SCHOOL HEALTH PROGRAMME IN PRIVATE AND PUBLIC PRIMARY SCHOOLS IN OGUN STATE.
PRESENTED BY
DR KUPONIYI OLUGBENGA TEMITOPE M.B.ch.B; (Ogun)
DEPARTMENT OF COMMUNITY MEDICINE AND PRIMARY CARE
OLABISI ONABANJO UNIVERSITY TEACHING HOSPITAL, SAGAMU.
SUBMITTED FOR THE
PART II EXAMINATION IN PARTIAL FULFILMENT
FOR THE AWARD OF FELLOWSHIP IN PUBLIC HEALTH
OF THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA.
MAY, 2015.
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DECLARATION
I, Dr KUPONIYI, Olugbenga Temitope a Senior registrar I in the department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu do hereby declare that this dissertation titled ‘‘A Comparative Study of the School Health Programme in Private and Public Primary Schools in Ogun State” was written by me, under the supervision of Dr. AMORAN O. E and that it has not been submitted in part or in full for any other examination.
______Dr Kuponiyi O. T
______Dr. A. A Salako Head, Community Medicine and Primary Care Department, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State.
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DEDICATION
To God: For the Mercy, For the Grace, For the Unconditional Love. To my Wife: For believing when no one else did and never changing your mind. I love you. To Opemipo: For reminding me always that ‘all things are possible’. To Dad: I have not forgotten.
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CERTIFICATION This is to certify that this proposal, titled ‘‘A Comparative Study of the School Health Programme in Private and Public Primary Schools in Ogun State” written by Dr KUPONIYI Olugbenga Temitope, a senior registrar I in the Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu was carried out under my supervision.
______Dr. AMORAN O. E; FMCPH (Supervisor)
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ACKNOWLEDGEMENT
At this point I truly pray that I do not forget anyone on this acknowledgment page. Just in case I do, let me stay by saying that I ‘acknowledge you’.
Dr. Amoran O.E, my supervisor, I have to start with you. Could not and probably would not have done this at this time without your constant push, encouragement, constructive, ‘very constructive’ criticism and painstakingly going through this project at very odd hours and odd places. I have asked God to openly reward you.
Dr. Salako A.A, my Head of Department, I say a big thank you. I truly appreciate your kind words.
Prof. Alausa O.K, thank you for being an ever present father figure.
Dr. Oluwole F.A, for being so kind hearted, I am grateful sir.
Dr. Jeminusi O.A, I do appreciate your deep concern and the constant words of encouragement.
Dr. Daniel O. Thank you for the selfless effort and keen interest.
Dr. Alabi, I remember your gentle persuasions. Thank you.
Dr. Yewande Soneye, Dr. Tomilola Musari, Dr. Bolanle Bolaji, Dr. Deola Odusolu. The first crew. Thank you for being the ‘First Crew’.
Dr. Feyifolu Mustapha, Dr. Tomilola Sofela, Dr. Folajimi Senjobi, Dr. Abe Oluwafeyi, Dr. Lamide Oyende, Dr. Lanre Modele, Dr. Femi Oyewusi Dr. Tosin Arubuolawe, Dr. Tola Adeniji-Soji. The second crew. You finished the work. Thank you.
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Father Blessing. You showed up just at the right time. A true son of consolation. Ibiyemi Ijaiya. I would still be typing if you had not showed up. I am grateful.
Dr. Tunde Oluwole. For always stepping in and filling the gaps. Thank you.
All the Residents and Staff of the Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital. I appreciate your assistance.
Samuel and Damilola Adejuyitan. I appreciate the push and the sacrifices.
Siji, Lara, Ire, and Ayo AKINBOLA. My second family. You people always amaze me.
My Siblings. Opeyemi, Tolulope, Oluwaseun, Oluwatoyin. The family support made it bearable.
Pastor Poju Oyemade. Thank you for shinning the Light on my pathway.
Finally, my biggest supporter and admirer, Dear Mum, you are simply the very best.
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ABSTRACT School Health Programme comprises of all the projects/ activities in the school environment for the promotion of the health and the development of the school community. The programme is one of the strategies for the achievement of the Health For All (HFA) declaration, education and health related Millennium Development Goals (MDGs) and goals of the National Policy on Education.
This study was therefore designed to assess and compare the School Health Programme in Public and Private Primary Schools in Ogun State, South West Nigeria.
It was a comparative cross sectional study carried out over a four month period in Public and Private Primary Schools in three Local Government Areas located in the three Senatorial districts of Ogun State. A total number of 360 Head Teachers and their Schools were recruited into the study.
Data was collected by the use of an adapted, pre-tested, semi structured, self administered questionnaire which assessed the Head Teachers’ knowledge of School Health Programme and an adapted observational checklist, which was used to evaluate the Practice of School Health Programme in the Schools. Data was analysed using the Statistical package for social sciences software version 15; McNemar’s chi-square and the t- test were used to test significant changes in the two groups. The mean knowledge score for the Public School Head Teachers was 11.78±2.83 while that of the Private School Head Teachers was 10.68±3.48 out of a possible total score of 25 (t=2.620, p=0.01). Thirty seven percent of the Private Schools had a sick bay as against as against 14.4% of the Public Schools (X2=24.371, P=0.001). Training and certification of food handlers was done in 78.5% of the Public Schools and in 33.3% of the Private Schools (X2=78.511, P=0.001). On Health Education, 22.2% and 21.7% of the Public and Private Schools respectively had three periods of Health Instruction in a week (X2=5.115, P=0.164). Nineteen percent of Private Schools had pipe borne water as against 9.4% of the Public Schools. A toilet pupil
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ratio of 1:<30 was found in 24% of the Private Schools as against 4.5% 0f the Public Schools (X2=42.75, P=0.001). Other sporting facilities outside a football field was present in 35.6% of the Private Schools compared with the 9.4% of the Public Schools (X2=35.189, P=0.001). A functional Parents-Teachers Association was reported in 94.2% and 97.2% of the Public and Private Primary Schools respectively. In the multiple logistic regression model, only one variable; ‘Type of School’ was found to be a predictor of School Health Programme (OR= 4.551, CI= 1.918 – 10.799).
The fact that only 24 (6.7%) of the Head Teachers studied had ever seen a copy of the National Policy on School Health Programme and none of them could produce a copy of it on demand was a major factor affecting the implementation of the Programme in the State. The Head Teachers also reported lack of funds and inadequate health personnel as major constraints affecting implementation.
The Practice of School Health Programme in Ogun State though poor was better in the Private Schools than the Public Schools. However knowledge of the School Health programme was very poor in both groups but slightly better among the Public School Teachers.
It is thus recommended that copies of the National Policy on School Health Programme should be made available to Private Schools either as a prerequisite for registration or at the point of renewing their licenses in Ogun State. It should also be made available to all Public Schools Head Teachers in the State through the Nigerian Union of Teachers (Ogun State chapter) and knowledge of the Policy should be a requirement for appointment as a Head Teacher in the Public Schools. An urgent health education intervention campaign on School Health Programme should be organized by the Government of Ogun State through its Ministries of Health and Education with the participation of the Medical Officers of Health (MOH) and the Zonal Education Officers (ZEO) in each of the 20 Local Government Areas to address the identified knowledge gaps.
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TABLE OF CONTENT
Subjects Pages
Title Page i Declaration ii Dedication iii Certification iv Acknowledgement v-vi Abstract vii-viii Table of Content ix List of Tables x List of Appendices xi CHAPTER ONE: INTRODUCTION 1-5 CHAPTER TWO: LITERATURE REVIEW 6-21 CHAPTER THREE: MATERIALS AND METHODS 22-32 CHAPTER FOUR: RESULTS 33-63 CHAPTER FIVE: DISCUSSION 64-76 CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS 77-79 REFERENCES 80-88 APPENDICES 89-105
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LIST OF TABLES
Table I: Characteristics of Respondents’ Socio-Demographic variables 34 Table II A: Knowledge of Respondents’ about School Health Programme 37 Table II B: Knowledge of Respondents about School Health Programme 40 Table III A: Practice of School Health Services in Public and Private Schools 43 Table III B: Practice of School Health Services in Public and Private Schools 45 Table IV: Practice of School Feeding Services in Public and Private Schools 47 Table V: Practice of Skill Based Health Education in Public and Private Schools 48 Table VI A: Practice of Healthful School Environment in Public and Private Schools 49 Table VI B: Practice of Healthful School Environment in Public and Private Schools 51 Table VI C: Practice of Healthful School Environment in Public and Private Schools 53 Table VII: Practice of Physical Health Education among Public and Private Schools 55 Table VIII: Practice of School Home and Community Relationship among Public and Private Schools 56 Table IX: Practice of Counselling and Psychological Services among Public and Private Schools 56 Table X A: Influence of Policy on Implementation of School Health Program in Public and Private Schools 57 Table X B: Influence of Policy on Implementation of School Health Program in Public and Private Schools 58 Table XI: Challenges Reported by Head Teachers in Implementing School Health Programme 60 Table XII: Crosstab of Practice Scores against Socio-Demographic Variables 61 Table XIII: Crosstab of Public and Private Schools against their Practice Scores 62 Table XIV: Crosstab of Respondents’ Practice against Knowledge 62 Table XV: Predictors of Practice of School Health Programme. 63
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LIST OF APPENDICES
Appendix I: Questionnaire 89-93
Appendix II: Observational Checklist 94-99
Appendix III: Informed Consent Form 100
Appendix IV: Approval Letter from Scientific and Ethical Committee 101
of Olabisi Onabanjo University Teaching Hospital, Sagamu
Appendix V: Copy of Approval Letter from Ministry of Education 102
Appendix VI: Map of Sagamu Local Government Area 103
Appendix VII: Map of Abeokuta-South Local Government Area 104
Appendix VIII: Map of Ado-Odo/Ota Local Government Area 105
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CHAPTER ONE
INTRODUCTION
1.1 PREAMBLE The School Health Programme (SHP) can be defined as the group of coordinated activities which contributes to the understanding, maintenance and improvement of the health of the school population. In concept and practice, it is multidisciplinary and involves inter-sectoral co-operation but revolves around the school teacher especially the Head Teacher1-2.
School Health Programme comprises of all the projects/ activities in the school environment for the promotion of the health and the development of the school community3-4. The programme is one of the strategies for the achievement of Health For All (HFA) declaration, education and health related Millennium Development Goals (MDGs); the National Economic Empowerment and Development Strategy (NEEDS); the Education For All (EFA); the Universal Basic Education Act (2004); and goals of the National Policy on Education (2004)5.
On the long term, it is a highly potent medium for fostering sustainable human and community development in the light of the fact that a child spends a good part of his life at school, exposed to a wide variety of environmental, physical, emotional and social influences1.
Globally the number of children reaching school age is estimated to be 1.2 billion children (18% of the world’s population) and rising6. In many homes across the world, children are getting into school system from as early as 5 to 6 months because mothers have to wean early to return to the work place6.
Eighty eight (88%) of these children live in less developed countries6-7. Generally, improving health brings the greatest education benefits to the poor and most vulnerable. School Health Programmes are among the most cost effective 12
interventions that exist to improve both children’s education and health. It can add 4-6 points to Intelligent Quotient (IQ) levels, 10% to participation in schooling and 1-2 years of education6-8.
1.2 STATEMENT OF RESEARCH PROBLEM The World Health Organization (WHO) in 1995 launched the Global School Health Initiative. The initiative seeks to mobilize and strengthen health promotion and educational activities at local, national, regional and global levels. It is designed to improve the health of students, school staff, families and other members of the community through schools. The goal of the initiative is to increase the number of schools worldwide that can truly be called ‘Health-Promoting Schools’. Although definitions will vary, a Health-Promoting School can be characterized as a school constantly strengthening its capacity as a healthy setting for living, learning and working9.
Working with the Regional offices, WHO’s Regional Networks for the development of Health-Promoting Schools may be the world’s most successful and comprehensive international effort to mobilize support for school health services and promotion. The first network was initiated by European regional office of WHO, the Council of Europe and the Commission of the European Communities in 1991. This Network grew within six years to 34 countries, 500 core schools and 1,600 affiliated schools, reaching about 400,000 students10.
Regional Networks were also started in Western Pacific (1995), Latin America (1996) and Southern Africa (1996) through joint efforts with WHO Headquarters and the respective WHO Regional office. In 1997, meetings were held to develop Networks in South East Asia and northern countries of the Western Pacific9-10.
Africa and its regional office, has not enjoyed as much success compared to its other counterparts. West Africa in particular, grappling with political instability and lack of clear cut policies on School Health Programmes and services, is yet to adopt most of 13
the WHO recommendations.
On 13th November 2007 in Abuja, Nigeria launched two important policy documents, related to the integration of health into the education system: the National School Health Policy and the National Education Sector HIV/AIDS Strategic Plan. These new Policies, developed by the Ministry of Education with UNICEF support, are designed to put in place a national framework for the formulation, co- ordination, implementation and effective monitoring and evaluation of the School Health Programme (SHP), including an elaborate and concrete response to the HIV/AIDS scourge11.
The launch of these documents came against the back drop of poor health status of school pupils and the impact of HIV/AIDS on the school system11.
Alongside the two policies, the Nigerian government also launched the National Guidelines for School Meal Planning with the objective to reduce malnutrition and hunger among school children, particularly among those living in poor rural communities, through the provision of at least one adequate meal a day11.
1.3 JUSTIFICATION OF STUDY. There are more schools than clinics and hospitals. Schools therefore have the advantage of collecting large number of pupils and students in one location and are therefore the ideal place for health education.
Oduntan quoting Bronckington in 1972 was of the opinion that education is fundamental to health and health to education. Unhealthy children cannot be properly educated while uneducated children cannot be healthy12.
In 2008, UNESCO concluded that poor health will prevent children from attending school. Also, the impact on learning and cognition is equivalent to a deficit of more than 630 million Intelligent Quotient (IQ) points6. 14
A National study of the School Health System in Nigeria by the Federal Ministries of Health and Education indicated that 30% of students have low Body Mass Index (BMI) and the common health conditions that contribute to absenteeism include fever (56%), headache (43%), stomach ache (29%), cough/catarrh (38%) and malaria (40%)11, 13
Another study in Edo State by Ojugo revealed that primary school children were not provided with basic health examination services. He further argued that because school children did not undergo Pre-entrance medical examinations, baseline health information about them were absent. Also, lack of routine medical examination which would have picked up deviations from normal were also absent. He then concluded by saying all these made early referrals impossible and children vulnerable to preventable diseases14. Whereas, WHO had reported that measures as simple as the assessment of height through a height census in schools can be a unique tool for locating areas of greatest poverty and need in a country15.
The school is the most common means through which every society prepares its young for the future. Establishing efficient school health programme is crucial to addressing several gaps in child health16-17.
A study by Mbarie revealed that many of the Nigerian States are yet to fully understand and adopt the National School Health Policy18. The effect of this is that most schools go ahead and practice School Health Programme as they understand it14,18. Baseline information on School Health Programme as reported in most parts of the country is poor5. Where present the results may no longer truly reflect present day realities. Again, most of the research work done have been on one or two individual components of the School Health Programme such as assessment of school health services, school feeding services, healthful school environment etc. These are done either as surveys, health appraisals or an awareness campaign14,18,19.
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1.4 GENERAL OBJECTIVE OF STUDY To assess and compare the School Health Programme in public and private primary schools in Ogun State, Nigeria.
SPECIFIC OBJECTIVES 1. To assess the knowledge and practice of School Health Programme among Head Teachers in public and private primary schools in Ogun State.
2. To compare the School Health Programme offered in public and private primary schools in Ogun State.
3. To identify factors that affect the implementation of National School Health Policy in public and private primary schools in Ogun State.
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CHAPTER TWO
LITERATURE REVIEW
2.1 HISTORY OF SCHOOL HEALTH PROGRAMME
The earliest recorded organized efforts to improve the health of school children were made in Europe4. In 1790, Bavaria, Germany provided free school lunches. In 1833, France enacted a law holding public schools responsible for the health of school children and this later included periodic inspection of schools by physicians2.
First World War sensitized Americans educators and the public to the health needs of school children. 34% of examined draftees had adverse physical, mental and emotional conditions. This raised the question of whether or not, the school could have prevented or corrected many of the observed conditions by conserving or improving the health of children2.
During the Second World War, 4 million out of 13 million recruits aged between 18 and 37 were found to be unfit for service, hence the existing school health services programme was therefore adjudged a failure. Efforts that followed have resulted in the present state of school health in Europe and America2.
In Nigeria, an attempt was made in 1929 to introduce a medical service that could cater for school children. The scheme proposed entrusted school inspection to Medical Officers with special training in the field and thrice a year examination of school children throughout the school years12.
In 1944, the Christian Council of Nigeria called attention to the high prevalence of malnutrition among school children and hoped the Government would inaugurate the then proposed medical services2.
