Assessment of school children and environment

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Assessment of School Children and Environment

(Source: Park's Textbook of Preventive and Social Medicine)

Overview

School health is a branch of community health. The modern concept has evolved from narrow periodic medical examinations to a comprehensive model covering the physical, mental, emotional, and social health of children throughout the school years - Park's Textbook of Preventive and Social Medicine, p. 670.

Health Problems of the School Child

In India and most developing countries, surveys identify five main health burden areas:

Malnutrition
Infectious diseases
Intestinal parasites
Diseases of skin, eye, and ear
Dental caries

Objectives of the School Health Programme

Promotion of positive health
Prevention of disease
Early diagnosis, treatment, and follow-up of defects
Awakening health consciousness in children
Provision of a healthful environment

PART 1: Assessment of School Children (Health Appraisal)

A. Periodic Medical Examination

The School Health Committee (1961) recommended examination at:

Entry into school
Every 4 years thereafter (more frequently in well-resourced settings)

The initial examination must be thorough and include:

Component	Details
History	Detailed past health history
Physical examination	Complete head-to-toe examination
Vision testing	Refractive errors, squint, amblyopia
Hearing and speech	Audiometry/screening
Nutritional assessment	Clinical signs of deficiency diseases
Stool examination	Intestinal parasitosis (important in India)
Tuberculin test / mass screening	For TB
Blood and urine routine	Baseline investigations

Parents should be present at these examinations whenever possible.

B. Daily Morning Inspection by Teacher

Teachers are a frontline resource for detecting early illness. Clues prompting referral to the school medical officer include:

Unusually flushed face, any rash or spots
Symptoms of acute cold, coughing, sneezing, sore throat
Rigid neck (meningism alert)
Nausea and vomiting, diarrhoea
Red or watery eyes, headache, fever/chills
Listlessness or sleepiness, disinclination to play
Skin conditions (scabies, ringworm), pediculosis

C. Routine Monitoring by Teachers

Quarterly recording of height and weight
Annual testing of vision
Preparing children for medical examinations (explaining "how" and "why")
Observing posture - poor sitting/standing postures should be corrected early

D. Assessment of School Personnel

Medical examination should extend to teachers and other school staff, as they are part of the environment to which children are exposed.

PART 2: Assessment of the School Environment

A healthful school environment is necessary for optimal emotional, social, and personal health. Schools should serve as demonstration centres of good sanitation for the community.

Minimum Environmental Standards (India)

Parameter	Standard
Location	Centrally situated; away from busy roads, factories, cinema houses, railway tracks
Site	High land, not prone to dampness/flooding; properly drained
Land area	10 acres for higher elementary schools; 5 acres for primary schools + 1 extra acre per 100 students
Structure	Single-storied for nursery and secondary schools; exterior walls min. 10 inches thick, heat-resistant
Classroom size	Maximum 40 students per classroom; per capita floor space not less than 10 sq. ft.
Furniture	Age-appropriate; single desks with proper back-rests; "minus-type" desks
Doors/Windows	Window bottom sill at 2'6" from floor; combined door+window area ≥ 25% of floor space; cross-ventilation ensured; ventilators ≥ 2% of floor area
Lighting	Adequate natural light; no glare
Colour	Light interior colours to reduce eye strain
Water supply	Safe, adequate drinking water
Sanitation/Latrines	Separate for boys and girls; hygienic
Waste disposal	Proper garbage disposal on school premises
Playground	Adequate space; in congested areas, nearest public park to be made available

PART 3: Key Aspects of School Health Service

1. Remedial Measures and Follow-Up

Medical examination findings must lead to action - special clinics for school children at PHCs (rural) or designated schools/dispensaries (urban) covering approximately 5,000 children. Referral beds in hospitals for children needing in-patient investigation.

2. Prevention of Communicable Diseases

Planned immunization programme against all common communicable diseases
Records of all immunizations maintained in school health records
Health record follows the child upon leaving school

3. Nutritional Services

Clinical assessment for nutritional deficiency at each examination
Iron and Folic Acid (IFA) tablets administered weekly (under Ayushman Bharat programme)
Albendazole (deworming) bi-annually - National Deworming Day

4. Mental Health

Emotional well-being is an integral component of school health. Assessment includes observing social behaviour, academic performance, and emotional responses.

5. Dental Health

Routine dental inspection; treatment of caries; emphasis on oral hygiene education.

6. Eye Health Services

Detection and treatment of refractive errors
Treatment of squint and amblyopia
Detection and management of trachoma and eye infections
Vitamin A supplementation for at-risk children

7. First Aid and Emergency Care

First aid box in each school
Teachers trained in basic first aid
Linkage with ambulance, fire brigade, police, and nearest health facility

8. Education of Handicapped Children

Aims to help the handicapped child reach maximum potential and become as independent as possible, requiring cooperation across health, welfare, social, and educational agencies.

PART 4: School Health Records

A cumulative health record for each student must be maintained containing:

(a) Identifying data (name, DOB, parent details, address)
(b) Past health history
(c) Findings of physical examinations and screening tests
(d) Record of all services and treatments provided

Purpose:

Continuous intelligent health supervision
Analysing and evaluating school health programmes
Providing a link between home, school, and the community

PART 5: Ayushman Bharat - School Health Programme

Under this programme, two designated teachers per school (preferably one male, one female) are trained as "Health and Wellness Ambassadors" to deliver health promotion activities for one hour per week.

Frequency	Activity
Weekly	Classroom health education; IFA tablet administration
Fortnightly/Monthly	Thematic school assembly; question box responses
Quarterly	Thematic Adolescent Health Days (AHDs); parent-teacher meetings
Bi-annual	National Deworming Day (albendazole)

Students act as "Health and Wellness Messengers" in their communities. Linkage maintained with WIFS, NDD, MHS, RBSK, and Adolescent Friendly Health Centres.

PART 6: School Health Administration

Responsibility shared between parents, teachers, health administrators, and the community
In India, administered through the Departments of Health and Education (varies by state)
School health service is an integral function of Primary Health Centres (PHCs)
One whole-time medical officer covers 5,000-6,000 children per year
School Health Committees at village, block, district, state, and national level to mobilize community resources

Summary: Components of School Health Assessment at a Glance

ASSESSMENT OF SCHOOL CHILDREN
├── Health Appraisal (Periodic + Daily inspection)
├── Nutrition (Growth monitoring, deficiency screening)
├── Vision and Hearing screening
├── Dental assessment
├── Mental health observation
├── Immunization status review
└── Stool examination (parasitosis)

ASSESSMENT OF SCHOOL ENVIRONMENT
├── Location and site suitability
├── Classroom adequacy (space, light, ventilation)
├── Furniture ergonomics
├── Safe water supply
├── Sanitation (toilets, drainage, waste disposal)
└── Playground/physical activity space

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