School Health Programme: An Indispensable Programme in Child Health

Obeagu Getrude Uzoma¹ & Obeagu Emmanuel Ifeanyi^2,3*

¹Department of Nursing Science, Ebonyi State University, Abakaliki, Nigeria
²Medical Laboratory Science, University Health Services, Michael Okpara University of Agriculture, Umudike, Nigeria
³Department of Medical Laboratory Science, Imo State University, Owerri, Nigeria

*Correspondence to: Dr. Obeagu Emmanuel Ifeanyi, Department of Medical Laboratory Science, Imo State University, Owerri and University Health Services, Michael Okpara University of Agriculture, Umudike, Nigeria.

Copyright © 2019 Dr. Obeagu Emmanuel Ifeanyi, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction
School health services were one of the earliest public health intervention targeted specifically at children, leading the way were Dr. Sara Josephine Baker and Lilian Wald who based in New York’s Henry street settlement organized in 1893 the first visiting nurse service and subsequently the first school health nursing programme in the country. These early effort used the school setting to shortcut infectious disease surveillance strategies in an effort to identify and quarantine children whose disease were a threat to others [1].

According to the present arrangement of school health programme in Nigeria, local governments are responsible for rendering primary health care services to the community. The school health service unit within the primary health care division in a local government area consists of a team of health workers, usually headed by an experienced community health officer. Ideally other members of the team should consist of public health nurses, dental assistants, community health aids etc. the team is expected to draw up a programme to cover all the schools.

Unfortunately, in practice the team concentrates its few resources on the schools within the local government headquarters. In Nigeria today, school health services have suffered a lot of setback due to the poor national economy. In some areas, it is almost unknown to many schools [2].

Where there are schools for children, there is the need for an organized school health programme. This is because the school is the most important agency outside the home in shaping the health and personality of the child (American school health association, 2007). The protection of the health of children in school is a joint responsibility of the ministries of education and health. It is the responsibility of the school to provide a safe and healthy environment for learning and for teaching healthy living as a part of the total education of the students. School health programme as a component of maternal and child health, is a programme of health promotion, protection and conservation which aims at ensuring that during the school period, the pupils are well enough to take part fully in school activities [2].

The school health can be referred to as the initiation, maintenance and improvement of the health of school children and school personnel. School health services include health education and offering health services during school hours. Universally, it is recognized that the health of school child deserves special attention and in order to achieve or receive maximum benefit from the educational programme, the child must be healthy physically, mentally and emotionally. Public school entry is the first time since birth that virtually all children are within the purview of an opportunity to proactive health intervention that has only partly been taken advantage of.

On the other hand, a comprehensive school health programme cannot only promote a child’s achievement in health literacy but also promote the capacity to obtain, interpret and understand basic health information, services and competence to use such information in ways which enhance health (Joint Committee 2005).

Often times, the rapid physical and mental development that children undergo occurs during school age. Therefore it is paramount that a healthy environment is required to provide children with the best opportunity to make appropriate adjustment during critical periods. The need for a good school health programme is particularly critical in many developing countries where the school children are the survivors of high childhood mortality apart from the universal reason mentioned earlier. Many of these school children still bear the sequel of the disease which were responsible for the death of other children and most are still subject to the environmental conditions which predisposes the high morbidity and mortality of pre-school age groups.

Objectives

1. To identify the components of school health programme
2. To identify common infections that may occur among school children and their prevention.
3. To discuss the roles of the health workers in school health programme.
4. To identify and discuss the relevance of school health programme in child health.

Components of School Health Programme
With reference to the objectives of school health services the components are as follows.

Health Education
Health education is an integral part of school health service. It is meant to give the student the opportunity of early development of insight into the implication of negative attitude to issues affecting their health. Through health education, pupils learn how to promote good health, prevent diseases and seek immediate medical attention. It is also designed to provide the pupils and staff with information in the area of health protection these include personal hygiene, chemical abuse, nutrition, education on drug abuse and use, alcohol, smoking, use of toilet facilities, sex education especially in relation to teenage pregnancy and sexually transmitted disease etc. Health education like general education is concerned with change in knowledge, attitude and behaviour. School health education is that part of health education which takes place in and through the schools.