The Government of Western Nigeria published a policy white paper in 1952 that
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contained a 4 year plan to introduce a school medical services that would be available and free for all school children. The objectives were that it would offer regular medical examination services, bring health education even into children’s homes and provide a liaison between homes and medical authority2.
A school health service programme emerged at the Federal Government level in Lagos in 1971. It was headed by a Medical Officer assisted by other professional heads2. Special clinics were set up to serve as treatment points for school children with minor ailment in some state capitals and large towns like Ibadan, Enugu, Kaduna, Benin and Jos2.
A school health unit was established in a health centre in Diobu, Port-Harcourt, Rivers State in 1975. It was manned by Public Health sisters with occasional inputs by physicians. The activities centred on occasional school inspections and health talks. There were serious complaints by primary school students about the centres in 1989 and 1990. This led to the formulation of a proposal for improvement of school health services by the state Ministry of Health in 1990 to address the issues raised by the children20. However, a school health programme status assessment exercise carried out in 1996 showed that the proposal has not been implemented to any degree20.
In 1991, Mr. Graves, the World Health Organization (WHO) representative in Nigeria, called on the Federal Government to start a school health services programme in Primary schools2. School Health education was subsequently introduced into the primary schools’ curriculum2.
By 1995 when WHO launched the Global School Health Initiative, the issues were still largely unaddressed9.
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2.2 CURRENT SITUATION OF THE NIGERIAN SCHOOL HEALTH PROGRAMME. All efforts at addressing the School Health Programme in Nigeria have remained largely at policy level, with minimal implementation. Where implementation has been attempted the emphasis has been outside rather than within the schools.2,3,13, 20 School children (age range 5-14 years) constitute at least 23% of the population of the average Nigerian community18. Although largely dependent and not considered productive in terms of income generation, their health status and indices are used to determine a nation’s state of development2.
With the background high infant and under 5 mortality rates, the school-age child is a survivor of the major childhood killer diseases and beneficiary of the gains of the child survival strategy2,12. This however, may be responsible for the unfounded assumption that once a Nigerian child attains school-age, he has become immune to diseases19.
Statistics from the National Study of School Health System in Nigeria revealed that only 14% of head teachers indicated that pre-enrolment medical examination was mandatory in their schools and 30% of the students had low body mass index5,12.
Studies carried out in 1987 and 1991 respectively reported large scale deficiencies in the provision of school health services in both primary and secondary schools19,21. Another study reported that health examination which was provided to children in Enugu state, Nigeria were those for measurement of height and weight21. 78% of school children studied in Edo state had no health records or health histories available in the schools. The results also showed that all aspects of health education (vision, hearing acuity, height, weight, medical and dental) that were investigated in the study were not provided to a majority of the children13. Ezedum reported the absence of virtually all forms of screening services for primary school children in Anambra state21. This is a serious issue as a teacher must not be in doubt about the visual and hearing capacity of his or her pupils. Ojugo noted that School Health
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Programme was poor in Edo state because there was the absence of an individual that took full responsibility for its implementation and therefore suggested that the School counsellor should be encouraged to take it up as his/her responsibility. He argued that School Health Services were handled haphazardly depending on how the teacher felt about it13.
Health education focuses on identifying health-related behaviour and risk factors and how to modify them. It has been noted that the school is a favourable setting through which you influence knowledge, attitudes and behavior22. A study carried out in Anambra State, Nigeria concluded that School based Health Education improved the personal hygiene practice of the pupils22.
Although School Health Programme became one of the strategies for promoting Primary Health Care services in Nigeria, it has not yet been fully adopted by the vast majority of schools17. School Health has been described as the neglected component of Primary Health Care2. Since almost every small community in Nigeria has a primary school, in those communities without health centres, it should be possible to use the primary school as a centre for Primary Health Care delivery not just for the pupils but also for the community2.
It has been argued that there is no organized Health Education in the public primary school system and that Health Instructions were carried out incidentally. When done, it is by teachers that have little or no professional preparation in Health Education22.
There is a dearth of school health clinics in Nigeria and where they exist, the services are not comprehensive enough or not organized to meet the needs of the pupils22. Where interventional training was instituted, primary school teachers were most useful in their establishments in dealing with measles, fevers, convulsions, cuts and wounds, difficult breathing, diarrhoea and vomiting, tepid sponging and temperature taking23.
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A well organized and properly executed School Health Programme can be used to create safe environment for school children23. A school survey that assessed condition of water supply, condition of latrine, presence of soap for hand-washing and presence of garbage around the schools, concluded that urgent steps were needed and necessary to safeguard the school environment and health of the pupils24. Ensuring ready access to safe drinking water and hygienic toilets that offer privacy to users in schools, has great potential to beneficially impact the children’s’ health25.
2.3 ROLE OF HEAD TEACHER IN IMPLEMENTATION OF SCHOOL HEALTH PROGRAMME. The head teacher is the key person in the School Health Programme because apart from the professional training as a teacher, he/she is the administrative head of the school. His/her work or attitude in health matters affects all the members of the school community1. He is a needed catalyst in successful implementation of the programme1. Therefore, the head teacher is expected to:
i. Provide the necessary leadership to carry out a successful programme. ii. See to the provision of sufficient funds for a programme that meets the needs of all students. iii. Designate one staff to be responsible for directing the programme and provide sufficient time from other school responsibilities for the staff to enable him/her oversee the School Health Programme adequately. iv. Support the programme and encourage all staff to participate actively. v. Favourably interpret the purpose of the programme to the community and especially before the Parent-Teachers Association, Board of Education, Local Government Authority legislature and executive towards ensuring their appreciation of the value of School Health Programme. Studies have however shown that Head Teachers may be unaware of this role, untrained for it, and also incapacitated by various factors in carrying out this very important function2,13,21,24. 21
2.4 ADMINISTRATION OF SCHOOL HEALTH PROGRAMME. Authority over School Health Programme lies with the Ministry of Health but with the active participation from the Ministry of Education. It is to be run as a component of Primary Health Care. The Federal Government is mainly concerned with the development of policy. The State Government deals with policy, manpower development, provision of infrastructure etc. The Local Government is expected to provide school health facilities to primary schools5.
2.5 SCOPE/ COMPONENTS OF SCHOOL HEALTH PROGRAMME. The five (5) major scope or components of School Health Programme according to the National School Health Policy include: (i) Healthful school environment (ii) School feeding services. (iii) Skills-based Health Education (iv) School health services. (v) School, Home and Community Relationships. However, there is a tendency to expand the list in order to highlight other important activities that are an essential part of School Health Programme. Hence there is the inclusion of physical education; counselling, psychological, and social services; and health promotion for school staff as additional components.
2.6 NATIONAL SCHOOL HEALTH POLICY5 The National School Health Policy was approved by the National Council on Education in December 2006 with a vision statement of promoting health of learners to achieve Education for All (EFA) and Health for All (HFA) in Nigeria.
The mission statement of the National School Health policy is to put in place adequate facilities, resources and programmes. This will guarantee physical and mental health, social well being and the safety and security of the school community
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which will promote the learning outcomes of the child.
The goals of the National School Health Policy are to enhance the quality of health in the school community and create an enabling environment for inter-sectoral partnership in the promotion of child friendly school environment, for teaching and learning and health development.
The Policy statement on School Health Programme (SHP) declares that the goal of SHP is to improve the health of learners and staff as responsible and productive citizens.
2.7 OBJECTIVES OF SCHOOL HEALTH PROGRAMME The objectives of the School Health Programme are to promote growth and development of every child taking into consideration his/her health needs. Create awareness of the collaborative effort of the school, home and the community in health promotion. Develop health consciousness among the learners. Create awareness on the availability and utilization of various health related resources in the community. Promote collaboration in a world of interdependence, social interaction and technological exposure in addressing emergent health issues and build the skill of learners and staff for health promotion in the school community.
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2.8 COMPONENTS OF SCHOOL HEALTH PROGRAMME
2.8.1 HEALTHFUL SCHOOL ENVIRONMENT5 Healthful School Environment is one of the interrelated aspects of the School Health Programme. The concept “Healthful School Environment” denotes all the consciously organized, planned and executed efforts to ensure safety and healthy living conditions for all members of the school community. A healthy school environment (physical, biological and socio-cultural) serves as a major determinant of health and greatly influences the individual’s level of intellectual growth and development.
OBJECTIVES The objectives of a Healthful School Environment are to create a healthy and safe learning environment in the school, provide adequate safe water supply and sanitation facilities for use in the schools.
The physical school environment encompasses the school building and all its contents including physical structures, infrastructure, furniture and the use and presence of chemicals and biological agents; the site on which a school is located and the surrounding environment including air, water and materials with which children may come into contact, as well as nearby land uses, roadways and other hazards26. The American Academy of Paediatrics defines a ‘healthful school environment’ as one that protects students and staff against immediate injury or disease and promotes prevention activities and attitudes against known risk factors that might lead to future disease or disability27.
WHO estimates that between 25% and 33% of the global burden of disease can be attributed to environmental risk factors. About 40% of the total burden of disease due to environmental risks falls on children under the age of 5 years28. Respiratory infections are the most common among all diseases in children and pneumonia is the primary cause of childhood mortality worldwide. Indoor and outdoor air pollution may be to blame for as much as 60% of the global burden of disease brought by respiratory infections29. Diarrhoeal diseases, the second most
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global illness affecting young children and a major cause of death in lower income countries, are closely linked with poor sanitation, poor hygiene and lack of access to safe and sufficient supplies of water and food30. Each year nearly two million children die of diarrhoeal diseases caused by unsafe water supplies, sanitation and hygiene. Interventions such as simple hand washing have been shown to reduce sickness from diarrhoeal diseases by up to 47%, and could save up to one million lives30.
Malaria, the most deadly of mosquito transmitted diseases kills over one million people each year, the majority of these deaths occur in African children31. In endemic areas, 60% of all school children may suffer from malaria32. Standing water and poor waste management in schools increase the risk of vectors breeding and spreading near the school environment26. Schools sited adjacent to pools of water and wetlands are more susceptible to mosquito-borne diseases.
In high income countries, road traffic injuries are the most common cause of death among children aged 5-14 and account for approximately 10% of deaths in this age group. In low and middle income countries, they are the fifth leading cause of death in the same age group behind diarrhoeal diseases, lower respiratory infections, measles and drowning33. Therefore, schools located near busy roads or water bodies, landfills, construction sites have increased risks of these types of injuries. Falls and injury within school grounds can occur as a result of poorly maintained schools or poor construction management33. Human excreta are the biggest source of disease producing organisms including parasites, bacteria and viruses. Success in eliminating faecal material from the school environment is dependent on: informed and responsible students, supervision of young pupils, a fence or structure to stop animals from defecating in areas where children play, toilets conveniently located- reliable, clean, odour-free, private and well maintained34. Separate facilities for girls can reduce dropout rates during or before menses35.
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2.8.2 SCHOOL FEEDING SERVICES5. School feeding services are aimed at providing an adequate meal a day to all children enrolled in schools nationwide. The services builds upon the Government’s current National Home-Grown Feeding and Health Programme (HGSF&HP) which aims to contribute to the realization of National and International initiatives for development.
OBJECTIVES. The objectives of the School Feeding Services are to reduce hunger among school children. It will also increase school enrolment, attendance, retention and completion rates particularly among children in poor rural communities and urban neighbourhoods. It increases the nutritional status of school children and enhances the comprehension and learning abilities of pupils/students.
School Feeding Programme is an organized programme which alleviates hunger while supporting education, health and community development36. School feeding can be provided as meals or snacks to be eaten during school hours or distributed as dry take home food rations to pupils at the end of each day, month or school term, if they attended school regularly50. It is a versatile safety net that is used as a platform to support children and their families in a variety of contexts37.
In line with this, the Federal Government of Nigeria initiated the Home Grown School Feeding and Health Programme (HGSFHP) in conjunction with United Nations Children Emergency Fund (UNICEF) in order to address the gaps in basic education. UNICEF provides technical assistance for the Feeding Programme. The Programme was launched on 26th September, 200538. It was expected to help alleviate ‘short term hunger’. This is a transitory non-clinical form of hunger that can affect physical and learning capacity. Children who are hungry in class are more likely to have difficulty concentrating and performing complex tasks even if they are well nourished39. It also helps to increase school attendance, retention and completion of basic education38. It helps to reduce gender inequality by attracting girls to schools.
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It will provide macronutrients and vitamins that will enable pupils to learn, function and develop physically and intellectually38.
The Programme after the launch has not taken off successfully. Nine years down the line, on 19th May, 2014, the Minister of Education Chief Nyesom Wike urged various State Governments to resuscitate the Home Grown School Feeding Programme (HGSFP) launched in 200540. He quoted a survey by the Ministry of Education in collaboration with UNICEF and other stakeholders which reported that 80% of children in primary schools were underweight with only 14% having normal weight40. The World Bank had postulated that if the programme was properly implemented, Nigeria was looking at feeding one-fifth of the children in Africa which is about 370 million40.
The Osun Elementary School Feeding and Health Programme now known as O- MEALS is one of the very few surviving school meal programmes in the country41. It has been restructured and enhanced by the State administration to reach a larger number of students (254,000) and to empower over 3000 community caterers. The scheme has gained international endorsement with Partnership for Child Development (PCD) UK strengthening the programme41. O-MEALS aims to reverse the low academic performance of pupils noting that good nutrition is necessary for the development of cognitive skills. Pupil daily allowance has also been increased from N50 to N250. The programme has helped increase school enrolment by 25% since 201241.
School meals served in schools have been reported to motivate pupils to come to school and stay in schools42. Students who attend schools where meals were served became more interested in academic activities42. This strategy if employed correctly can help achieve Millennium Goal Two which says that by 2015, all Nations should achieve universal primary education. With increased school attendance more girls are attracted to schools. This has implication on Millennium Goal Three which is out to promote gender equality in education and also empower women. The school feeding programme is one of the powerful tools that Government can use to eliminate gender disparity in primary education especially in Northern Nigeria, where
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early marriage is widely practiced37. It would also stem the tide of malnutrition and other nutrition related diseases.
2.8.3 SKILL-BASED HEALTH EDUCATION5
Skill-based Health Education is to promote the development of sound health knowledge, attitudes, skills and practice among the learners. The subject is also aimed at meeting the growth and developmental needs and interests of learners. Health education is education for life; therefore emphasis should be placed on skills necessary for promoting appropriate behaviours and practice as against just theory- based lessons.
OBJECTIVES The objectives of Skill-Based Health education are to provide information on key health issues affecting the school community; develop skill-based health education curriculum for the training of teachers and learners provide participatory learning experiences for the development of knowledge, attitudes, skills and desirable habits in relation to personal and community health and evaluate learners’ progress towards healthy development.
Health education aims at changing an individual’s behaviour in a way that will lead to protection, promotion and maintenance of his health and thus, the health of his family and community43. It can take place in different setting. Of all the known settings, the school setting has been identified as having the greatest and most lasting impact on people and society43. It has been pointed out that due to increased knowledge about individual health; large groups of responsible people are now convinced that significant gains in health in the future can best be achieved through health education in the school setting43. School health education is therefore preventive, promotive, advisory and educational. It changes perceptions, values, attitudes and behaviours for healthy life.
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In an examination of the status of health education in educational institution in Nigeria, studies concluded that there was no organized health education in the public primary school system22. Health Instruction is carried out only incidentally. The instruction component of health education is emphasized in secondary schools, but health education at this level is taught by teachers who have little or no professional preparation in health education22.
There is more concentration on health information rather than participation and behaviour change among students. Even though health education has been included in the primary school curriculum, replacing hygiene as a separate subject, it is still being taught with physical education in most schools and physical education is usually given more prominence60. Other studies have recommended the inclusion of safety measures in school health education curriculum among others44. School health education programmes especially those that are integrated with other community health promotion efforts can provide information to families of participating students by employing the students as a ‘common messenger’ to precipitate healthier family behaviours43. More importantly, school health education can be expected to increase specific competencies and skills that students can use to predispose, enable and reinforce healthy lifestyles of the families they would be responsible for as adults45.
We should therefore enable and then expect our schools to be able to increase the desires and abilities of individuals to participate effectively in civic decisions and activities that will ultimately influence their personal health, the health of their families and the health of the communities in which they reside43. The potential of health education is only limited by its inadequate integration with others sources of influence on health such as social structures, legal framework, economic and environmental factors. The proper understanding and use of health education is in the context of the several determinants of behaviour and health and not in isolating it in the class room without regard for the family, economics, genetics and environment etc that it will influence. The end result would be temporary or partial achievements of intended outcomes43.
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2.8.4 SCHOOL HEALTH SERVICES5. School Health Services are preventive and curative services provided for the promotion of the health status of learners and staff. The purpose of the School Health Services is to help children at school to achieve the maximum health possible for them to obtain full benefit from their education.
School Health Services include pre-entry medical screening, routine health screening/ examination, school health records, sick bay, First Aid and referral services. It also provides advisory and counselling services for the school community and parents.
