SCHOOL HEALTH SERVICES

2. SCHOOL HEALTH SERVICES

3. Learning objectives At the end of the class students will be able to : Define school health Define school health services Enlist the health aspects school health services Discuss the components of school health services Describe healthful school living List the health problems of school children Enumerate the school health team Explain role of a community health nurse in school health services

4. INTRODUCTION School health is an important branch of community health. According to modern concepts, school health service is an economical and powerful means of raising community, health and more important, in future generations.

5. HISTORICAL DEVELOPMENT: The beginning of school health service in India dates back to 1909,when for the first time medical examination of school children was carried out in Baroda city. The Bhore Committee(1946) reported that school health services strongly recommended.

6. Cont….. In 1953,the secondary education committee emphasized the need for medical examination of pupils and school feeding programmes. 1958 the school health education division set up in the central health education bureau. 1979 the nation school health scheme was launched was handed over to the state government.

7. Cont.. 1981 task force was established by the government of India. 1989 directorate general of health services had launched an intensive school health education project. Innovative measures such as ‘’child to child’’ and ‘’youth to child’’ approaches were used.

8. HEALTH PROBLEMS OF SCHOOL CHILD A school health service must be based on the local health problems of the school child ,the culture of the community and the available resources in terms of money ,material .and manpower. while the health problems of school children vary from place to place to another, surveys carried out in India indicate that the main emphasis will fall in the following categories:

9. Cont…. Malnutrition Infectious Diseases Gastro intestinal Skin Conditions Eye conditions Respiratory problem Behaviour problems

10. Definition of school health services It refers to need based comprehensive services rendered to pupils, teacher and personnel in the school to promote and protect their health, prevent and cotrol diseases and maintained their health.

11. Aims of school health services Create health awareness among school children, parents and teachers Provide healthy and safe environment Communicate health information Prevent communicable and non communicable diseases

12. Cont… Identify and treat any abnormalities as earliest Referral and follow-up services Engage teacher and the parents management of health problems of children's. Help the teacher and children constructive productive use co -curricular and extra curricular activities

13. OBJECTIVES OF SCHOOL HEALTH SERVICE The objectives of the programme of school health service are as follows: 1.promotion of positive health 2.the prevention of diseases 3.early diagnosis and treatment 4.awakening health consciousness in children 5.the provision of healthful school environment

14. ASPECTS OF SCHOOL HEALTH SERVICE Some aspects of a school health service are as follows: 1.health appraisal of school children and school personnel 2.remedial measures and follow up 3.prevention of communicable diseases 4.healthful school environment 5.nutritional services

15. Cont…. 6.first aid and emergency care 7.mental health 8.dental health 9.eye health 10.health education 11.education of handicapped children 12.proper maintenance and use of school health records.

16. I.HEALTH APPRAISAL The health appraisal should cover not only the students but also the teachers and other school personnel. Health appraisal consists of periodic medical examinations and observation of children by the class teacher.

17. (a) Periodic medical examination: The school health committee (1961) in India recommended medical examination of children at the time of entry and they’re after every 4 years. • The initial examination should include a careful history and physical examination of the child with tests for vision, hearing and speech routine examination of blood and urine should be carried out.

18. Cont…. Clinical examination for nutritional deficiency and examination of faeces for intestinal parasites are particularly important in India. Tuberculin testing or mass screening should not be with held. The parents should be persuaded to be present at these examinations.

19. Cont… The teachers should help in the quarterly recording of height and weight annual testing of vision, and preparing children for examination by helping them to understand the” how” and “why” of health appraisal. (b)school personnel: medical examination should be given to teachers and other school personnel as they form the part of the environment to which the child is exposed

20. Cont… (c) daily morning inspection:the teacher is in a unique position to carry out the “daily inspection”as he is familiar with the children and can easily detect the changes in the child’s appearance or behaviour that suggest illness or improper growth and development.