“Cleanliness is next to Godliness” is a common saying, mere teaching of cleanliness of body and surroundings is not enough unless it is effectively demonstrated and maintained by teachers and students themselves in schools, homes, family and in the community. Essential and obligatory “five cleans” to be observed and practiced daily include clean hands before eating, clean mouth and teeth, clean food, clean water and clean Environment.

Therefore, careful planning in health education and integration with other subjects are of utmost important [3].

Nutrition
The importance of maintaining good nutritional status in a school child cannot be over emphasized. Nutritional care as a component of school health service is aimed at ensuring that every school child is in good nutritional condition so as to be able to develop and grow normally, maintain a reasonably level of resistance to infection and hence have both physical and mental health.

One strategy which most school health service organizers used to adopt before the structural adjustment programme was to ensure that every school child had at least a meal in the school per day. This was aimed at ensuring that a school child had at least a balanced diet once a day. The school should have school meal programme as this provides a valuable demonstration of good balanced diets. The school meal can also be specifically designed to supplement the child’s home diet in such a way as to make up any major specific nutritional deficiencies. Before food vendors are allowed to sell food in a school, they must be sent to a hospital for screening of infectious diseases, such as typhoid and tuberculosis. Their homes must also be inspected by the staff of the school health unit before being contracted and routinely later [4].

Healthy/Safe School Environment
The school is like a second home for the child. He spends 6-8hrs a day in the school premises throughout his childhood. In order to safeguard the health of the children and also provide them with a practical example of healthy living. It is important to ensure that the school environment is maintained at a high standard. School environment must reinforce the theoretical lessons learnt in the class.

School should be sited in a safe place free from excessive noise and nuisance example smoke soot. School building should be well constructed with a non-leaking roof, walls free from dampness, structure being stable so as to minimize accidents and classrooms should be well ventilated and well lit. The black board and visual aids should not be a strain on the eyes. The facilities needed in the school includes good sanitary facilities for waste disposal is essential to prevent breeding ground for flies that may cause many diseases, adequate safe water supply for drinking and washing and adequate facilities for recreation should be provided.

If the physical environment of a school is untidy and consists of dangerous, dilapidated structures, the children stand at risk of being exposed to infection and accident, therefore, a school health service should include a programme of environmental sanitation whereby pupils and teachers can be motivated to maintain good personal and environmental hygiene and keep their environment free of things that can cause accidents such as uncompleted latrines, open trenches, fire, open dumping etc [5].

Routine Immunization Against Communicablediseases
Immunization is the administration of a vaccine or vaccines to stimulate the body to create immunity against specific diseases. Immunization is necessary and needed to prevent episodes of illness which may lead to morbidity and mortality of children. Also children with the illness are also more likely to develop other infections such as diarrhea as their resistance and ability to fight off infection is reduced. The wide spread use of vaccine in the developed world is a major factor in the reduced mortality and morbidity from the six diseases and associated illness. Immunization is a more effective way of using scarce resources than treating diseases after they occur.

If parents keep to the present arrangement for immunization, it is expected that all Nigerian children must have completed their immunization schedule before the age of two years. Many children remain unimmunized by the time they enter school therefore, as part of school health programme, immunization services should be offered on continuous basis.

Apart from failure to receive immunization during early childhood, children need to be routinely vaccinated against some diseases such as yellow fever, cholera, poliomyelitis etc especially during epidemics [2].

Medical Inspection
In advanced countries like Britain and America, there are policies which require that specific screening measures should be taken at specific period and intervals in schools. For example, in some countries, all children must compulsorily be screened for abnormalities before they enter elementary school and during the first year in school. Apart from routine screening, all children must also undergo a compulsory screening test in the middle of the elementary school course and during the final year that is before leaving the school. The screening tests usually cover learning disabilities, speech problem, sight, hearing disabilities and physical defects.

In most developing countries, including Nigeria, such services are not available due to lack of policy, poor planning and misplaced priority. This often results to failure to defect minor effects early and sending such children for treatment. The implication of this is that a minor defect such as congenital cataract, may lead to poor performance or failure to cope with school demands and possibly becoming a dropout and later becoming a beggar or a liability to the family and the society at large. For example, an author was carrying out a research on the handicapped school children in Ibadan, a grown up boy with bilateral congenital cataract was found in a class meant for the mentally retarded children because his partial blindness prevented him from being able to cope in a school for normal children. So, they thought that he had low intelligent quotient.