OBJECTIVES The objectives of School Health Services are to provide basic services for disease prevention and management of injuries in the school and build capacity of the school community to identify, treat and manage simple illnesses, injuries, infections and infestations.
School Health Services refers to the health care delivery system that is operational within a school or college. This service aims at promoting and maintaining the health of school children so as to give them a good start in life. In addition the services seek to enable children benefit optimally from their school learning experience21.
School health services deal with health appraisals, control of communicable diseases, record keeping and supervision of the health of school children and personnel. Health appraisals are a major component of School Health Services46. It is the aspect that concerns itself with the evaluating the health of an individual objectively. It includes health observation (which involves physical inspection of the physiology and behaviours of children), health examinations (screening tests and medical diagnosis) and health records (keeping of records of the health histories of children)46. Health appraisals afford the school authorities the opportunity to detect signs and
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symptoms of common diseases as well as signs of emotional disturbances that could impede the learning activities of children13. Besides it helps in providing information to parents and school personnel on the health status of school children47.
With regards to Health records, it assesses if health records are available within the school. If available, are the records cumulative and if cumulative are they transferrable? Peculiar health records and histories of each child within the school system should be readily available for school health personnel and teachers. Deviations from normal should be noted and appropriate preventive measures instituted. This should also include health records of the teachers and all other school staff.
School guidelines and protocols are to be developed especially for the diagnosis and treatment of common communicable diseases within the community where the school is located. This should be made available to members of the immediate community and parents/ guardian of the school children. The school therefore serves as functional boost to the primary health care activities within its immediate environment.
2.8.5 SCHOOL HOME AND COMMUNITY RELATIONSHIPS5.
The success of the School Health Programme depends on the extent to which community members are aware of, and are willing to support health promotion efforts. Schools are to therefore encourage parents and community members to make inputs regarding the design, delivery, content and assessment of the School Health Programme so as to respond to their concerns and obtain their commitment. At the same time, schools can play an important role in improving the health and development of the community as a whole.
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OBJECTIVES The objectives of promoting school, home and community relationship with regard to School Health Programme are to build and strengthen capacity for effective community involvement and participation in school management and improve advocacy and community mobilization to bring about necessary support from stakeholders.
Parents and educators pull together expertise and skills in support of a common focus: the improved education of all children. The parents bring to the table all the available community assets, skills, capacity and expertise48. The benefits of such collaborative efforts include improvement in students’ attitude towards schools49, and better grades by students49.
An improved relationship between the school, home and the community, from previous studies resulted in more engagement in classroom learning by students50, improved test scores50 and improved attendance rates/ lower suspension rates51. Overall the schools were more successful52. The dynamics of this relationship is summed up by Kelly Hor48; ‘to ensure a productive parent- school staff relationship. Parents and school staff need to accept the child holistically in the context of the home and school. When both parties are uncooperative in investing in the relationship, the child is segmented into the school child and the home child ignoring the whole child’48.
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CHAPTER 3
MATERIALS AND METHODS.
3.1 STUDY AREAS.
The study was carried out in Ogun State, South West Nigeria. Ogun State was created on February 3rd 1976 out of the defunct Western Nigeria. The State is named after Ogun River which runs right across it from North to South. Ogun state is situated on latitude 7.000N and longitude 3.350E in the Greenwich Meridian. It covers a total land area of 16,409.26 square kilometers within the South West region of the country. It is bounded in the north by Oyo and Osun States, in the east by Ondo State, in the west by the Republic of Benin which makes it an access route to the expansive market of the Economic Community of West African States (ECOWAS) and in the south by Lagos State and the Atlantic Ocean. The State Capital Abeokuta, lies about 100km north of Lagos State, Nigeria’s business Capital.53 The projected population of the State as at 2012 is 5.1 million. The people of the State belong to the Yoruba ethnic group of South-West Nigeria. The main ethnic groups of the State are Egbas, Ijebus, Remos, Yewas, Eguns and Aworis. A greater proportion of the State lies in the tropical rain forest zone.53 The State has Twenty (20) Local Government Areas (LGA). Each LGA is headed by an Executive Chairman. It has three (3) Senatorial Districts and is divided into four (4) geo-political zones. The Ogun State Universal Basic Education Board (SUBEB) is in charge of Primary School Education and activities within the State under the Ministry of Education. There are One thousand, four hundred and forty nine (1,449) registered Public Primary Schools and One thousand, six hundred and ninety four (1694) registered Private Primary Schools within the State making a total of 3,143 Primary Schools. The Schools have an Administrative Head known as the Head Teacher and he/she supervises all school activities and the activities of the Teaching and Non- Teaching Staff. The Head Teacher and other Staff within the Public Schools are employed by
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the State’s Ministry of Education while the Private School Heads and Staff are employed by a Proprietor/ Proprietress who may also function as the Head Teacher. All the Public Schools run the Six (6) year programme but some Private Schools run a Five (5) year programme. The Private Schools usually have an attached Crèche and Nursery Units. The Zonal Education Office (ZEO) is responsible for compliance and adherence to the Educational standards as specified by the Ministry of Education for all Public and Private Schools within each Zone. In each Local Government, the Local Government Education Authority (LGEA) is directly responsible for the supervision and human resource management of Public Primary Schools. The three (3) Local Government Areas where the study was carried out are Sagamu, Abeokuta South and Ado-Odo/Ota.
3.1.1 SAGAMU LOCAL GOVERNMENT AREA.
Sagamu Local Government54 is found in Ogun State, South West Nigeria. The town is an urban area, bounded in the East by Ikenne LGA, in the North by Remo LGA, in the West by Obafemi Owode LGA and in the South by Ikorodu LGA of Lagos state. The men in the area are civil-servants, artisans, factory workers and farmers while the women are mostly traders. It is a predominantly Yoruba speaking (Remo dialect being the main local language) town with an estimated population54 of 269,744 and an annual growth rate of 3%. The Local Government as at the time of study had 62 registered public primary schools and 191 registered private primary schools making a total of 253 schools.
3.1.2 ABEOKUTA- SOUTH LOCAL GOVERNMENT AREA.
Abeokuta South Local Government55 usually referred to as the ‘Premier Local Government’ in Nigeria owing to her historic eminence as well as the seat of the Government of Ogun State and the fact that Local Government administration originated from the ancient city in 1898. There are 4 sections namely Egba Alake, Egba Oke-Ona, Egba Owu and Egba Gbagura. 34
It is bounded by the Odeda Local Government in the north, Obafemi-Owode Local Government in the east and Abeokuta North Local Government in the western and southern parts respectively. It has an estimated population of 374,843 people55 (1991 population census). It is inhabited mainly by the Yoruba speaking Egbas. It is internationally recognized as the home of tie and dye (Adire and Kampala materials). Some of its tourist sites include Cathedral Church of St. Peters (The first Church in Nigeria), Alake’s Palace, Ijaye Poultry, Itoku Tie and Dye, Olumo Rock. Majority of the people are civil-servants, farmers, traders and potters.
As at the time of this Study, the Local Government had 65 registered public primary schools and 173 registered private primary schools making a total of 238 schools.
3.1.3 ADO-ODO/OTA LOCAL GOVERNMENT AREA.
The most populous and industrialized Local Government in Ogun State came into existence in May, 1989 following the merging of Ota with Ado-Odo56. It is the second largest Local Government in Ogun State with Headquarters at Ota. It is bounded by Lagos State in the south, Yewa South and Ifo Local Governments in the west, and Ipokia Local Government in the north-east. It has an estimated population of 527, 242 (2006 census)56 with about 450 towns, villages and settlements.
The people are mainly Yoruba speaking Aworis, Eguns and Yewas. It has a large concentration of expatriates because of the numerous industries.
As at the time of this study, the Local Government had 116 registered public primary Schools and 312 registered private primary Schools making a total of 428 Schools.
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3.2 STUDY DESIGN The study design was a comparative cross sectional study that assessed the School Health Programme in Public and Private Primary schools in Ogun State.
3.3 STUDY POPULATION The study population consisted of all the Head Teachers in Public and Private Primary Schools in Ogun State and their Schools.
3.4 INCLUSION CRITERIA
All fully registered Public and Private primary schools in Ogun State.
3.5 EXCLUSION CRITERIA
Private schools that are not fully registered in Ogun State.
3.6 SAMPLE SIZE In a School Health Programme: Knowledge, Attitude and Practice (KAP), cross sectional study of 133 head teachers of 104 Private and 29 Public primary schools in Egor LGA Edo State, Nigeria, 40.4% of Private Schools compared to 31.0% of Public Schools had School Health Programme57. The minimum required sample therefore was obtained from the formula for comparative study proportions between two groups58.
N = Zα√P1(1-P1) + Zβ√P2 (1-P2)
2 (P1- P2)
Where P1 = Proportion of Private Schools with School Health Programme from Previous study =40.4%
P2 = Proportion of Public Schools with School Health Programme from Previous study = 31.0%
Zα = Standard normal deviate corresponding to the probability of type I error α at 5% level of significance = 1.96
Zβ = Standard normal deviate corresponding to the probability of making type II error
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β at 20%, Power at 80% = 0.84
P1-P2 = Minimum difference in proportions between Private and Public Schools which will be considered significant at 10%.
N = 1.96 × √ [0.404 (1-0.404)] + 0.84 × √ [ 0.31 (1-0.31)] (0.404 – 0.31)2
N= 153
Thus, a minimum sample size of 153 Head Teachers is required per group. However, correcting for possible 10% Non-responses, Incompletely filled questionnaires and other unforeseen problems with Data collection, n=n/ (1-f) N= 153/1-0.1 =170 The calculated Sample size N was rounded up to 180 per group. Thus a total of 360 Head Teachers were studied.
3.7 SAMPLING TECHNIQUE
A Multi-stage Sampling technique was employed.
Ogun State consists of three (3) Senatorial Districts. Ogun East, Ogun Central and Ogun West.
STAGE I
There are nine (9) Local Government Areas in Ogun East Senatorial District. These are Sagamu, Ikenne, Remo-North, Ijebu-Ode, Odogbolu, Ijebu- North, Ijebu- East, Ijebu- North East and Ogun Waterside. Sagamu Local Government Area was selected into the study using Simple Random Sampling method by balloting.
There are six (6) Local Government Areas in Ogun Central Senatorial District. These are Ifo, Ewekoro, Obafemi/ Owode, Odeda, Abeokuta North and Abeokuta South. Abeokuta South Local Government Area was selected into the study using Simple Random Sampling method by balloting.
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There are five (5) Local Government Areas in Ogun West Senatorial District. These are Imeko Afon, Yewa North, Yewa South, Ado Odo/ Ota, Ipokia. Ado-Odo/Ota Local Government Area was selected into the study using Simple Random Sampling by balloting.
STAGE II
Proportional allocation of Schools to each of the selected Local Government Area was done. Sagamu Local Government had 62 Public Primary Schools and 191 Private Primary Schools. Abeokuta South Local Government had 65 Public Primary Schools and 173 Private Primary Schools. Ado-Odo/Ota Local Government had 116 Public Primary Schools and 312 Private Primary Schools. Thus, the total number of Public Schools in the three Local Governments was two hundred and forty three (243) while the total number of Private Schools was six hundred and seventy six (676). In order to achieve the desired number one hundred and eighty (180) schools in each of the two categories, the number of Public and Private Schools in each Local Government was divided by the appropriate total number of schools and multiplied by one hundred and eighty (180).
Sagamu Local Government was subsequently allotted forty six (46) Public Schools and fifty one (51) Private Schools. Abeokuta South Local Government was allotted forty eight (48) Public Schools and forty six (46) Private Schools while Ado-Odo/Ota Local Government had eighty six (86) Public Schools and eighty three (83) Private Schools allotted.
STAGE III
In each Local Government Area, the required number of Public and Private Schools were recruited by listing out all the Public and Private Schools within the Local Government and randomly selecting one after the other till the expected allocated number was obtained.
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3.8 DATA COLLECTION INSTRUMENTS AND TECHNIQUE
QUESTIONNAIRE
A self-administered semi-structured Questionnaire with open and closed ended questions for the Head Teachers was designed for the study. It was adapted from that used by Ofovwe and Ofilli in a similar study in 200457. The Pre-tested Questionnaire was administered to the 360 Head Teachers. It addressed the following:
Section A: Socio-economic and Demographic characteristics such as age, sex, marital status, highest educational qualification and length of time as a Head Teacher. This section gave insight into the Respondents’ socio-economic and demographic background.
Section B: This section contained questions that assessed the Head Teachers’ knowledge of School Health Programme domain by domain. Questions covered School Health Services, Healthful School Environment, School Feeding Services, Skill Based Health Education, School Home and Community Relationships, etc.
Section C: This section assessed some of practices of School Health Programme by the Head Teachers in their various Schools. The section served to augment the main Instrument that was used to assess Practice of School Health within the Schools which was the Observational Checklist.
Section D: This section assessed the factors that affect the Implementation of the National School Health Policy and Challenges faced by the Head Teachers in implementing School Health Programme in their various Schools.
OBSERVATIONAL CHECKLIST
The Observational Checklist was adapted from the School Health Programme Evaluation Scale1 by Nwadiulo et al and the Federal Ministry of Education’s Sanitary Inspection Form59. The Checklist covered all the Domains of the School Health Programme within the Schools. It was the main Instrument that evaluated the
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Practice of School Health Programme as it checked the presence or absence of School Health Programme activities as witnessed within the Schools. It assessed the presence or absence of personnel, structures, equipment needed for effective practice of School Health Programme. It covered School Health Services, School Feeding Services, Skill Base Health Education, Healthful School Environment, Physical Education, School, Home and Community Relationships, Guidance and Counselling Services.
DATA COLLECTION PROCESS. 1. Official permission was obtained from the office of the Permanent Secretary, State Ministry of Education to carry out the study in the State. 2. Official permission was obtained from the three (3) Local Government Authorities to carry out the study in their respective Local Governments. 3. The Instruments for Data Collection: a self-administered semi- structured questionnaire for the Head Teachers and an Observational Checklist for the Schools were pre-tested in ten (10) Public and ten (10) Private Primary Schools in Ibadan North East Local Government and modified as appropriate. 4. Twenty (20) final year medical students from the Olabisi Onabanjo University Teaching Hospital were recruited as Research Assitants and trained in the correct use of the Questionnaire and the Checklist for the Project.
5. Identification tags with pictures were issued to the Research Assistants to facilitate School Entry. 6. The Zonal Education Officers of Sagamu, Abeokuta South and Ado- Odo/Ota Local Government Areas were approached with the Permission letter from the Permanent Secretary of the Ministry of Education and the complete list of all the Public Primary Schools and 40
approved Private Primary Schools obtained from them. 7. Schools were then randomly selected into the study from the obtained list of Schools. 8. School entry was made by approaching the Head Teacher and the Project carefully explained to them. 9. Once the Head Teacher consented by signing the Informed Consent form, he/she was given a copy of the Questionnaire to fill in the presence of a Research Assistant who explained grey areas when necessary. At no point would the Head Teacher be left to fill the Questionnaire alone. 10. Two other Research Assistants would then inspect the School with the Observational Checklist to assess practice of School Health Programme usually in the company of a Teacher nominated by the Head Teacher or alone. 11. Both Instruments were subsequently collected and stored and the consenting Head Teacher thanked for the cooperation. 12. Data was collected over a three (3) month period.
3.9 ANALYSIS OF RESULTS Quantitative Data collected was checked for errors, cleaned, entered and analyzed using the SPSS version 15.0. Data was summarized with proportions and means and presented using frequency tables. Inferential statistics to test for associations between variables was done using the chi-square test. T-test was used to compare the difference between the mean knowledge scores of the Public and Private Schools’ Head Teachers. Logistic regression was then used to estimate predictors of willingness to practice School Health Programme. Variables that were found to be significant at 0.05 for factors affecting Implementation of School Health Programme were fed into the Logistic regression model. The level of statistical significance was set at 5%.
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MEASUREMENT OF KNOWLEDGE SCORES There were 25 questions on knowledge with a maximum score of 25 marks. Individual knowledge scores were summed up and stratified as follows: 0-11 marks Poor Knowledge; 12-17 marks Fair Knowledge; 18 marks and above Good Knowledge. One (1) mark was awarded for each correct response and no mark for wrong or ‘I don’t know’ responses. Quantitative data was coded and analysis done using Chi- square. Mean Knowledge scores for both groups was compared using the T test. P value was set at 0.05.
MEASUREMENT OF PRACTICE SCORES Observational Checklist was essentially used to measure Practice of School Health Programmes in the Schools. Different Domains of School Health Programme were graded and a possible maximum score of 120 was obtainable. Individual School scores were summed up and stratified as follows: 0-59 marks Poor Practice; 60-89 marks Fair Practice; 90 marks and above Good Practice. Practice Scores for each Domain were computed and test of significance carried out using Chi-square for each of the parameters in the various Domains for the Public and Private Schools. P value was set at 0.05.