21. Cont… ·        The following clues will help the school teacher in suspecting children who need medical attention: ·        Unusually flushed face ·        Any rash or spots ·        Symptoms of acute cold ·        Coughing and sneezing ·        Sore throat ·        Rigid neck ·        Nausea and vomiting ·        Red or watery eyes ·        Headache

22. Cont…. Chills or fever ·        Restlessness or sleepiness ·        Disinclination to play ·        Diarrhea ·        Pains in the body ·        Skin conditions like scabies or ring worm ·Pediculosis

23. Cont… Children showing any such signs or symptoms should be referred to the school medical officer. teacher’s should be adequately trained during teacher training courses and subsequently by short-service training courses.

24. REMEDIAL MEASURES AND FOLLOW-UP     Medical examinations are not an end in themselves; special clinics should be conducted exclusively for school children at the primary health centers in the rural areas, and in one of the selected schools or dispensaries in the urban areas. the clinic days and time should be intimated to all the schools concerned.

25. Cont… Considering the high the high prevalence of dental ,eye, ear, nose and throat defects in the school children in India,Special clinics should be secured or provided for the excusive use of school children for examination and treatment of such defects. There should provision for beds in the existing referral hospitals for the children to be admitted for investigation and treatment as and when required.

26. 3.PREVENTION OF COMMUNICABLE DISEASES: Communicable diseases control through immunization is the most emphasized school health service function .A well planned immunization programme should be drawn up against the common communicable diseases. A record of all immunizations should be maintained as part of school health services/records. When the children leave the school health record should accompany him.

27. 4.HEALTH FUL SCHOOL ENVIRONMENT: A healthful school environment therefore is necessary for the best emotional, social and personal health of pupils. Schools should also serve as demonstration centers of good sanitation to the community. The following minimum standards for sanitation of the school and its environs have been suggested in India.

28. 1) Location: The school should normally be centrally situated with proper approach roads and at a fair distance from busy places and roads, cinema houses, factories, railway tracks and market places .the school premises should be properly fenced and kept free from all hazards. 2) Site: The site should be on suitable high land, and not subject to inundation or dampness and can properly be drained.

29. The school health committee (1961) recommends that 10 acres of land be provided for higher elementary schools and 5 acres for primary schools with an additional of 1 acre of land per 100 students. In congested areas, the nearest public park or play ground should be made available to the students.

30. 3) Structure: nursery and secondary schools, as far as possible should be single storied. Exterior wall should have a minimum thickness of 10 inches and should be heat resistant. 4) Class room: verandas should be attached to the classrooms. No classroom should accommodate more than 40 students. per capita space for students in a classroom should not be less than 10 sq.ft

31. Cont… 5) Furniture • Furniture should suit the age group of students. it is desirable to provide single desks and chairs. desks should be of minus type chairs should be provided with back rest, with facilities for desk work. 6) Doors and windows: the windows should be broad with bottom sil, at the height of 2-6’ from the floor level. combined door and window area should be placed on different walls for cross ventilation; the ventilators should not be less than 2% of the floor area.

32. Conti… 7) Co lour: inside co lour of the class room should be white and should be periodically white washed. 8) lighting: class rooms should have sufficient natural light ,preferably from left, and should not be from front.  9) Water supply: there should be an independent source of safe and portable water supply, which should be continuous and distributed from the taps.

33. Conti.. • 10) Eating facilities: vendors other than those approved by the school authorities should not be allowed inside school premises; there should be a separate room provided for mid-day meals • 11) Lavatory: rives and urines should be provided-one urinal for 60 students and one latrine for 100 students. Arrangements should be separately made for boys and girls.

34. Conti… 5.NUTRITIONAL SERVICES: A child who is physically weak will be mentally weak, and cannot be expected to take full advantage of schooling. the diet of the school child should therefore receive first attention. the diet should contain all the nutrients in proper proportion. adequate for the maintenance of proper health. Studies in India have shown that nutritional disorders are widely prevalent among school children, particularly deficiencies relating to proteins, vitamins A C, thiamine and riboflavin calcium and iron.

35. Conti.. Mid day school meal: The school health committee recommended that school children should be assured of at least one nourishing meal. Those who can afford it may bring their lunch packets from home and during lunch hours take their meals in schools. Otherwise schools should have some arrangement for providing mid-day meal through their own cafeteria on a “no profit no loss basis” in view of the limited finances in India, it is recommended that the school meal should provide at least one-third of the daily calorie requirement and about half of daily protein requirement.