In an ideal situation, screening services for school children may take the following forms: informational screening of each child may be done daily by the teacher during morning assembly or in the class, this may cover the teeth, hair, nails, skin, school uniform etc Routine screening examination for vision, hearing and speech defects may be conducted by a doctor or a community health officer in schools, at least once a term.

Screening for specific diseases such as tuberculosis, and typhoid may be done for school children who have been exposed to such infection. Periodic medical examination may be performed by a doctor or community health officer or a nurse to identify children suffering from minor illness and topical ulcers [3].

Treatment of Minor Ailment/First Aid
School children are prone to sudden illness especially malaria and accident. Therefore, a school health service should aim at establishing an adequate first aid or emergency service to attend to minor illnesses and injury. Regular deworming of school children should be encouraged as there is evidence that intestinal worm infestation may affect the cognitive skills of school children.

Apart from setting up a first aid box in every school, the teachers should also be trained to manage common emergency health problems among children such as convulsion, epistaxis, fever, minor abdominal pain etc. A staff nurse should be in the school to carryout first aid treatment and should be made to appreciate the importance of referring serious cases to the hospital [6].

Counseling Services
There are several factors which can lead to emotional problems among pupils, their parents or teachers. Example, children from broken homes often lack emotional support and that can lead to psychosocial problem such as truancy, psychosomatic illnesses etc. Therefore, there is the need to establish a counseling unit within school health programme where children, their family and teachers can be counseled on matters related to the progress of school children. The unit should be headed by a psychologist (if possible) or experienced community physicians [4].

Assessment of Handicapped Children
Through medical examination some children that are physically/ mentally handicapped had the opportunity to be identified. Such groups are assessed, supervised and placed in the most appropriate institution of special care as indicated. The groups are classified as follows.

Blind and partially sighted Children with speech/hearing defect
Educationally subnormal
Maladjusted and psychotic
Physically handicapped or delicate Epileptic

In Nigeria, Iike many countries of the world, the national policy on education make special provision for the education of handicapped children. In many states there are special schools and special units within regular schools for education of handicapped children and these children have special health and social problems. Therefore special services should be provided for them and it includes regular medical examination, provision of wheel chairs, family supportive system, such as counseling, special drugs etc [6].

Control of Infection
Children see going to the school as an opportunity to mix with other children from the society other than their immediate neighbours/close relatives. School therefore often serves as their first contact with infections to which they are susceptible. Early detection of sick children suffering from infectious disease is very necessary in controlling infection. The protection of susceptible children against such infections as diphtheria, polio, typhoid through immunization is also important. There is need to provide routine vaccination programme by the school health service. Parents should be achieved not to send sick children to school. Teachers should note any sign of illness during the course of teaching and inspection of children. The health of the school teachers and other personnel should be kept under control and careful observation to ensure prevention of transmission of infection to school children. Example food vendors should be screened for enteric infections while teachers for tuberculosis routinely. Routine screening and closure of school should be done during outbreak [3].

Record Keeping
Records on number and types of illness treated or referred out, accident records and results of pre-admission and periodic medical examination of the pupils and staff among others should be kept. This is useful for planning, decision making baseline data and for statistical purpose [6].

Common Infections That May Occur Among School Children / Preventions
These include :-

Dental disease
Ear and Eye infections
Open wounds and ulcers Scabies
Gastroenteritis
Tineacapitus
Measles
Worm infestation

Prevention of Dental Disease
Health education on oral hygiene which include regular cleaning of teeth with toothbrush, chewing sticks among others in the morning, after meal and last thing at night. Minimize soft drinks. Do not use the teeth to open bottle drinks, avoidance of tooth picking with sharp objects example pins, needles etc. there should be once or twice dental check up in a year, early detection and referral [6].

Prevention of Ear and Eye Infection
Do not put sharp objects in the ear, use cotton wool swabs to clean the ear and eye, treatment of ear or eye infections, avoid slapping or flogging on the eye or ear, encourage intake of food rich in vitamin A example carrots, palm oil and vitamins supplement, annually medical check up on visual acuity and ear check up. Prompt treatment and referral.