3.10 ETHICAL CONSIDERATION Consent to conduct the study was obtained from the ethical committee of the Olabisi Onabanjo University Teaching Hospital, Sagamu. Approval was also obtained from the Permanent Secretary of the Ogun State Ministry of Health and the Local Government Authorities of Sagamu, Abeokuta-South and Ado-Odo/Ota Local Governments respectively. Written informed consent was obtained from all the participants after study objectives were explained to them. They were assured that participation was voluntary and they would incur no loss if they decided not to participate.
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CONFIDENTIALITY Study participants were assured of strict confidentiality and this was indicated on the questionnaire. Data collected was only used for research purposes and was kept confidential on a password protected computer. Research assistants were also trained not to disclose the information divulged by the respondents during the interview. Anonymity was assured as names or any other personal identifying information was not required from subjects. Those who declined from the study were politely dismissed.
3.11 LIMITATIONS OF THE STUDY
A number of Head Teachers specifically from the Private Schools were unwilling to participate in the study and wanted to inform the Proprietors before filling the questionnaire. Some refused to allow the Team to go round the School to correctly assess Practice of School Health Programme fearing the results may be used against them and their schools. However confidentiality was assured and names of respondents and Schools protected. Some of the Schools randomly recruited into the study were located in ‘hard to reach’ areas with difficult terrains that required very long treks on foot and crossing of rivers in canoes. Some Head Teachers wanted the Questionnaire left with them and for the Team to return a day or two to pick it up. When politely informed that the study would not grant their request, a few Head Teachers opted out.
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CHAPTER FOUR
RESULTS
A total of three hundred and sixty questionnaires were distributed and three hundred and sixty were returned, giving a 100% response. All the checklists, 360 in number were also returned. Below are the results:
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TABLE I: CHARACTERISTICS OF RESPONDENTS’ SOCIO-DEMOGRAPHIC VARIABLES
CHARACTERISTICS PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) Age at last birthday 21-30 0 (0.0) 30 (16.7) 30 (8.3) 31-40 2 (1.1) 110 (61.1) 112 (31.1) 41-50 31 (17.2) 30 (16.7) 61 (16.9) 2.250 0.001 51-60 147 (81.7) 9 (5.0) 156 (43.3) >/=60 0 (0.0) 1 (0.6) 1 (0.3) Sex Male 39 (21.7) 51 (28.3) 90 (25.0) 1.809 0.179 Female 141 (78.3) 129 (71.7) 270 (75.0) Marital Status Single 5 (2.8) 31 (17.2) 36 (10.0) Married 152 (87.8) 144(80.0) 302 (83.9) 25.803 0.001 Separated/Divorced 3 (1.7) 1 (0.6) 4 (1.1) Widowed 14 (7.8) 4 (2.2) 18 (5.0) Religion Christianity 155 (86.1) 158( 87.8) 313 (86.9) Islam 24 (13.3) 20 (11.1) 44 (12.2) 0.966 0.617 Others 1 (0.6) 2(1.1) 3 (0.8) Ethnicity Hausa 0 (0.0) 0 (0.0) 0 (0) Ibo 18 (10.0) 32 (17.8) 50 (13.8) 5.343 0.069 Yoruba 158 (87.8) 141 (78.3) 299 (83.1) Others 4 (2.2) 7 (3.9) 11 (3.1) Highest Educational Qualification Masters Degree 8 (4.4) 17 (9.4) 25 (6.9) 7.417 0.060 University Degree 98 (54.4) 93 (51.7) 191 (53.1) Certificate from College of 69 (38.3) 59 (32.8) 128 (35.6) Education Teacher’s Training School Certificate 5 (2.8) 11 (6.1) 16 (4.4) How long have you been a Head Teacher 1-5 Years 93 (51.7) 98 (54.4) 191 (53.1) 6-10 Years 35 (19.4) 47 (26.1) 82 (22.8) 6.804 0.078 11-15 Years 20 (11.1) 19 (10.6) 39 (10.8) >15 Years 32 (17.8) 16 (8.9) 48 (13.3) The overall mean age of all the Head Teachers was 45.7± 9.9 years. The mean age of the Head Teachers in Public Schools was 53.0 ± 3.6 years while that for the Head
Teachers in the Private Schools was 37.4 ± 8.0 years. Majority of the Public School Head
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Teachers, 147 (81.7%) fell into the 51-60 age group, while the highest number of the
Private School Head Teachers, 110(61.1%) were in the 31-40 age group. The Private
Head Teachers also had 30 (16.7%) members in the 21-30 age group while the Public
Head Teachers had 0 (0%) members within that age group. There is a statistically significant difference in age between the Public and Private School Head Teachers
(X2= 2.250, p=0.001).
Female Head Teachers outnumbered their male counterparts in both the Public and Private
Schools. The Public Schools had a total of 141 (78.3%) Female Head Teachers while the
Private Schools had 129 (72.7%) Female Head Teachers. This showed no statistically significant difference. (X2= 1.809, p= 0.179).
A high percentage of the total respondents numbering 302 (83.9%) were married. This was similar in both Public School Teachers, 152 (87.8%) and Private School Teachers, 144
(80.0%). However, 5 (2.8%) of the Public School Head Teachers were single, compared with 31 (17.2%) of the Private School Teachers. The marital status of both groups showed a statistically significant difference (X2 = 25.803, p= 0.001).
Over 80% of the respondents were Christians: One hundred and fifty five (86.1%) of the
Public School Teachers and 158 (87.8%) of the Private School Teachers. This had no statistically significant difference (X2 = 0.966, p =0.617).
Most of the respondents were of the Yoruba tribe: One hundred and fifty eight
(87.8%) of the Public Teachers and 141 (78.3%) of the Private Teachers. There was no statistically significant difference in the ethnicity of the Head Teachers in Public and Private Schools (X2= 5.343, p= 0.069).
About half of the Teachers in both groups had a University degree as their highest educational qualification: Ninety eight (54.4%) of the Public School Teachers and 93 46
(51.7%) of the Private School Teachers. However, 8 (4.4%) of the Public School
Teachers had a Masters Degree compared to 17 (9.4%) of the Private School
Teachers. This showed no statistical significance. (X2= 7.417, p= 0.060).
Ninety three (51.7%) and 98 (54.4%) of the Public and Private School Teachers respectively had between 1-5 years working experience as a Head Teacher. Whereas,
32 (17.8%) of the Public School Teachers and 16 (9.0%) of the Private School
Teachers had been working as a Head Teacher for over 15 years. This gave no statistically significant difference (X2= 6.804, p= 0.078).
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SECTION B
KNOWLEDGE OF SCHOOL HEAD TEACHERS: The knowledge of the respondents regarding SHP was explored and the relevant findings are presented below.
TABLE II A: KNOWLEDGE OF RESPONDENTS’ ABOUT SCHOOL HEALTH PROGRAMME KNOWLEDGE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2)
Definition of school health programme (Poor) 166 (92.2) 167 (92.8) 333 (92.5) 2.043 0.360 (Fair) 12 (6.7) 13 (7.2) 25 (6.9) (Good) 2 (1.1) 0 (0.0) 2 (0.6) Knowledge of the components of school health programme (Poor) 164 (91.1) 167 (92.8) 331 (91.9) (Fair) 15 (8.3) 9 (5.0) 24 (6.7) 3.327 0.189 (Good) 1 (0.6) 4 (2.2) 5 (1.4) Knowledge of the impact of medical record keeping in School Health Programme Correct 176 (97.8) 175 (97.2) 351 (97.5) 0.203 0.652 Incorrect 4 (2.2) 5 (2.8) 9 (2.5) Knowledge of the role of school health programme in the care of children with disabilities Correct 62 (34.4) 42 (23.3) 104 (28.9) 5.083 0.024 Incorrect 118 (65.6) 138 (76.7)) 256 (71.1) Knowledge of school feeding services among head teachers Correct 169 (93.9) 155 (86.1)) 324 (90.0) 4.562 0.033 Incorrect 11 (6.1) 25 (13.9) 36 (10.0) Relevance of dental inspection and health in School Health Programme. Correct 169 (93.9) 164 (91.1) 333 (92.5) 1.133 0.287 Incorrect 11 (6.1) 16 (8.9) 27 (7.5) Effective knowledge of First Aid among Head Teachers Correct 140 (77.8) 130 (72.2) 270 (75.0) 1.398 0.237 Incorrect 40 (22.2) 50 (27.8) 90 (25.0)
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More than three quarters of the Head Teachers in both groups could not provide a basic definition of the School Health Programme. While 166 (92.2%) of the Public
School Head Teacher had a poor definition with scores between 0-1 out of a possible
4 marks, 167 (92.8%) of the Private School Head Teachers also had a poor definition with the same scores (X2= 2.043, p= 0.360). Again both sets of Head Teachers, 164
(91.1%) of the Public School Head Teachers and 167 (92.8%) of the Private School
Head Teachers were unable to correctly list the components of the School Health
Programme and scored between 0-1 (X2= 3.327, p= 0.189). The scores for definition and components of School Health Programme between the Public and Private Schools’
Head Teachers showed no statistically significant difference.
A high percentage 176 (97.8%) and 175 (97.2%) of the Public and Private Schools’
Head Teachers felt that Health records of school children must be consistently updated periodically and this did not show a statistically significant difference (X2=
0.336, p= 0.845). Sixty two (34.4%) of the Public School Head Teachers and 42
(23.3), of the Private School Teachers were of the opinion that School Health
Programme made provision for physically and emotionally challenged children.
However, 118 (65.6%) and 138 (76.7%) of the Public and Private School Teachers felt it did not. This was a statistically significant difference (X2= 5.083, p= 0.024).
In response to the question, ‘school nutrition services will reduce hunger and malnutrition among learners’, 169 (93.9%) of the Public School Head Teachers and
155 (86.1%) of the Private School Teachers answered correctly and this gave a statistically significant difference (X2= 4.562, p= 0.033). One hundred and sixty nine
(93.9%) and 164 (91.1%) of the Public and Private School Head Teachers were of the
49
opinion that inspection of children would also include both tooth decay and bad breath
(X2= 1.133, p= 0.287). This was not statistically significant.
While 40 (22.2%) of the Public School Head Teachers and 50 (27.8%) of the Private
School Head Teachers did not know if basic life support is an integral skill needed by the school’s first aider, 140 (77.8%) and 130 (72.2%) of the Public and Private School
Head Teachers respectively responded that it was needed. However, there was not a significant statistical difference (X2= 1.398, p= 0.237).
50
TABLE II B: KNOWLEDGE OF RESPONDENTS ABOUT SCHOOL HEALTH PROGRAM KNOWLEDGE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) Knowledge of the role of advocacy and community participation for an effective School Health Programme
Correct 148 (82.2) 149 (82.8) 279 (82.5) 0. 019 0.890 Incorrect 32 (17.8) 31(17.2) 63 (17.5) Knowledge of environmental factors and its influence on School Health Programme Correct 151 (83.9) 156 (86.7) 307 (85.3) 0.553 0.457 Incorrect 29 (16.1) 24 (13.3) 53 (14.7) Knowledge of the sources of funding for School Health Programme activities Correct 50 (27.8) 54 (30.0) 104 (28.9) 0.216 0.642 Incorrect 130 (72.2) 126 (70.0) 256 (71.1) Knowledge of the relationship between School Health Program and Millennium Development Goals Correct 147 (81.7) 152 (84.4) 299 (83.1) 0.493 0.482 Incorrect 33 (18.3) 28(15.6) 61 (16.9) Knowledge of School Health Program as part of World Health Organization’s strategy to produce health promoting schools worldwide Correct 168 (93.3) 156 (86.7) 324 (90.0) 4.444 0.073 Incorrect 12(6.7) 24 (13.3) 36 (10.0) Knowledge of the most important personnel/ staff needed in the implementation of School Health Program activities Correct 18 (10.0) 77 (42.8) 95 (26.4) 49.778 0.001 Incorrect 162(90.0) 103(57.2) 265 (73.6)
One hundred and forty eight (82.2%) of the Public School Head Teachers and 149
(82.8%) of the Private School Head Teachers were of the opinion that advocacy to community and the parents was necessary to have an effective School Health
Programme (X2= 0.019, p= 0.890).
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A high number of respondents, 151 (83.9%) of Public School Head Teachers and 156
(86.7%) of the Private School Head Teachers said that schools should not be sited close to the community market area to provide easy access to traders’ children (X2=
0.553, p= 0.457). This difference was not statistically significant.
While 130 (72.2%) of the Head Teachers in Public Schools felt that government must provide all the funding needed for School Health Programme activities, 50 (28.7%) of them felt funding should come from other sources. On the other hand, 126 (70.0%) of the Private School Head Teachers felt government should provide all the funding while
54 (30.0%) were of the opinion that there should be other sources of funding (X2=
0.216, p= 0.624).
One hundred and forty seven (81.7%) and 152 (84.4%) of the Public and Private
School Teachers respectively were of the opinion that the School Health Programme plays a vital role in the attainment of Millennium Development Goals (X2= 0.493, p=
0.482).
That the School Health Programme is part of the World Health Organization’s strategy to produce health promoting schools worldwide was affirmed by 168 (93.3%) of the
Public School Head Teachers and 156 (86.7%) of the Private School Head Teachers.
These last two parameters were not statistically significant.
Very few respondents that is 18 (10.0%) among the Public School Head Teachers compared to 77 (42.8%) among the Private School Head Teachers knew that the key personnel/ staff needed in the implementation of School Health Programme activities in school is the Head Teacher. Most 162 (90.0%) and 103 (57.2%) among Public and
52
Private Head Teachers, gave incorrect answers. This showed a statistically significant difference. (X2= 49.778, p= 0.001).
Overall the total knowledge score was 25. The mean knowledge score for both groups was 11.33±3.17. The mean knowledge score for the Public School Head Teachers was
11.78±2.83 while that of the Private School Head Teachers was 10.86±3.48 with a mean difference of 0.92±0.34. This result was statistically significant (t= 2.620, p=
0.01; 95%CI = 0.23).
53
SECTION C
The Practice of the various components of the School Health Programme among the schools was determined essentially with the Checklist. The findings are presented below:
SCHOOL HEALTH SERVICES.
TABLE III A: PRACTICE OF SCHOOL HEALTH SERVICES IN PUBLIC AND PRIVATE SCHOOLS. PRACTICE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) PERSONNEL None 86 (47.8) 110 (61.1) 196 (54.4) Health Assistant/Trained First-Aider 24 (13.3) 33(18.3) 57 (15.8) Health Educator/Nutritionist 11 (6.1) 10 (5.6) 21 (5.8) 17.122 0.002 Nurse/Midwife 57 (31.7) 27 (15.0) 84 (23.3) Doctor 2 (1.1) 0 (0.0) 2 (0.6) HEALTH APPRAISALS Routine (Teacher) Inspection Yes 168 (93.3) 175 (97.2) 343 (95.3) 3.025 0.082 No 12 (6.7) 5 (2.8) 17 (4.7) Screening test for growth defect, Handicaps, Disabilities Yes 14 (7.8) 10 (5.6) 24 (6.7) 0.714 0.398 No 166 (92.2) 170 (94.4) 336 (93.3) Periodic Medical Exams for Staff & Pupils Yes 13 (7.2) 31 (17.2) 44 (12.2) 8.398 0.004 No 167 (92.8) 149 (82.8) 316 (87.8) Referrals to Health Centres/Hospitals Yes 82 (45.6) 88 (48.9) 170 (47.2) 0.401 0.526 No 98 (54.4) 92 (51.1) 190 (52.8) Supervision of Health of the Handicapped Yes 14 (7.8) 7 (3.9) 21 (5.8) 2.478 0.115 No 166 (92.2) 173 (96.1) 339 (94.2)
There was no health personnel or a trained first aider in 86 (47.8%) Public Schools and 110 (61.1%) Private Schools. Also, a Nurse/ Midwife was present in 57 (31.7%) and 27 (15.0%) Public and Private Schools respectively. The findings on the
54
availability and the type of health personnel in the schools were statistically significant. (X2= 17.122, P= 0.002).
Periodic medical examination for staff and pupils was carried out in only 13 (7.2%)
Public Schools and 31 (17.2%) Private Schools. This was a statistically significant finding (X2= 8.398, P= 0.004).