36. Conti.. Applied nutrition programme:UNICEF is assisting in the implementation of applied nutrition programme in the form of implements, seeds ,manure ,and water supply equipment .wherever land is available ,the facilities provided by the UNICEF should be utilized in developing kitchen gardens .the produce may be used in school feeding programmes as well as for nutritional education.

37. Specific nutrients: specific nutrients may be necessary for the prevention of some nutrient disorders. dental caries .endemic goiter ,night blindness, protein malnutrition . anemia's and a host of other nutrient disorders are preventable, use of specific nutrients is indicated where such nutrient disorders are problems in the community.

38. Conti.. 6.FIRST AID AND EMERGENCY CARE:The responsibility of giving first aid and emergency care to pupils who become sick or injured on school premises rests with the teacher and therefore all teachers should receive adequate training during in service or teacher training programmes. the emergency commonly met with in schools are(a)accidents leading to minor and serious injuries(b)medical emergencies such as gastro enteritis, colic ,epileptic fits, fainting. in every school fully equipped first aid post should be provided as per regulation of st, John’s ambulance association of India.

39. Conti… 7.MENTAL HEALTH: The mental health of the child affects his physical health and learning process .Juvenile delinquency ,maladjustment and drug addiction are becoming problems among school children. the school is the most strategic place for shaping the child ’s behaviour and promoting mental health

40. Cont… the school routine should be planed that there is enough relaxation between periods of intense work, and every effort should be made to relieve the medium of the class room. No distinction should be made between race ,religion, cast or community ,between rich and poor and between clever and dull .it is now increasingly realized that there is a great need for vocational councilors and psychologist in schools for guiding the children into careers into which they are suited.

41. Conti.. 8.DENTAL HEALTH:Children frequently suffer from dental diseases and defects.Dental caries and periodontal disease are the two common dental diseases I India.A school health programme should have provision of dental examination, at least once a year. They make preliminary inspection of teeth and do prophylactic cleansing which is of great value in preventing gum troubles and in improving personal appearance.they take part in the teaching of dental hygiene as they work with the children.

42. Conti.. • 9.EYE HEALTH SERVICESSchools are responsible for the early detection of refractive errors, treatment of squint and amblyopia, and detection and treatment of eye infections such as trachoma. Administration of vitamin A to children at risk has shown gratifying results .in other words basic eye health services should be provided in schools.

43. Conti.. 10.HEALTH EDUCATION:The most important element of the school health programme is health education. the goal of health education should bring about desirable changes in health knowledge in attitudes and in practice and not mererly to teach the children a set of rules of hygiene..health education in schools covers the following areas,personalhygiene,environmentalhealth,family life etc.

44. 11.EDUCATION OF HANDICAPPED CHILDREN: The ultimate goal is to assist the handicapped child and his family so that the child will be able to reach his maximum potential to lead as normal a life as possible to become as independent as possible and to become productive and self supporting member of the society.

45. Conti.. 12.SCHOOL HEALTH RECORDS: A cumulative health record of each student should be maintained .such records should contain (a)identification data-name, date of birth. parents name and address(b)past health history(c)record of findings of the physical examination and screening tests and record of services provided.

46. Cont…. The purpose of maintaining school health record is to have cumulative information on the health aspects of school children in order to give continuing intelligent health supervision. these records will also be useful in analyzing and evaluating school health programmes and providing a useful link between home school and the community.

47. Principles of school health services Be based on the need Be planned in coordination with school health personnel, parent and community people. Be part of community system Highlight on promotive and preventive aspects Health education should be integrated in regular school curriculum.

48. Cont... Insist on health education to promote, protect, improve and maintain health of children and school. Emphasize on learning through active and desirable participation Be on going and continuous programme Maintain records keeping and eporting.

49. Components of school health programme The health services need to be comprehensive in nature and it include all the promotive , preventive therapeutic and rehabilitative care. i.e primary, secondary and tertiary level care

50. Cont… • Promotive and protective services • Healthy school environment • Maintenance of personal hygiene • Regular nutritional survives • Physical and recreational activities • Promotion of mental health • Health education in related aspects • Immunization to all children.