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. 1 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. 2 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. 3 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) 4 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. 5 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. 6 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 7 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. 8 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 9 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.