55
TABLE III B: PRACTICE OF SCHOOL HEALTH SERVICES IN PUBLIC AND PRIVATE SCHOOLS PRACTICE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) TREATMENT FACILITIES First Aid Box Yes 167 (92.8) 162 (90.0) 329 (91.4) 0.882 0.348 No 13 (7.2) 18 (10.0) 31 (8.6) Essential Drugs & Materials Yes 114 (63.3) 140 (77.8) 254 (70.6) 9.039 0.003 No 66 (36.7) 40 (22.2) 106 (29.4) Sick Bay/Clinic Yes 26 (14.4) 67 (37.2) 93 (25.8) 24.371 0.001 No 154 (85.6) 113 (62.8) 267 (74.2) Ambulance/School Bus 5 (2.8) Yes 44 (24.4) 49 (13.6) 35.931 0.001 No 175 (97.2) 136 (75.6) 311 (86.4) EMERGENCY CARE First Aid Treatment Usually given Yes 147 (81.7) 167 (92.8) 314 (87.2) 9.970 0.002 No 33 (18.3) 13 (7.2) 46 (12.8) Treatment Given Recorded or Referral copy seen Yes 39 (21.7) 33 (18.3) 72 (20.0) 0.625 0.429 No 141 (78.3) 147 (81.7) 288 (80.0) Notification of Parent Yes 149 (82.8) 158 (87.8) 307 (85.3) 1.792 0.181 No 31 (17.2) 22 (12.2) 53 (14.7) Transport Child to nearest Health Post Yes 115 (63.9) 132 (73.3) 247 (68.6) 3.728 0.054 No 65 (36.1) 48 (26.7) 113 (31.4) Transport Child Home Afterwards Yes 42 (23.3) 34 (18.9) 76 (21.1) 1.067 0.302 No 138 (76.7) 146 (81.1) 284 (78.9) HEALTH RECORDS No Records Available 132 (73.3) 126 (70.0) 258 (71.7) Available but not Cummulative 37 (20.6) 42 (23.3) 79 (21.9) Cummulative but not transferrable 10 (5.5) 8 (4.5) 18 (5.0) 2.478 0.479 Cummulative and transferrable 1 (0.6) 4 (2.2) 5 (1.4) Wash hand basins and stands in class Yes 32 (17.8) 54 (30.0) 86 (23.9) 7.394 0.007 No 148 (82.2) 126 (70.0) 274 (76.1) Dust bins and waste paper baskets available Yes 58 (32.2) 123 (68.3) 181 (50.3) 46.946 0.001 No 122 (67.8) 57 (31.7) 179 (49.7)
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Essential drugs and materials were totally absent in 66 (36.7%) of Public Schools and
40 (22.2%) of Private Schools. (X2= 9.039, P= 0.003). A sick bay/ clinic was present only in 26 (14.4%) and 67 (37.2%) Public and Private Schools respectively. (X2=
24.371, P= 0.001). While an ambulance/ school bus was present in 5 (2.8%) of the
Public Schools, 44 (24.4%) of the Private Schools had an ambulance or a school bus.
(X2 =35.931, P= 0.001). All these three parameters showed statistically significant findings.
First Aid of any type was unavailable in 33 (18.3%) Public Schools and 13 (7.2%)
Private Schools. This was a statistically relevant finding. (X2= 9.970, P= 0.002).
Wash hand basins and stands were present in 32 (17.8%) and 54 (30.0%) Public and
Private Schools respectively. This was however statistically significant. (X2= 7.394,
P= 0.007).
Dust bins and waste paper baskets were available in 58 (32.2%) Public Schools and
123 (68.3%) Private Schools. This was a statistically significant finding. (X2= 46.946,
P= 0.001).
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SCHOOL FEEDING SERVICES
TABLE IV: PRACTICE OF SCHOOL FEEDING SERVICES IN PUBLIC AND PRIVATE SCHOOLS PRACTICE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) School meals available Yes 151 (83.9) 139 (77.2) 290 (80.6) No 29 (16.1) 41 (22.8) 70 (19.4) 2.554 0.110 Screening of Vendors /Food Handlers Yes 124 (68.9) 81 (39.6) 205 (56.9) 20.949 0.001 No 56 (31.1) 99 (60.4) 155 (43.1) Training & Certification of Food handlers/ Vendors Yes 122 (67.8) 71 (39.4) 193 (53.6) 29.052 0.001 No 58 (32.2) 109 (60.6) 167 (46.4) Cleanliness of food area Poor 143 (85.0) 113 (62.8) 266 (73.8) 23.150 0.001 Good 27 (15.0) 67 (37.2) 94 (26.1 ) Nutritional Supplement Yes 36 (20.0) 41 (22.8) 77 (21.4) 0.413 0.520 No 144 (80.0) 139 (77.2) 283 (78.6)
Food vendors/ handlers were not screened for any diseases in 56 (31.1%) Public
Schools and 99 (60.4%) Private Schools (X2= 20.949, P= 0.001). No formal training or certification of handlers/ vendors had ever been done in 58 (32.2%) Public Schools and 109 (60.6%) of Private Schools (X2= 29.052, P= 0.001). These two practices under the School Feeding Services were statistically significant between Public and
Private Schools.
The cleanliness of the food area was assessed and was seen to be poor in 143
(85.0%) of the Public Schools and 113 (62.8%) of the Private Schools assessed (X2=
23.150, P= 0.001). This finding was statistically significant.
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SKILL BASED HEALTH EDUCATION TABLE V: PRACTICE OF SKILL BASED HEALTH EDUCATION IN PUBLIC AND PRIVATE SCHOOLS PRACTICE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) HEALTH INSTRUCTIONS None 13 (7.2) 8 (4.4) 21 (5.8) One Period per Week 30 (16.7) 46 (25.6) 76 (21.1) 5.115 0.164 Two periods per week 97 (53.9) 87 (48.3) 184 (51.1) Three periods per week 40 (22.2) 39 (21.7) 79 (22.0)
A total of 167 (92.8%) of Public Schools and 172 (95.6%) of Private Schools had varied periods of health education per week. However this was not statistically significant.
None of the Schools within this study had any health promoting Information,
Education and Communication (IEC) materials in and around the school compound.
There was also no evidence of a health based or health promoting activity group, club or society among pupils and staff in any of the schools.
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HEALTHFUL SCHOOL ENVIRONMENT
TABLE VI A: PRACTICE OF HEALTHFUL SCHOOL ENVIRONMENT IN PUBLIC AND PRIVATE SCHOOLS PRACTICE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) Water supply Pipe Borne 17 (9.4) 34 (18.9) 51 (14.2) 33 0.001 Bore Hole/Mono Pump 90 (50.0) 97 (53.9) 187 (52.0) Wells 14 (7.8) 30 (16.7) 44 (12.2) Surface water 3 (1.7) 0 (0.0) 3 (0.8) None 56 (31.1) 19 (10.5) 75 (20.8) Distance of water supply Within the school 72 (40.0) 94 (52.2) 166 (46.1) <200 meters outside school 67 (37.2) 67 (37.2) 134(37.2) 10.982 0.004 >200 meters outside school 41 (22.8) 19 (10.6) 60 (16.7) Refuse Disposal Open Dumping/Burning 162 (90.0) 128 (71.1) 290 (80.6) Controlled Tipping 12 (6.7) 44 (24.5) 56 (15.6) 22.56 0.001 Incineration 6 (3.3) 8 (4.4) 14 (3.8) Sewage Disposal Surface (Bush/Water) 20 (11.1) 3(1.7) 23 (6.4) 58.013 0.001 Bucket 6 (3.3) 2 (1.1) 8 (2.2) Pit/Trench 114 (63.3) 67 (37.2) 181 (50.3) Water Closet/Septic tank 40 (22.3) 108 (60.0) 148 (41.1) Gender Differentiated Toilets Yes 61 (33.9) 86 (47.8) 147 (40.8) 7.186 0.007 No 119 (66.1) 94 (52.2) 213 (59.2) Toilet Rolls Available Yes 135 (75) 169 (93.9) 304 (84.4) 24.445 0.001 No 45 (25) 11 (6.1) 56 (15.6) Soap for Hand wash available Yes 23 (12.8) 80 (44.4) 103 (28.7) 44.186 0.001 No 157 (87.2) 100 (55.6) 257 (71.3) State of Toilet and Toilet area Poor 158 (87.8) 137 (76.1) 295 (81.9) 8.280 0.004 Good 22 (12.2) 43 (23.9) 65 (18.1) Toilet Pupil Ratio None 66(36.7) 44 (24.4) 110 (30.6) 1>90 58 (32.2) 29 (16.2) 87 (24.2) 39.283 0.001 1:61-90 12 (6.7) 24 (13.3) 36 (10.0) 1:46-60 17 (9.4) 18 (10.0) 35 (9.77) 1:31-45 17 (9.4) 22 (12.2) 39 (10.8) 1:<30 10 (5.6) 43 (23.9) 53 (14.2)
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About half of the respondents in both groups, 90 (50.0%) and 97 (53.9%) in Public and Private Schools respectively use a bore hole or a mono pump as their source of water supply. However, 14 (7.8%) Public Schools and 30 (16.7%) Private Schools make use of well water (X2= 33, P= 0.001). Forty one (22.8%) and 19 (10.6%) of the
Public and Private Schools respectively had their water source >200meters outside the School (X2=10.982, P=0.004). Most of the schools practiced open dumping/ burning of refuse with 162 (90.0%) Public Schools and 128 (71.1%) Private Schools
(X2= 46.22, P= 0.001). These three practices were all statistically significant
Water closet/ septic tank was used by 40 (21.2%) of Public Schools and 108 (60.0%) of Private Schools. However 20 11.1%) and 3 (1.7%) Public and Private Schools respectively practiced surface (bush/water) method of waste disposal (X2= 58.013,
P= 0.0001). Gender differentiated toilets were absent in 119 (66.1%) of Public
Schools and 94 (52.2%) of Private Schools (X2= 7.186, P= 0.007). It was also observed that soap for hand washing was unavailable in 157 (87.2%) and 100
(55.6%) of Public and Private Schools studied (X2= 44. 186, P= 0.001). Again, these three practices were statistically significant.
State of the toilet area was good in only 22 (12.2%) Public Schools and 43 (23.9%)
Private Schools (X2= 8.280, P= 0.004). Toilet to Pupil Ratio of 1< 30 was observed in just 10 (5.6%) Public Schools and 43 (23.9%) Private Schools. A ratio of 1 toilet to greater than 90 pupils was however observed in 58 (32.2%) and 29 (16.1%) Public and Private Schools respectively (X2= 39.283, P= 0.001). The differences in these findings were statistically significant.
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TABLE VI B: PRACTICE OF HEALTHFUL SCHOOL ENVIRONMENT IN PUBLIC AND PRIVATE SCHOOLS. PRACTICE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) BUILDING Dilapidated 2 (1.1) 2 (1.1) 4 (1.1) 48.995 Old walls, leaking roofs 49 (27.2) 14 (7.8) 63 (17.5) 0.001 Strong walls with minor cracks 58 (32.2) 29 (16.1) 87 (24.2) Strong walls & Roof 71 (39.5) 135 (75.0) 206 (57.2) FIRE PROTECTION All Prefab Buildings 29 (16.1) 13 (7.2) 42 (11.7) Some Prefab Buildings 92 (51.1) 86(48.3) 178(49.4) 9.755 0.008 All Buildings with fire resistant 59 (32.8) 81(44.5) 140 (38.9) Materials FLOOR Sandy 5(2.8) 0 (0) 5 (1.4) Worn Off, Broken & dusty 57 (31.7) 19 (10.6) 76 (21.1) 31.595 0.001 Flat, Glossy 22 (12.2) 38 (21.1) 60 (16.7) Flat, Non-Glossy 96 (53.3) 123 (68.3) 219 (60.8) VENTILATION I Not Adequate 27(15.0) 38 (21.1) 65 (18.1) 2.272 0.132 Adequate 153 (85.0) 142 (78.9) 295 (81.9) VENTILATION II Not Controllable 54 (30.0) 41 (22.8) 95 (26.4) 2.417 0.120 Controllable 126 (70.0) 139 (77.2) 265 (73.6) LIGHTNING Poor 52(28.9) 43(23.9) 95 (26.4) Supplementary light 0(0) 3(1.7) 3(0.8) Good 127 (70.5) 124(68.9) 251 (69.7) 11.252 0.010 Good Plus Supplementary light 1 (0.6) 10(5.5) 11 (3.1) INSULATION No ceiling 19 (10.6) 14(7.8) 33 (9.2) Partially Ceiled 74 (41.1) 35(19.4) 109 (30.3) 23.592 0.001 Properly Ceiled 87 (48.3) 131(72.8) 218 (60.5)
Old walls with leaking roofs were found in 49 (27.2%) Public Schools and in 14
(7.8%) Private Schools (X2= 45.995, P= 0.001). Floors were worn out, broken and dusty in 57 (31.7%) and 19 (10.6%) Public and Private Schools respectively.
However, in 96 (53.3%) Public Schools and 123 (68.3%) Private Schools the floors were flat and non- glossy (X2= 31.595, P= 0.001). The findings from these two practices were statically significant.
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It was observed that the ceilings of 19 (10.6%) Public Schools and 14 (7.8%) Private
Schools were absent but 87 (48.3%) and 131 (72.8%) Public and Private Schools were properly ceiled (X2= 23.592, P= 0.001). This finding was statistically relevant.
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TABLE VI C: PRACTICE OF HEALTHFUL SCHOOL ENVIRONMENT IN PUBLIC AND PRIVATE SCHOOLS.
PRACTICE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) SITTING COMFORT Pupils <100% seated 52 (28.9) 7 (3.9) 59 (16.4) 41.050 0.001 100% seated 128 (71.1) 173 (96.1) 301 (83.6) Teachers No seats available 0 (0.0) 1 (0.6) 1 (0.3) <100% seated 21 (11.7) 6 (3.3) 27 (7.5) 9.924 0.007 100% seated 159 (88.3) 173 (96.1) 332 (92.2) SAFETY MEASURES School Fence Yes 63 (35.0) 148 (82.2) 211 (58.6) 82.732 0.001 No 117 (65.0) 32 (17.8) 149 (41.4) Fire Extinguisher Yes 2 (1.1) 31 (17.2) 33 (9.1) 28.057 0.001 No 178 (98.9) 149 (82.8) 327 (90.9) Fire Alarm Yes 1 (0.6) 3 (1.7) 4 (1.1) 1.011 0.315 No 179 (99.4) 177 (98.3) 356 (98.9) Safety Patrol Team Yes 11 (6.1) 21 (11.7) 32 (8.8) 3.430 0.064 No 169 (93.9) 159 (88.3) 328 (91.2) NUISANCE & HAZARDS Noise Pollution Presence in any form 62 (35.0) 73 (35.3) 135 (37.5) 0.002 0.961 Absence 118 (65.0) 107 (64.7) 225 (62.5) Flooding/Open Drainages Presence in any form 85 (47.2) 56 (31.1) 141 (39.1) 9.805 0.002 Absence 95 (52.8) 124 (68.9) 219 (60.9)
Less than 100% of pupils in 52 (28.9%) Public Schools and in 7 (3.9%) Private
Schools had seats provided for them in the schools (X2= 41.050, P= 0.001). This was statistically significant.
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School fences were absent in 117 (65%) of Public Schools and 32 (17.8%) of Private
Schools (X2= 82.732, P= 0.0001). One hundred and seventy eight (98.9%) of Public
Schools and 149 (82.8%) of Private Schools did not have a fire extinguisher available in their school premises (X2= 1.011, P= 0.0001). These findings were statistically significant.
Flooding/ open drainages were present in 85 (47.2%) and 56 (31.1%) Public and
Private Schools respectively in one form or the other (X2= 9.805, P= 0.002). This was also statistically significant.
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TABLE VII: PRACTICE OF PHYSICAL HEALTH EDUCATION AMONG PUBLIC AND PRIVATE SCHOOLS PRACTICE PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) PHYSICAL HEALTH EDUCATION Sports field available Yes 129 (71.7) 92 (51.1) 221 (61.3) 16.043 0.001 No 51 (28.3) 88 (48.9) 139 (38.7) Other Sports Facilities Yes 17 (9.4) 64 (35.6) 81 (22.5) 35.189 0.001 No 163 (90.6) 116 (64.4) 279 (77.5) Adequate Emotional Climate Yes 98 (54.4) 148 (82.2) 246 (68.3) 32.029 0.001 No 82 (45.6) 32 (17.8) 114 (31.7)
Sports field were found in 129 (71.7%) Public Schools as against 92 (51.1%) Private
Schools. This difference was statistically significant. (X2= 16.043, P= 0.001). Sixty four (35.6%) of the Private Schools had other sports facilities while 17 (9.4%) of the
Public Schools had other sports facilities outside a football field. This difference was statistically significant (X2=35.189, P=0.001).
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TABLE VIII: PRACTICE OF SCHOOL HOME AND COMMUNITY RELATIONSHIP AMONG PUBLIC AND PRIVATE SCHOOLS
PRACTICE PUBLIC PRIVATE TEST p-VALUE SCHOOLS SCHOOLS STATISTIC N=180 (%) N=180 (%) VALUE (X2) Functional parents-teachers association?
Yes 167 (92.8) 165 (91.7) 0.694 0.155 No 13 (7.2) 15 (8.3) Functional school health committee? Yes 76 (42.2) 88 (48.9) 1.613 0.204 No 104 (57.8) 92 (51.1)
A functional Parents-Teachers Association was found in 162 (94.4%) of the Public
Schools and in 160 (94.7%) of the Private Schools. This was not statistically significant. (X2=0.039, P= 0.694).
