Assessment of school children and environment
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Assessment of School Children and School Environment
(Source: Park's Textbook of Preventive and Social Medicine)
Overview
School health service has evolved from the narrow concept of periodic medical examination to a broader, comprehensive programme covering the health, nutrition, and well-being of children throughout their school years. In India, formal school health began in Baroda (1909), and the School Health Committee (1961) remains the landmark policy document.
The main health problems identified in Indian school children are:
- Malnutrition
- Infectious diseases
- Intestinal parasites
- Diseases of the skin, eye, and ear
- Dental caries
Objectives of the School Health Service
- Promotion of positive health
- Prevention of diseases
- Early diagnosis, treatment, and follow-up of defects
- Awakening health consciousness in children
- Provision of a healthful environment
Aspects (Components) of School Health Service
1. Health Appraisal of School Children
Health appraisal covers both students and school personnel. It has three components:
(a) Periodic Medical Examination
- The School Health Committee (1961) recommended examination at entry and thereafter every 4 years (more frequently in cities).
- The initial examination should include:
- Careful history and full physical examination
- Tests for vision, hearing, and speech
- Routine blood and urine examination
- Clinical examination for nutritional deficiency
- Examination of faeces for intestinal parasitosis
- Tuberculin testing / mass screening for TB
- Height and weight recording (quarterly by the teacher)
- Annual testing of vision
- Parents should be present at examinations.
(b) School Personnel Examination
- Teachers and other staff must also undergo medical examination, as they form part of the child's environment.
(c) Daily Morning Inspection (Teacher's Role)
The class teacher performs daily observation and watches for:
| Symptom/Sign | Symptom/Sign |
|---|---|
| Unusually flushed face | Listlessness or sleepiness |
| Any rash or spots | Disinclination to play |
| Symptoms of acute cold | Diarrhoea |
| Coughing and sneezing | Pains in the body |
| Sore throat | Skin conditions (scabies, ringworm) |
| Rigid neck | Pediculosis (lice infestation) |
| Nausea and vomiting | Headache / chills / fever |
| Red or watery eyes |
Children with any of the above should be referred to the school medical officer.
2. Remedial Measures and Follow-up
- Medical examinations are not an end in themselves - they must be followed by treatment and follow-up.
- Special clinics exclusively for school children should be held at primary health centres (rural) or at selected schools/dispensaries serving ~5,000 children (urban).
- Special clinics for dental, eye, ENT defects are needed given their high prevalence.
- Referral beds in hospitals should be available.
3. Prevention of Communicable Diseases
- Immunization is the most emphasized function.
- A planned immunization programme against common communicable diseases should be maintained.
- Immunization records should be part of school health records and accompany the child when they leave school.
4. Healthful School Environment
The school building and site are part of the child's developmental environment. Minimum standards recommended:
| Parameter | Standard |
|---|---|
| Location | Centrally situated, away from busy roads, factories, railway tracks, cinema halls |
| Site | Elevated, well-drained, not prone to inundation or dampness |
| Land area | 10 acres for higher elementary; 5 acres for primary school + 1 extra acre per 100 students |
| Structure | Nursery and secondary schools should preferably be single-storied; exterior walls min. 10 inches thick |
| Classroom | Max 40 students per class; min. 10 sq. ft. per capita space |
| Furniture | Age-appropriate single desks and chairs; "minus" type desks; chairs with backrest |
| Doors and Windows | Bottom sill at 2'6" from floor; combined door + window area ≥ 25% of floor space; cross-ventilation; ventilators ≥ 2% of floor area |
| Colour | Inside walls white, periodically whitewashed |
| Lighting | Sufficient natural light, preferably from the left, not from the front |
| Water Supply | Independent, safe, potable, continuous supply from taps |
| Eating Facilities | Only school-approved vendors; separate room for mid-day meals |
| Lavatories | 1 urinal per 60 students; 1 latrine per 100 students; separate facilities for boys and girls |
5. Nutritional Services
- A nutritionally deprived child cannot take full advantage of schooling.
- Studies in India show widespread deficiencies of: proteins, vitamins A, C, thiamine, riboflavin, calcium, and iron among school children.
- Mid-day Meal Programme: The School Health Committee (1961) recommended at least one nourishing meal per school day. The meal should provide at least one-third of the daily caloric and nutrient requirements.
6. Health Records
A School Health Record should be maintained for every child and should include:
| Item | Details |
|---|---|
| Personal details | Name, date of birth, class, address, parent/guardian details |
| Family history | Significant health background |
| Past medical history | Illnesses, operations, injuries |
| Immunization record | Dates and types of vaccines |
| Growth measurements | Quarterly height and weight |
| Periodic medical exam findings | Vision, hearing, clinical findings |
| Follow-up and treatment | Referrals made and outcomes |
Records should accompany the child when they leave school.
7. Health Education
- The most important element of the school health programme.
- Goal: bring about desirable changes in health knowledge, attitudes, and behavior.
- Teachers are key agents for health education.
School Health Programme under Ayushman Bharat
Under the Ayushman Bharat initiative, the school health programme uses "Health and Wellness Ambassadors" - two trained teachers (one male, one female) per school - who deliver 1 hour of health promotion per week.
Activity Calendar
| Frequency | Activity |
|---|---|
| Weekly | Classroom health transactions; IFA (Iron-Folic Acid) tablet administration |
| Fortnightly/Monthly | Thematic school assemblies; question box responses |
| Quarterly | Thematic Adolescent Health Days (AHDs); parent-teacher meetings |
| Bi-annual | Albendazole tablet (National Deworming Day) |
Age-Appropriate Health Promotion Topics
Primary School:
- Health, growth and development
- Personal safety
- Nutrition and physical activity
- Hygiene practices
- Prevention of malaria, dengue, TB, worm infestation, diarrhoea, vaccine-preventable diseases
Middle School:
- Puberty and related changes
- Eye care and oral hygiene
- Nutrition; mental health
- Bullying prevention; internet safety
- Prevention of substance abuse; HIV/AIDS
High School:
- Sexual and reproductive health
- Violence prevention; road safety
- Prevention of substance abuse
- Unintentional injury prevention
School Health Administration (India)
- Primary responsibility: State governments
- Staff at primary health centre level should be augmented for school health work
- School Health Committees should be formed to mobilize community resources and make the programme continuous and self-sustaining
- A National School Health Council serves as an advisory and coordinating body
Park's Textbook of Preventive and Social Medicine, Chapter on School Health Service (pp. 670-678)
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