School-age children bear 13.7 per cent of the burden of disease in sub-Saharan Africa. This affects their school attendance and performance. How can schools improve the health of their pupils? Researchers from The Partnership for Child Development at Imperial College, London and UKUMTA (the Tanzania Partnership for Child Development) assess health problems among school-age children in Tanzania and make recommendations for the country’s National School Health Programme (NSHP).

Injuries are the biggest cause of illness in school-age children in sub-Saharan Africa but the researchers found a number of other important health problems in this age group, including:

• malaria
• intestinal worms
• urinary and intestinal schistosomiasis
• protein-energy malnutrition, micronutrient deficiencies and short-term hunger
• teenage pregnancy, abortions and sexual abuse
• diarrhoea
• skin infections.

Many of these conditions can be tackled through the FRESH (Focusing Resources on Effective School Health) framework, involving relatively simple interventions in schools, such as:

• skills-based health education, initially covering HIV/AIDS and reproductive health and then expanding to cover subjects such as malaria, injury prevention and sexual health
• development of a safe school environment
• hygiene promotion and provision of clean drinking water and at least three latrines (for boys, girls and teachers) with covers and functioning doors
• treatment for worms (albendazole or mebendazole) and schistosomiasis (praziquantel) and supplements of iron, vitamin A and iodine.

Other strategies, such as feeding programmes and providing first aid kits in schools, may not be feasible under current conditions.

The government developed the NSHP to tackle these issues which so far has formulated a national policy and introduced and trained District School Health Co-ordinators. The NSHP has also established a steering committee and conducted a national survey of the health of school-age children. However, there are few specific details of how school health interventions will be put into action. In addition, the manager of the NSHP has identified three areas for improvement:

• advocacy to convince district officers of the importance of school health and nutrition programmes
• practical guidelines to advise district co-ordinators on how to develop school health plans
• transport for District School Health Co-ordinators to implement and monitor school health activities.

The report recommends that the Ministry of Education and Culture should take the lead in implementing school health initiatives. The roles of both the Education and Health Ministries need to be more closely defined. The study also offers a plan of action and timetable for implementing the school health programme.

Steps include:

• conducting workshops for personnel at ministry and NSHP levels
• performing situational analysis of district school health activities
• training a team to instruct teachers on delivery of school-based health services
• developing a curriculum and lesson plans
• establishing a system for buying and distributing drugs
• appointing a team of advisors to monitor and evaluate the programmes
• developing and implementing school health plans for pilot districts
• repeating this process in all school districts nationwide.

Source(s):
‘A situational analysis of the health of school children and current school health and nutrition programs in Tanzania’, in ‘Focusing resources on effective school health: a FRESH start to enhancing the quality and equity of education', UNESCO, by M. Jukes and D. Ngorosho, 2000

Funded by: Wellcome Trust + James S. McDonnell Foundation + Rockefeller Foundation.

id21 Research Highlight: 28 April, 2003

Further Information:
Matthew Jukes
Partnership for Child Development
Department of Infectious Disease Epidemiology
Imperial College School of Medicine
Norfolk Place
London
W2 1PG
UK

Tel: +44 (0)20 7589 5111
Contact the contributor: m.jukes@imperial.ac.uk

Imperial College, London, UK

Other related links:
'Taking the register – surveying the health of schoolchildren in Chad'

'Meeting their needs? Discussing young people’s sexual health'

'Gut feelings - community views on deworming programmes'

Find out more about the FRESH (Focusing Resources on Effective School Health) framework.