TABLE IX: PRACTICE OF COUNSELLING AND PSYCHOLOGICAL SERVICES AMONG PUBLIC AND PRIVATE SCHOOLS PRACTICE PUBLIC PRIVATE TEST p-VALUE SCHOOLS SCHOOLS STATISTIC N=180 (%) N=180 (%) VALUE (X2) Presence of Counselling and psychological services? 58 (32.2) 90 (50.0) Yes 11.749 0.001 No 122 (67.8) 90 (50.0)
Counselling and Psychological Services were present in 90 (50.0%) of the Private
Schools and in 58 (32.2%) of the Public Schools. This difference in the availability of
Counselling and psychological services was statistically significant (X2=11.749, P=
0.001).
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SECTION D: FACTORS AFFECTING IMPLEMENTATION.
TABLE X A: INFLUENCE OF POLICY ON IMPLEMENTATION OF SCHOOL HEALTH PROGRAM IN PUBLIC AND PRIVATE SCHOOLS CHARACTERISTICS PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) Awareness of the National School Health policy (NSHP) in
Nigeria? 0.035 Yes 99 (55.0) 79 (43.9) 178 (49.4) 4.445 No 81 (45.0) 101 (56.1) 182 (50.6) CHARACTERISTICS PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 178 (%) STATISTIC N=99 (%) N=79 (%) VALUE (X2) Copy of NSHP ever seen? Yes 9 (9.1) 17 (21.5) 26 (14.6) 5.441 0.020 No 90 (90.9) 62 (78.5) 152 (85.4) CHARACTERISTICS PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 26 (%) STATISTIC N=9 (%) N=17 (%) VALUE (X2) Copy of NSHP in School?
Yes 4 (44.4) 9 (52.9) 13 (50.0) 0.170 0.680 No 5 (55.6) 8 (47.1) 13 (50.0)
It was observed that 99 (55%) Public School Head Teachers and 79 (43.9%) Private School Head Teachers were aware of the existence of the National Policy on School Health in Nigeria (X2=4.445, P=0.035). This was statistically significant.
However, out of the 99 Public School Head Teachers who were aware of the existence of the National School Health Policy, only 9 (9.1%) of them had ever seen a copy of it. Similarly, out of the 79 Private School Head Teachers who were aware of the existence of the National School Health Policy, only 17 (21.5%) of them had seen a copy of it (X2=5.441, P=0.020). This was also statistically significant.
Out of the 9 Public School Head Teachers who had seen a copy of the School Health Policy, only 4 (44.4%) of them reported that they had a copy in their Schools. On the other hand, out of the 17 Private School Head Teachers who had seen a copy of the Policy, 9 (52.9%) reported that they had a copy of it in their Schools (X2=0.170, P=0.680). This finding was not statistically significant. Overall, 4 (2.2%) Public School Head Teachers out of 180 and 9 (5%) Private Head Teachers out of 180 reported that they had a copy of the National Policy in their schools. However, when 68
asked to produce the copy, it was observed that none of the Head Teachers in both the Public and Private Schools were able to do so.
TABLE X B: INFLUENCE OF POLICY ON IMPLEMENTATION OF SCHOOL HEALTH PROGRAM IN PUBLIC AND PRIVATE SCHOOLS CHARACTERISTICS PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 360 (%) STATISTIC N=180 (%) N=180 (%) VALUE (X2) Awareness about the “Implementation guidelines on National School Health Programme” (IGNSHP)? Yes 59 (32.8) 55 (30.6) 114 (31.7) 0.205 0.650 No 121 (67.2) 125 (69.4) 246 (68.3) CHARACTERISTICS PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 114 (%) STATISTIC N=59 (%) N=55 (%) VALUE (X2) Copy of IGNSHP seen?
Yes 13 (22.0) 19 (34.5) 32 (28.1) 2.207 0.137 No 46 (78.0) 36 (65.5) 82 (71.9) CHARACTERISTICS PUBLIC PRIVATE TOTAL TEST p-VALUE SCHOOLS SCHOOLS N = 32 (%) STATISTIC N=13 (%) N=19 (%) VALUE (X2) Presence of IGNSHP copy in School? Yes 6 (46.2) 12 (63.2) 18 (56.2) 0.907 0.341 No 7 (53.8) 7 (36.8) 14 (43.8)
It was observed that 59 (32.8%) Public School Head Teachers and 55 (30.6%) Private School Head Teachers were aware of the existence of the Implementation Guidelines on National School Health Programme in Nigeria (X2=0.205, P=0.650). This was not statistically significant.
However, out of the 59 Public School Head Teachers who were aware of the existence of the Implementation Guidelines on National School Health Programme, only 13 (22.0%) of them had ever seen a copy of it. Similarly, out of the 55 Private School Head Teachers who were aware of the existence of the Implementation Guidelines on National School Health Programme, only 19 (34.5%) of them had seen a copy of it (X2=2.207, P=0.137). This also was not statistically significant.
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Out of the 13 Public School Head Teachers who had seen a copy of the Implementation Guidelines on School Health Programme, only 6 (46.2%) of them reported that they had a copy in their Schools. On the other hand, out of the 19 Private School Head Teachers who had seen a copy of the Guidelines, 12 (63.2%) reported that they had a copy of it in their Schools (X2=0.170, P=0.680). This finding was not statistically significant. Overall, 6 (3.3%) Public School Head Teachers out of 180 and 12 (6.7%) Private Head Teachers out of 180 reported that they had a copy of the Implementation Guidelines in their schools. However, when asked to produce the copy, it was observed that none of the Head Teachers in both the Public and Private Schools could produce it.
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TABLE XI: CHALLENGES REPORTED BY HEAD TEACHERS IN IMPLEMENTING SCHOOL HEALTH PROGRAMME. S/N CHALLENGES PUBLIC PRIVATE SCHOOLS SCHOOLS N= 180 (%) N=180 (%) 1. Lack of infrastructures 93 (51.7) __ 2. Lack of Funds 77 (42.8) 44 (24.4) 3. Inadequate Health Personnel 56 (31.1) 37 (20.6) 4. Lack of cooperation between Parents __ and the School Management 29 (16.1)
The Public School Head Teachers had reported that lack of infrastructures (51.7%), lack of funds (42.8%) and inadequate health personnel (31.1%) as the three most important challenges that they faced in running the School Health Programme. On the other hand, the Private School Head Teachers had listed lack of funds (24.4%), inadequate health personnel (20.6%) and friction between parents and the school management (16.1%) as the three major challenges faced while trying to implement the School Health Programme.
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TABLE XII: CROSSTAB OF PRACTICE SCORES AGAINST SOCIO-DEMOGRAPHIC VARIABLES
CHARACTERISTICS TEST p-VALUE STATISTIC Grade of Grade of TOTAL – VALUE (X2) Score: (Poor) Score: (Good) N= 360 (%) Age at last birthday
21-30 15 (8.0) 15 (8.7) 30 (8.3) 12.53 0.006 31-40 45 (24.1) 67 (38.7) 112 (31.1) 41-50 30 (16.0) 31 (17.9) 61 (16.9) >50 97 (51.9) 60 (34.7) 157 (43.6)
Sex Male 46 (24.6) 44(25.4) 90 (25.0) 0.33 0.855 Female 141(75.4) 129 (74.6) 270 (75.0) Marital Status Single 16 (8.6) 20 (11.6) 36(10.0) 0.971 0.808 Married 159 (85.0) 143 (82.7) 302 (83.9) Separated/Divorced 2 (1.1) 2 (1.2) 4 (1.1) Widowed 10 (5.3) 8(4.6) 18 (5.0) Religion 124(66.3) 104 (60.1) 228 (63.3) Christianity 63 (33.7) 69 (39.9) 132 (36.7) 1.485 0.223 Islam
Ethnicity Ibo 23 (12.3) 27 (15.6) 50 (13.9) 6.320 0.042 Yoruba 162 (86.6) 137 (79.2) 299 (83.1) Others 2 (1.1) 9(5.2) 11 (3.1) Highest Educational Qualification Masters Degree 9 (4.8) 16(9.2) 25 (6.9) 2.803 0.423 University Degree 101 (54.0) 90 (52.0) 191 (53.1) Certificate from 68 (36.4) 60 (34.7) 128 (35.6) College of Education Teacher’s Training 9 (4.8) 7 (4.0) 16 (4.4) School Certificate Length as a Head teacher?
1-5 Years 99 (52.9) 92 (53.2) 191 (53.1) 6-10 Years 43 (23.0) 39 (22.5) 82 (22.8) 0.267 0.996 11-15 Years 19 (10.2) 20 (11.6) 39(10.8) >15 Years 26 (13.9) 22 (12.7) 48 (13.3)
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The study revealed that the practice of School Health Programme was dependent on the age (X2=12.53, P= 0.006) and the ethnicity of the respondents (X2=6.330,
P=0.042). It was however not dependent on sex, marital status, religion, highest educational qualification and how long they had been a Head Teacher (P>0.05).
TABLE XIII: CROSSTAB OF PUBLIC AND PRIVATE SCHOOLS AGAINST THEIR PRACTICE SCORES PRACTICE SC0RE PUBLIC PRIVATE TOTAL - TEST p-VALUE SCHOOLS – SCHOOLS - N= 360 (%) STATISTIC N= 180 (%) N= 180 (%) VALUE (X2)
Poor 117 (65.0) 70 (38.9) 187 (51.9) 29.120 0.001 Good 63 (35.0) 110 (61.1) 173 (48.1)
The practice score of the Public and Private Schools when compared in Table XIII above was dependent on the type of school. The difference was statistically significant (X2= 29.120, P=0.001).
TABLE XIV: CROSSTAB OF RESPONDENTS’ PRACTICE AGAINST KNOWLEDGE CHARACTERISTICS TEST p-VALUE STATISTIC Grade of Grade of Grade of TOTAL – VALUE (X2) Score: (Poor) Score: (Fair) Score: (Good) N= 360 (%) Knowledge of School
Health Programme 114 (61.0) 93 (54.4) 1 (50.0) 208 (57.8) Poor Knowledge 1.652 0.799
Inadequate or Fair 72 (38.5) 77 (45.0) 1(50.0) 150 (41.7) knowledge
Adequate or Good 1 (0.5) 1 (0.6) 0 (0.0) 2 (0.6) knowledge
The Practice of School Health Programme was not dependent on the knowledge of the Head Teachers as shown in Table XIV (X2=1.653, P=0.799).
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LOGISTICS REGRESSION
MULTIVARIATE ANALYSIS.
TABLE XV: PREDICTORS OF PRACTICE OF SCHOOL HEALTH PROGRAMME. S/N VARIABLES ADJUSTED OR (95% CI) 1. TYPE OF SCHOOL PRIVATE 4.551 (1.918 – 10.799) PUBLIC 1.00 2. AGE 31 – 40 0.377 (1.121 – 1.172) 41 – 50 0.596 (0.232 – 1.530) >50 0.905 (0.434 – 1.887) 3. ETHNICITY IBO 0.214 (0.043 – 1.055) OTHERS 0.264 (0.049 – 1.423) YORUBA 1.00
In the multiple logistic regression model, only one variable (Type of School) was found to be a predictor of School Health Programme. (OR = 4.551, CI = 1.918 –
10.799).
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CHAPTER FIVE
DISCUSSION
This study set out to compare the School Heath Programme in Public and Private Primary Schools in Ogun State, Nigeria. The importance of a good and functional School Health Programme as a component of Primary Health Care in the overall development of children and the citizenry of a nation cannot be over emphasized. Various studies in the last 20 years or more in Nigeria have indicated poor status of the School Health Programme13,16,21,46,60.
The overall mean age for the Public and Private School Head Teachers in this study was 45.7±9.9 years with a range of 21-68 years. The mean age for Public Head Teachers was 53.0±3.6 years while that for the Private Head Teachers was 37±8.0years. The overall mean age was similar to that in a study in a Nigerian community where the mean age for all the Head Teachers was 44 years with a range of 27-58 years57. Private Schools have a tendency to take in younger school leavers as Teachers who can eventually rise up to become the Head Teacher. This may explain the overall lower ages found within the Private Schools.
The study population has a relatively higher educational qualification when compared to that of similar studies that have been conducted. About 50% of the Head Teachers were holders of a University Degree whereas the findings in other studies showed majority of the Head Teachers were holders of Certificate from Colleges of Education13, 61.
The Private Schools had more single Head Teachers than the Public Schools and the female Head Teachers were about three (3) times the number of their male counterpart in both groups similar to the findings from another study in South- western Nigeria62. Over 80% of the respondents were Christians. This is in line with the predominant religion in the study area located in the south western part of the country.
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Generally in this study the demographic variables of the respondents were not significant outside their age and marital status. Sex, religion, ethnicity and years of experience on the job showed essentially the same distribution.
All the Head Teachers were examined and scored on the various domains of the School Health Programme. Significant difference in knowledge was found in only three (3) main domains.
Knowledge was generally poor among all the respondents. Almost all (99.4%) of the Head Teachers had inadequate knowledge about the School Health Programme especially as it relates to its basic definition and components. This is consistent with previous studies in Egor57, Jos63, Lagos64 and Turkey65.
Though generally poor, knowledge of the School Feeding Services was better among the Public School Head Teachers than the Private School Head Teachers. This may be explained by the fact a lesser number of Private Schools make use of the services food vendors. This was however in contrast to a study in Egypt where Private Head Teachers had better knowledge regarding nutritional services when compared to their Public counterparts66. However, another study in Taiwan concluded that Teacher’s knowledge on nutrition was generally poor and only increased significantly after a health education intervention67.
Knowledge of the School Health Services domain was again generally poor but the scores from the Public School Head Teachers though just slightly better was enough to cause a significant difference. This may be due to the fact that the training curriculum for Public School Teachers has some modules on School Health incorporated into it. The Private School Teachers do not have such a training manual for their staff. The general poor knowledge on School Health Services has been demonstrated in other previous studies13,63.
Eighteen percent of the Private School Head Teachers as against 5% of the Public School Head Teachers knew the most important personnel necessary for the implementation of the School Health Programme. The mean knowledge scores between the two groups, though poor, revealed that the Private School Head
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Teachers overall had a significantly lower knowledge when compared with the Public School Head Teachers. Several studies have indicated poor knowledge across board among Head Teachers of Primary Schools13,16,21,63,68.
The practice of the School Health Programme was evaluated in the Schools primarily by the use of an Observational Checklist which covered all the domains of the School Health Programme.
School Health Services constitute one of the major components of the School Health Programme and deals with the maintenance of the health of the school children. Effective School Health Service facilitates early detection and early diagnosis and prompt intervention in order to prevent mortality and reduce morbidity.
This study showed that only 2(1.1%) of the Public Schools had the services of a medical doctor routinely while none of the Private Schools had the services of a doctor. This was similar to a study conducted in Primary Schools in Sagamu Local Government Area where one (1.1%) of the Schools studied benefited from the services of a doctor69. Another related study in Jos North LGA also showed that one (1.5%) of the Schools benefited routinely from the services of a physician63. In this study, 23% of all the Schools studied had the services of a nurse. This was in the contrast to the study in Jos North LGA where only 7.6% of the schools had a school nurse63 and much better than 31 nurses out of 830 (3.7%) schools in a study in Akwa Ibom State70 and 19 nurses in 942 (2%) in Cross Rivers State70.
Furthermore, only one out of every six of the Schools in this study had someone trained in First Aid. This was lower to the one out of every four of the Schools in the Jos North LGA63 but higher than the less than one in every ten recorded in the Schools studied in Obio-Akpor LGA of Rivers State71. It should however be noted that the study in Obio-Akpor was carried out on Public Primary Schools only and this may account for the low number of trained First Aiders. However, a steady deterioration in the School Health Programme within the last four decades as noted by some authors 2,4,63. Every teacher should be trained to be able to administer First
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Aid within the Primary School system. However as a minimum requirement three persons trained in First Aid should be available at all times in the schools63.
Routine inspection by teachers was the commonest form of Health Appraisal done in this study. In about 95% of the Schools, the Teacher carried out routine inspection of the pupils. This figure is close to the 99% in the Jos study63, and 100% as reported in other studies71-72. Other authors however reported a general absence of health appraisal services16,21.
Screening tests for growth defect, handicaps and disabilities were only available in 7% of the schools in this study. The study in Sagamu reported screening activities in 11%69 of the Schools studied while the absence of virtually all forms of screening was reported in Edo and Anambra13,21. These low figures suggest that most handicaps and disabilities would be discovered much later and at a time when they might have become permanent and irreversible. A teacher must never be in doubt about the seeing and hearing status of the pupils in his or her class.