Prevention of Tinea Capitus
Health education on personal hygiene such as hair washing, plaiting and barbing, avoid sharing objects or materials example hair tie and cap. Early detection of infected cases and appropriate treatment, infected pupils should be referred to the hospital and excluded from school.

Prevention of Worm Infestation
Wash hands before food and after using the lavatory; eat well cooked food, boiling and filtering water before drinking, avoid contamination of vegetable by faecal matters, proper washing of fruits and vegetable before eating, finger nails should be cut and trimmed neatly, Prophylactic periodic use of anti-helmenthics preferably every six months.

Prevention of Open Wound and Ulcers
Proper wearing of shoes, cleaning of the school compound to avoid pricks or sharp objects like bottles, needles, razor blade, educate the children against rough play, supervision of pupils in school during break period. Engage them in constructive plays, diversional plays like toys to distract them example allow them to watch cartoons.

Prevention of Gastroenteritis
Proper hand washing before and after toilet, boil and filter drinking water, proper washing of vegetables before eating. Proper disposal of excreta from known cases in the school and early detection, treatment during epidermics.

Prevention of Scabies
Ensure personal hygiene that is daily bathing, avoid sharing of clothes especially those with infection, ensure pupil wash hair uniform regularly dry them under the sun. Promoting of environmental hygiene, discourage children from lying on the floor, proper management and isolation of identified cases.

Prevention of Measles
Ensure immunization has been given on admission to school, health education on adequate diet, supplementary immunization of pupil during outbreak. Early detection of cases, exclusion of infected cases from school and proper management of identified cases.

Roles of Health Officers in School Health Programme
Health officers include Nurses, doctors and other health care providers, their roles are as follows:

They should know the target group (student or pupils) and those that need particular care, they should attend all meeting concerning the welfare of the students, conduct general examination of students at entrance into the school and periodically. Give health education on issues concerning healthy living example personal and environmental hygiene; inspect the sanitation of the school in collaboration with the school teachers (toilet facilities, water supply), supervises the school meals in conjunction with the school teachers, maintaining, the students medical record for follow up and referrals, liase with school teachers to identify students who are in the vulnerable group example hearing and speech defect or mentally challenged.

Also liase with parents of those children who needs special care, treatment of minor ailments and first aid in emergency situation.Immunization of the target group, investigation of food vendors to eliminate carriers of infectious diseases [6].

The Relevance of School Health Programme in Child Health
School health programme is an indispensable tool in child health because children must be healthy physically, mentally and emotionally, in order to achieve or receive maximum benefit from educational programme and to successfully undergo rapid physical and mental development of this stage. School health programme has the unique opportunity to provide health education which is a sure means of establishing a firm foundation for the children and to ensure healthy future adults of tomorrow for the nation.

Provision of adequate diet for good development of school children is an integral part of school health programme. School health programme also provide practical demonstration, instruction on nutrition which could include growing of food crops in the school garden, mother-craft and cookery classes especially for girls. Children see going to school as an opportunity to mix with other children from the society other than their immediate close relatives. School often serves as their first contact with infection to which they are susceptible.

School health programme offers early detection, proper control of infection and closure of school during epidermics to ensure the school children grow and develop healthy.

School health programme provides adequate first aid and emergency services for the treatment of common injuries / diseaseslike convulsions, epistaxis, sprain; fracture and so on, thereby prevents permanent disabilities among school children.

Counselling services provides emotional comfort for children from broken homes and severed handicapped children, contributing to their psychosocial development and good academic performance.

In general, the roles of school health programme in child health cannot be overemphasized. Organization of school health services that are provided in school health programme include Medical inspection, screening tests for defects and clinics for consultation and child guidance ensuring that children grow and develop healthy both physically, mentally, spiritually, emotionally, socially, academically and psychologically [7].

Conclusion
This study deals with school health programme, an indispensableprogramme in child health. School health programme is run to prevent diseases and also to treat any illness in school children. The promotion of the physical and mental health of a child is a joint responsibility between the parents, the school and the school health service providers. Therefore the parents teachers Association (P.T.A) School form an integral part of a school health services.

Consequently, it was discovered that school health programme is an indispensable tool in child health because children must be healthy physically, mentally and emotionally for them to achieve maximum benefit from educational programme and to successfully undergo rapid physical and mental development of this stage.

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