Periodic medical examination was carried out by 17% of Private Schools as against 7% of Public Schools. In contrast, the Edo State study reported 51% of Private Schools and 26.7% of Public Schools57. The Sagamu study reported that 5 (5.5%) of the Schools carried out some periodic examination among Staff and Pupils69. A national study in Nigeria reported that only 14% of Head Teachers reported medical examination5. Others studies showed poor medical examinations in schools19,71,72.
This study shows that about a quarter of the Schools had a sick bay/ clinic. This was distributed as 14% of the Public Schools and 37% of the Private Schools. Different authors have quoted different figures in their studies such as 48% in Jos63, 31.6% in Edo57, 27% in Sagamu69, 1% in Cross Rivers State70 and 3.6% in Akwa Ibom70 with a sick bay. Absence of sick bays reflected the poor state of School Health Services in the schools with the Private Schools just slightly better. In the same vein, none of the schools in this study had an ambulance. However, 24% of the Private had a school bus that could be used to convey a sick pupil or staff to a medical centre as opposed to 3% of Public Schools. The Sagamu study reported that no School had an
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ambulance but 89% of the Schools had a school bus that could be used to convey pupils and staff to a health facility69. Others resorted to the use of public transport or carried the pupil on foot.
Hand washing facilities were present in 24% of the Schools in the study population and dust bins and waste paper baskets were available in 50% of the Schools. Similar poor figures have been recorded in other studies19,22,57,63,69. All these factors reduce the capacity of the Schools to control communicable diseases and they basically just send sick children home or ask for their parents/ wards to come and pick them up. Generally the practice of School Health Services is poor in the study population but the situation was generally better in the Private Schools.
School feeding services are an effective means of curbing under-nutrition among school age children in the country by the provision of a mid day meal63. School meals though available in 81% of the Schools in this study were not served by the schools. Meals were available for sale in 84% of the Public Schools by approved mobile or permanent food vendors within the school premises. In the Private Schools most of the foods were brought from the homes of the pupils as lunch packs. Even though Nigeria had adopted and launched the School Feeding Service in 2005, it is yet to be implemented in the Home Grown School Feeding and Health Programme (HGSFHP)5,63,73. Similar situation were reported in studies in Jos63 and Edo71. Free mid day meals are served to pupils in Osun State under the present administration as part of its O-Meals Programme74. Free meals are given to pupils in Ghana75 and in Chicago, USA76 to help reduce hunger and facilitate learning in pupils77-78.
Screening of food vendors/ handlers a very important statutory public health function and preventive strategy was carried out in 69% of Public Schools as against 40% of Private Schools. This may be due to the fact that the Local Governments in Ogun State employ most of the food handlers posted to the Public Schools unlike their counterparts in the Private Schools. This finding indicate that the majority of pupils in the study locations especially in the Private Schools are exposed to public health hazards through consumption of food from unscreened food vendors.
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The Local Governments in Ogun State are also responsible for the training and certification of the food handlers posted to the Public Schools and this explains why 78.5% of food handlers in Public Schools are trained and certified.
Food area was generally cleaner in Private Schools 72.8% as opposed to Public Schools with 27.2%. This is consistent with the finding in a similar study that concluded that Private Schools had cleaner food areas because they had fewer school meal serving points than Public Schools23.
Studies have also shown that increasing the knowledge of Teachers on food and nutrition led to better outcomes of the School Feeding Services program in schools77- 78. Provision of school meal will ensure that children have something to eat, a factor which can result in improved attention in school, as it has been reported that many children go to school without taking breakfast79.
School Health Education has been described as the neglected component of primary health care,12,80. In this study, 51% of the Schools devoted three (3) periods in a week to teaching Skill Based Health Education. This was better than the studies reported in South western Nigerian schools where Health Education was absent in the schools19. This study was better than the Anambra State study which noted that no school (0%) complied with the National Education Research Council’s recommendation of three (3) periods per week of health teaching2. The Anambra study also reported that physical and health education were optional courses and that trainee teachers graduated without completing up to 50% of their scheduled work on health related matters2. The study then concluded that teachers subsequently deployed to primary schools had no knowledge on health matters and were plain generalists2. On the contrary, Kerala an extremely poor community in South India transformed its health indices to those of more developed economies in a very short time. The bedrock of the transformation was the utilization of the School Health Programme in the training of teachers as health workers. The teachers then passed the knowledge to the pupils and students as agents of change to galvanize community action81. In all the three hundred and sixty (360) schools studied, it was observed that no school could boast of a single Information
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Education and Communication (IEC) material within the school. Again, not a single health based club, society or activity was seen. This may be due to the fact that the Head Teachers do not see the Schools as a vantage point for health and the transforming power of Health Education unknown and underutilized. It has also been postulated that unlike what obtained a few years back, training for health is presently deficient among Teachers82 at all levels.
Healthful School Environment deals with conditions within the school that are most conducive to optimal physical, mental and emotional health, safety of pupils, satisfactory relations amongst pupils, teachers, administrators, as well as for rest, relaxation and recreation2. It includes both the emotional and physical environment2.
In this study 78% of the total number of Schools studied had some form of water supply even though about 52% of this was from bore holes/ mono pumps. This is high compared to the 46% reported by the Federal Ministries of Health and Education in their assessment of availability of water supply in schools5. This figure however represents a national average as primary, secondary and universities were involved in the study. It is also higher than the figures in another related study in Rivers State where 35% of the schools had water supply83. It is also better than the 17.3 % and 2.6% reported in Edo State57 and Imo State84 respectively.
In this study, sources of water were found within and less than 200 meters outside the school in 66% of the schools studied. This was acceptable as the Universal Basic Education (UBE) strategic plan had stipulated that clean water supply should be within 500 meters of the school85. The Rivers83 study reported that 40% of the schools had their water supply within 200 meters of the school premises while most of the schools in the Imo study lacked water within 500 meters from the schools84. Poor water supply means that activities that involve its use such as hand washing, cleaning, flushing of toilets and even drinking would suffer and indirectly create unhygienic environment for the pupils. They will also become exposed to accidents and unnecessary hazards in their attempts to obtain clean water outside the school premises.
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81% of the Schools in this study practiced open dumping/ burning as their method of waste disposal with the Public Schools more than the Private Schools. This was similar to a study in Ikenne Ogun State where the Public Schools practiced open dumping of refuse as against the Private School that did not86. All the schools in the Rivers study (100%) practiced open dumping and burning83. The results were also similar in the studies in Edo57 and Imo84. Open dumping provides excellent breeding sites for flies, rodents and reptiles. Huge piles of waste will constitute an environmental nuisance. They also serve as breeding grounds for mosquitoes when they contain broken bottles, plastic, cans etc. Children will also suffer from cuts and bruises when they play around the piles of rubbish and hence must be discouraged.
Only 39% of schools studied have functional toilets. This is made up of 23% Public Schools and 77% Private Schools. These findings are better than that done in Rivers State where 25% of the schools studied had functional toilets83. There were no toilet facilities for children’s convenience at all in the study done in Imo State84. Similar study in Edo State showed that 40% of the schools studied has functional toilets and was distributed as 13% Public Schools and 87% Private Schools57. Similar findings were reported from the study at Obio-Akpor Local Government Area71 and in Ikenne86. They showed absent functional toilets in Public Schools. Absence of toilet facilities suggests increase in unsanitary methods of sewage disposal with contamination of the hands and environment with faecal matter leading to more cases of diarrhoeal diseases, helminthiasis and possible disease epidemics from water contamination. It has also been reported that unsanitary toilets lead to an increase in urinary tract infection in children as they tend to hold back from voiding urine as at when due87.
Gender differentiated toilets were available in 41% of the schools studied. With the Private Schools having 59%. In a study assessing toilet facilities in secondary schools in Jos North LGA, 54% of the schools had gender differentiated toilets88. Studies in Ethiopia89 have reported that toilet differentiation can lead to more school attendance by girls especially if they are clean, safe, secure and private.
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Soap for hand wash was available in 29% of schools as at the time of study and 78% of the schools were Private Schools. This was similar to the study in Edo state where soap was present in 33% of the schools studied and 88% of them were Private Schools57. Others studies reported absence of hand washing soaps in the schools83-86. Whereas, hand washing has been described as the single most effective way to prevent the spread of infections90.
WHO had recommended a ratio of 1toilet to a maximum of 30 pupils91. In this study, only 14% of the schools met this WHO requirement and 84% of them were Private Schools. While this finding is very poor, others studies were much worse off and reported abysmal ratios83,86,88. An insufficient toilet/pupil ratio contributes to overuse, filthy conditions and a consequent return to open defecation around schools, or absenteeism in order to use a home toilet92.
Schools with strong walls and roof were 56% of the total schools in this study. Out of this, 65% were Private Schools. Less than 1% of the schools were completely dilapidated. This is contrast to the schools studied in Rivers where 25% were dilapidated but 50% had strong walls and roofs83. One school in the Rivers study had no building at all and the students sat under a shade83. It is important to note that the environment in which learning takes place is an important factor in the learning process93.
Ventilation was adequate in 81% of the schools and controllable in 71%. This is similar to another study that reported adequate ventilation in 85% of schools but differed by reporting controllable ventilation in 35% of the schools studied83. Others reported inadequate and uncontrollable ventilation84. Seventy-two percent of the Schools had good lighting while 61% had intact ceiling. The Rivers study reported 85% with good lighting and 60% of the schools there with intact ceiling. These studies are in contrast to the one that reported an abysmal 2.2% of schools with good lightning and poor ceiling of its buildings84. Very little teaching and learning would be on going in these schools.
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Pupils were completely seated in 83% of schools studied. The Private Schools accounted for 57% of this number. This study found pupils sitting on the floor in 27% of the schools in the study population. This is in contrast to the study in Bonny in which pupils were completely seated in 55% of the schools and on the floor in 45% of the schools83. The results are poorer from the study in Obio-Akpor where pupils were completely seated in 11% of the schools and were on the floor in 89% of the schools in the Local Government71. Sitting comfort has been identified as one of the factors that affect learning93. Children in these schools would find learning difficult and uninteresting. Teachers too would be very frustrated and would do very little effective teaching.
Complete school fence was present in 59% of the schools in this study. Of this number, 70% were Private Schools. This is in contrast to the schools in the Rivers83 study that reported 10% of the schools as completely fenced and the study in Imo84 in which none of the schools were fenced. Again 9% of the schools in this study had a safety patrol team and 66% of this were Private Schools. This is in contrast to the studies in Rivers83 and Imo84 where patrol teams were totally absent in all the schools. Primary school fencing and gates serve two principal purposes, namely preventing the unauthorized departure of children and keeping out people seen as a threat to young children94. For these reasons primary schools in the UK tend to implement even tighter security than other types of schools particularly in relation to personnel access94. Security has become a major issue in Nigeria right now and schools have to be more conscious of this. Still fresh in our memory is the abducted Chibok girls. Fencing and patrol teams are no longer options but necessities. They would at least serve as a line of defence. School security in the UK now revolve around the Head Teacher as the Chief Officer but supported by the Staff, pupils and the community under the ‘Schoolwatch’ schemes95.
Sports field for sporting and recreation activities were available in 64% of schools studied and the Public Schools constituted 59% of this population. This is in contrast to the study in Imo84 that reported the presence of a sports field in 100% of the schools studied. The fields were however for football activities only. Physical
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education (PE) provides children with the knowledge, skill and understanding necessary to perform a variety of physical activities, maintain physical fitness and to value as well as enjoy physical activity as an ongoing part of a healthy lifestyle96. In an era of increasing childhood and adult obesity, alongside healthy eating lifestyle they have the combined potential to make a positive lifestyle change. It provides additional benefits for pupils- co-operation in group situations, acceptance of failure and success, concepts of working hard and fair play and an appreciation of the skills and attributes of others96. In our environment, the Kanus, Jay-Jay Okochas, Falilat Ogunkoyas, Okagbares etc have made a name for themselves through excelling in sporting activities and should be encouraged in children.
Provision of an adequate emotional climate in the school is a necessity for effective learning83. A positive or adequate emotional climate is dependent on the adequate provision for the physical and psychological needs of the pupils and the school personnel83. In this study, 68% of the schools affirmed the presence of an adequate emotional climate within the schools. Out of this, 60% were Private schools. A cordial relationship between the School Administrators, Head Teachers, Classroom Teachers, School Community and the Host Community helps to create an excellent environment for living, teaching and learning83.
The success of the School Health Programme is dependent on the extent to which community members are aware of and are willing to support health promotion efforts5. Parents Teachers Association (PTA) is a voluntary association of parents and teachers in a particular school established for its development97. Where functional and effective, it facilitates good school and community relationship97. Eighty-nine percent of the schools have a functional Parents Teachers Association (that is, one that meets regularly at least once every 3-4 months). This figure was higher than that obtained in another study where 65% of the schools studied had a functional PTA83.
However, the fact that the PTA met did not mean that Health issues were discussed or ways of improving the School Health Programme within the School and its immediate community was discussed. Most PTA meetings were usually centred on
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issues related to finance and funding97. This will account for the high number of schools with Parents Teachers Association but poor practice of School Health Programme.
The low impact of the Parents Teachers Association is also reflected on the fact that in this study only 39% of the schools in the study population have a functional School Health Committee with the figures slightly higher on the side of the Private Schools. This was similar to the 36% of schools reported in a similar study69. It should be noted however that on probing about the functions and activities of the School Health Committee, none of the schools provided a satisfactory answer.
Counselling is a process through which an individual who needs help is professionally assisted and helped to make necessary adjustment to life and to his environment98. Most primarily schools in Nigeria do not have established guidance and counselling units for now that could help the Nigerian child have the right physical, psychological and social setting for growth99. Primary education in Nigeria lacks formal guidance and counselling services which could help the cognitive, affective and psychomotor domains of child development99. Thirty four percent of the schools in this study have counselling and psychological services. Sixty three percent of this was from the Private school. This was quite surprising because the National Policy on Education had emphasized the training of interested teachers in guidance and counselling and that it would feature in teacher education programmes and in all Teacher Training Colleges and Colleges of Education designed for public school teachers100. None of the schools however had a trained or certified counsellor. This means that the quality of counselling services offered was questionable.
Out of the 178 (49.4%) Head Teachers who were aware of the National School Health Policy, only 26 (14.6%) of them had seen a copy of it. Nine (9) Teachers claimed to have a copy of the Policy but none (0%) could produce it on demand. The same trend was seen with the Implementation Guidelines since none of the ten (10) Head Teachers who claimed to have a copy could produce it on demand. This simply means that Head Teachers are not aware of the existence of the Policy. They do not have a copy and have never seen it. The downside is that it will be practically
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impossible to implement an efficient School Health Programme. Most activities would be mere trial and error as different schools would practice the School Health Programme based on personal understanding of the Head Teacher13.
Both groups of Head Teachers reported lack of funds and inadequate health personnel as major challenges faced while trying to implement School Health Programme. A similar question to Head Teachers in the Mpumalanga and Gauteng Provinces in South Africa identified barriers related to governance, citing lack of national policy for guidelines for health services and the failure of government to prioritise School Health Programme. They also identified programme-related issues, such as lack of inter-sectoral collaboration, management related issues such as lack of support from management and managers’ limited knowledge of the Health- promoting Schools Initiative, community-related issues such as health professionals not including the communities in School Health Programmes101.
On further analysis, the age and ethnicity of the Head Teacher and the type of school he/ she was heading were strong determinants in the practice of School Health Programme. School Health Programme is 4 times more likely to be implemented in a Private School when compared to the Public School (OR= 4.551, CI= 1.198 – 10.799). Private Schools have better access to funding because they are also run as a profit-oriented business. Some of the available structures that complement School Health Programme activities are available because they have to compete with other Private Schools for pupils. They therefore have a tendency to provide some of the services not because they have an understanding of the requirements of the School Health Programme but as a business model to attract clientele. Public Schools on the other hand have to wait for the Government in order to have funds available for all activities. They are usually barred from fund raising activities and when they do the funds are very limited.
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CONCLUSION
This study revealed a generally poor knowledge of the School Health Programme among Head Teachers in Public and Private Primary Schools in Ogun State. This includes poor knowledge of its definition, its components and its objectives and very poor knowledge of the National Policy and its Implementation Guidelines. It has also shown that the practice of School Health Programme though poor in both groups is slightly better among the Private Primary Schools because they have better funding than Government-owned Schools.
In view of these findings above, the following recommendations are being made to improve the School Health Programme among Head Teachers in Public and Private Primary Schools in Ogun State.
RECOMMENDATIONS
TO THE LOCAL AND STATE SCHOOL REGISTERING BODIES:
1. A copy of the National Policy on the School Health Programme and the Implementation Guidelines should be given to the Proprietor/ Proprietress of every new Private School that comes for registration so that they can become aware of the requirement of the Policy and practice School Health Programme based on the documents. For all Private Schools that are registered, a copy should be given to the Head Teacher/ Proprietor at the point of renewal of their licenses. They should be mandated to implement the Policy and the Implementation Guidelines.
2. All the Head Teachers in the Public Schools should be sent copies of the Policy or given copies of the Policy during their usual meetings with the Zonal Education Officers (ZEO).
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TO THE STATE GOVERNMENT:
1. State Ministry of Education and the State Ministry of Health should start a campaign on School Health Programme in all the Local Government Areas of Ogun State. The Medical Officers of Health and the Zonal Education Officers should be mandated to assess the School Health Programme in their domains and design appropriate health education intervention programmes to address it.
2. Twice a year or at the least once a year, a School Health Team made up of representatives of the State’s Ministries of Education and Health, ZEO, a member of the Association of Private School Owners and the State Chapter of the Nigerian Union of Teachers (NUT) should visit the schools and make recommendations. An annual School Health Programme Prize should be awarded to the best implementing Schools in the Public and Private categories.
3. Private companies should be encouraged to practice an “Adopt a School Programme” which will serve as Corporate Social Responsibility. Companies that respond should have some tax rebates. This should be encouraged especially for the Public Schools to help improve funding.
4. Medical officers and other health workers should have schools placed under their watch which they would oversee and help conduct routine medical examination. Pre-entrance medical screening must become an admission requirement into all Public and Private Schools in Ogun State complimented by good record keeping practices at the schools.
5. All Schools in the State must be properly fenced to provide some degree of security to staff and children while they are within the school premises. This should be a requirement for school registration.
6. Government should provide schools with necessary funding to ensure that all staff and pupils are seated and that basic amenities such as clean water,
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gender differentiated toilets with hand washing facilities are available in all public schools.
7. Ogun State should commence the Home Grown School Meal initiative in order to attract more children to schools and more importantly combat malnutrition and nutrition related diseases.
TO THE HEAD TEACHERS:
1. All Head Teachers must become familiar with the National Policy and Guidelines. They should also ensure that all the Teachers in their respective schools have a working knowledge of the Policy and the Guidelines.
2. They should ensure that at least four (4) of their staff members are trained first aiders.
3. Encourage all parents, pupils and staff to sign up with Social Health Insurance Scheme and if possible, use the school as an operative centre for the scheme.
4. They should commence the creation of health based clubs, societies and activities such as the Red Cross and other health initiatives in their schools. Information, Education and Communication materials such as posters, hand bills etc should be placed at strategic areas within the school to serve as ’health reminders’ to staff and students.
5. The Head Teacher should ensure that at least one of the School Teachers is trained as a Guidance Counsellor.
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APPENDIX QUESTIONNAIRE COMPARATIVE STUDY OF SCHOOL HEALTH PROGRAMME IN PRIVATE AND PUBLIC PRIMARY SCHOOLS IN OGUN STATE.
SECTION A SCHOOL PUBLIC ( ) PRIVATE ( )
1. AGE LAST BIRTHDAY: ______
2. SEX: MALE ( ) FEMALE ( )
3. MARITAL STATUS: SINGLE ( ) MARRIED ( ) SEPARATED/DIVORCED ( ) WIDOWED ( )
4. RELIGION: CHRISTIANITY ( ) ISLAM ( ) OTHERS ( )
5. ETHNICITY: HAUSA ( ) IBO ( ) YORUBA ( ) OTHERS ( )
6. HIGHEST EDUCATIONAL QUALIFICATION: MASTERS DEGREE ( ) UNIVERSITY DEGREE ( ) CERTIFICATE FROM COLLEGE OF EDUCATION ( ) TEACHERS’ TRAINING SCHOOL CERTIFICATE ( )
7. HOW LONG HAVE YOU BEEN A HEAD TEACHER: 1-5 YEARS ( ) 6-10 YEARS ( ) 11-15 YEARS ( ) >15 YEARS ( )
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SECTION B.
8. HAVE YOU EVER HEARD ABOUT THE SCHOOL HEALTH PROGRAMME? YES ( ) NO ( ) 9. DEFINE SCHOOL HEALTH (SHP) PROGRAMME IN YOUR OWN WORDS.
10. LIST THE COMPONENTS OF SCHOOL HEALTH PROGRAMME THAT YOU KNOW (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x)
11. IS SHP A COMPONENT OF PRIMARY HEALTH CARE IN NIGERIA? YES ( ) NO ( ) I DON’T KNOW ( ) 12. THE ACTIVITIES OF SHP IS REGULATED BY: LOCAL GOVERNMENT ( ) STATE GOVERNMENT ( ) FEDERAL GOVERNMENT ( ) ALL OF THE ABOVE ( ) NONE OF THE ABOVE ( ) 13. SCHOOL NUTRITION SERVICES WILL REDUCE HUNGER AND MALNUTRITION AMONG LEARNERS: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 14. SCHOOL HEALTH SERVICE CENTRE ‘MUST’ AND CAN ONLY BE SITED WITHIN SCHOOL PREMISES: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 15. INSPECTION OF CHILDREN WILL ALSO INCLUDE TOOTH DECAY AND BAD BREATH: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 16. SHP DOES NOT ASSESS CHILDRENS’ IMMUNIZATION STATUS: TRUE ( ) FALSE ( ) I DON’T KNOW 17. PLASTER OF PARIS IS A USUAL CONTENT OF THE FIRST AID BOX: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 18. BASIC LIFE SUPPORT IS AN INTEGRAL SKILL NEEDED BY THE SCHOOL’S FIRST AIDER: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 101
19. ADVOCACY TO COMMUNITY AND PARENTS IS NOT NECESSARY TO HAVE AN EFFECTIVE SHP: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 20. HEALTH RECORDS OF CHILDREN MUST BE CONSISTENTLY UPDATED PERIODICALLY: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 21. SHP DOES NOT MAKE PROVISION FOR PHYSICALLY AND EMOTIONALLY CHALLENGED CHILDREN: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 22. SCHOOLS SHOULD BE SITED CLOSE TO THE COMMUNITY MARKET AREA TO PROVIDE EASY ACCESS TO TRADER’S CHILDREN: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 23. GOVERNMENT MUST PROVIDE ALL THE FUNDING NEEDED FOR ALL SHP ACTIVITIES: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 24. SHP DOES NOT PLAY A VITAL ROLE IN THE ATTAINMENT OF MILLENIUM DEVELOPMENT GOALS: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 25. SHP IS PART OF WORLD HEALTH ORGANIZATION’S STRATEGY TO PRODUCE ‘HEALTH PROMOTING SCHOOLS’ WORLDWIDE: TRUE ( ) FALSE ( ) I DON’T KNOW ( ) 26. THE KEY PERSONNEL/STAFF NEEDED IN THE IMPLEMENTATION OF SHP ACTIVITIES IN SCHOOLS IS ______
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SECTION C 27. DO YOU HAVE SCHOOL HEALTH PROGRAMME IN YOUR SCHOOL: YES ( ) NO ( ) 28. DO THE PUPILS UNDERGO MEDICAL INSPECTION BEFORE ENTRY INTO THE SCHOOL? YES ( ) NO ( ) 29. IF YES, ARE THERE RECORDS AVAILABLE? YES ( ) NO ( ) 30. IF NO, WHY IS IT NOT DONE? ______31. DO YOU PERFORM ROUTINE MEDICAL INSPECTION ON THE PUPILS? YES ( ) NO ( ) 32. IF YES, ARE RECORDS AVAILABLE? YES ( ) NO ( ) 33. IF NO, WHY IS IT NOT DONE? ______34. WHO CONDUCTS THE MEDICAL INSPECTION? DOCTOR ( ) NURSE ( ) CHEW ( ) HEALTH ATTENDANT ( ) TEACHER ( ) 35. DO YOU HAVE A FIRST AID BOX? YES ( ) NO ( ) 36. DO YOU HAVE A SCHOOL CLINIC OR SICK BAY? YES ( ) NO ( ) 37. IF YES, IS THERE A HEALTH WORKER IN THE SICK BAY? YES ( ) NO ( ) 38. IS THERE A SCHOOL MEAL POLICY IN THE SCHOOL? YES ( ) NO ( ) 39. WHAT ARE THE SOURCES OF SCHOOL MEAL? HOME ( ) MOBILE FOOD VENDORS ( ) PERMANENT FOOD VENDORS ( ) 40. ARE FOOD HANDLERS SCREENED FOR DISEASES? YES ( ) NO ( ) 41. WHAT DISEASES ARE THEY SCREENED FOR? ______42. HOW MANY HOURS IN A WEEK ARE SCHEDULED FOR SKILLS BASED HEALTH EDUCATION AND PROMOTION? NONE ( ) 1 ( ) 2 ( ) 3 ( ) 4 AND ABOVE ( ) 43. ARE PUPILS ENGAGED IN PHYSICAL EDUCATION? YES ( ) NO ( ) 44. IS THERE COUNSELLING AND PSYCHOLOGICAL SERVICES THAT CATER FOR MEDICAL CONDITIONS DISCOVERED IN CHILDREN? YES ( ) NO ( ) 45. IS THERE A FUNCTIONAL SCHOOL HEALTH COMMITTEE? YES ( ) NO ( ) 46. IS THERE A FUNCTIONAL PARENTS- TEACHERS ASSOCIATION OR SCHOOL BASED MANAGEMENT COMMITTEE? YES ( ) NO ( )
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SECTION D 47. ARE YOU AWARE OF THE ‘NATIONAL SCHOOL HEALTH POLICY IN NIGERIA’? YES ( ) NO ( ) If No, go to question 50. 48. HAVE YOU SEEN A COPY OF IT? YES ( ) NO ( ) If No, go to question 50. 49. DO YOU HAVE A COPY OF IT IN THE SCHOOL? YES ( ) NO ( ) 50. ARE YOU AWARE OF THE ‘IMPLEMENTATION GUIDELINES ON NATIONAL SCHOOL HEALTH PROGRAMME’? YES ( ) NO ( ) If No, go to question 53 51. HAVE YOU SEEN A COPY OF IT? YES ( ) NO ( ) If No, go to question 53 52. DO YOU HAVE A COPY OF IT IN THE SCHOOL? YES ( ) NO ( ) 53. LIST THE THREE MOST IMPORTANT CHALLENGES THAT YOU FACE IN RUNNING THE SCHOOL HEALTH PROGRAMME IN YOUR SCHOOL. i ii iii
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CHECK LIST
TYPE OF SCHOOL PRIVATE [ ] PUBLIC [ ]
AGE/DATE ESTABLISHED
SCHOOL POPULATION
1. TOTAL NO OF CHILDREN : MALE FEMALE
2. TEACHING STAFF:
3. NON-TEACHING STAFF:
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SCORES OBTAINABLE SCORES OBTAINED PERSONNEL NONE 0 HEALTH ASSISTANT/TRAINED 1 FIRST-AIDER HEALTH 2 EDUCATOR/NUTRITIONIST NURSE/MIDWIFE 3 DOCTOR 4 HEALTH APPRAISALS ROUTINE INSPECTION 1 (TEACHER OBSERVATION) SCREENING TESTS FOR 1 GROWTH DEFECT, HANDICAPS, DISABILITIES PERIODIC MEDICAL EXAMS FOR 1 STAFF & PUPILS REFERRALS TO HEALTH 1 CENTRES/HOSPITALS SUPERVISION OF HEALTH OF 1 THE HANDICAPPED TREATMENT FACILITIES FIRST AID BOX 1 ESSENTIAL DRUGS & 1 MATERIALS SICK BAY/CLINIC 1 AMBULANCE/SCHOOL BUS 1 TELEPHONE SERVICES 1 EMERGENCY CARE FIRST AID TREATMENT 1 USUALLY GIVEN TREATMENT GIVEN RECORDED 1 OR REFERRAL COPY SEEN NOFICATION OF PARENT 1 TRANSPORT CHILD TO 1 NEAREST HEALTH POST TRANSPORT CHILD HOME 1 106
AFTERWARDS DISEASE CONTROL NO ACTIVITY 0 HEALTH TALKS 1 SEND CHILD HOME 1 ISOLATE/QUARANTINE CHILD 1 INITIATE IMMUNIZATION 1 WHERE POSSIBLE HEALTH RECORDS NO RECORDS AVAILABLE 0 AVAILABLE BUT NOT 1 CUMMULATIVE CUMMULATIVE BUT NOT 2 TRANSFERABLE CUMMULATIVE AND 3 TRANSFERABLE NUTRITIONAL SERVICES SCHOOL MEALS AVAILABLE 3 SCREENING OF VENDORS/FOOD 3 HANDLERS TRAINING & CERTIFICATION 2 OF FOOD HANDLERS/ VENDORS CLEANLINESS OF FOOD AREA GOOD – 2, FAIR – 1, POOR – 0 NUTRITIONAL SUPPLEMENTS 1 HEALTH INSTRUCTION ONE PERIOD/WEEK 1 TWO PERIODS PER WEEK 3 THREE PERIODS PER WEEK 5 WATER SUPPLY PIPE BORNE 4 BORE HOLE/MONO PUMP 3 WELLS 2 SURFACE WATER 1 WITHIN THE SCHOOL 3 <200 METERS OUTSIDE 2
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SCHOOL >200 METERS OUTSIDE 1 SCHOOL REFUSE DISPOSAL INCINERATION 4 CONTROLED TIPPING 3 COMPOSTING 2 OPEN DUMPING/BURNING 1 SEWAGE DISPOSAL WATER CLOSET/SEPTIC TANK 3 PIT/TRENCH 2 BUCKET 1 SURFACE (BUSH/WATER) 0 GENDER DIFFERENTIATED 3 TOILETS TOILET ROLLS AVAILABLE 1 SOAP FOR HANDWASH 2 AVAILABLE STATE OF TOILET AND TOILET GOOD- 5, FAIR- 3, POOR- 1 AREA TOILET-PUPIL RATIO 1:<30 5 1: 31-45 4 1: 46-60 3 1: 61-90 2 1:>90 1 NONE 0 BUILDING STRONG WALS & ROOF 4 STRONG WALLS WITH MINOR 3 CRACKS OLD WALLS, LEAKING ROOFS 2 DILAPIDATED 0 FIRE PROTECTION ALL BUILDINGS WITH FIRE 3 RESISTANT MATERIAL
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SOME PREFAB BUILDING 2 ALL PREFAB BUILDINGS 1 FLOOR FLAT, NON-GLOSSY 3 FLAT GLOSSY 2 WORN OFF, BROKEN & DUSTY 1 SANDY 0 VENTILATION ADEQUATE 2 NOT ADEQUATE 1 CONTROLLABLE 2 NOT CONTROLLABLE 1 LIGHTING LIGHTING GOOD – 2, POOR -1, SUPPLEMENTARY LIGHT +1 INSULATION INSULATION PROPERLY CEILED- 2, PARTIALLY CEILED- 1, NO CEILING- 0 SITTING COMFORT PUPILS 100% SEATED- 2, <100% SEATED- 1, NONE- 0 TEACHERS 100% SEATED- 2, <100% SEATED- 1, NONE- 0 SAFETY MEASURES SCHOOL FENCE 1 FIRE EXTINGUISHER 1 FIRE ALARM 1 SAFETY PATROL TEAM 1 NUISANCE & HAZARDS NOISE POLLUTION ABSENCE – 5, PRESENCE IN ANY FORM – 0 FLOODING/OPEN DRAINAGES ABSENCE- 3, PRESENCE IN ANY FORM- 0 HEALTHFUL LIVING ADEQUATE EMOTIONAL 1 CLIMATE
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SHOES WORN COMPULSORILY 1 BY STAFF & PUPILS SPORTS FIELD AVAILABLE 1 OTHER SPORTS FACILITIES 1 WASH HAND BASINS & STANDS 1 IN CLASS DUST BINS & WASTE PAPER 1 BASKETS AVAILABLE PRESENCE OF HEALTH BASED 2.5 IEC MATERIALS PRESENCE OF HEALTH BASED 2.5 CLUBS/SOCIETIES/ACTIVITIES POLICY MATERIALS COPY OF NATIONAL POLICY ON 5 SHP IN SCHOOL COPY OF IMPLEMENTATION 5 GUIDELINES IN SCHOOL TOTAL OBTAINABLE 120
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HEAD TEACHERS’ INFORMED CONSENT
Dear Head Teacher,
You are being asked to participate in a research/study. The purpose of the study is to evaluate the School Health Programme in your school. You will be asked to fill a questionnaire and your facility will also be inspected.
Your participation in this research is strictly confidential. Only the investigator will have access to your identity and to the information that can be associated with your identity. In the event of publication of this research, no personal identifying information will be disclosed.
Taking part will not expose you to any untoward risks. There will be no charges on you taking part in this study.
Your participation is VOLUNTARY and you are free to withdraw at any stage of the study.
I FULLY UNDERSTAND THE STUDY AND MY PARTICIPATION IN IT.
NAME OF HEAD TEACHER: ______
NAME OF SCHOOL: ______
SIGNATURE OF HEAD TEACHER: ______
DATE:______
NAME OF INVESTIGATOR: ______
SIGNATURE OF INVESTIGATOR: ______
DATE:______
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