School Health Services

School health is a branch of community health that is an economical & powerful means of raising the health of future generations.

• Medical examination of school children carried for the first time in India in Baroda city in 1909.
• In 1953, the 'secondary examination committee' emphasized the need & in 1960, the GOI constituted a school health committee.

Health problems of the school children

It may vary from one place to another but the main emphasis will fall in the following categories:

• Malnutrition
• Infectious diseases
• Intestinal parasites
• Diseases of the skin, eye, & ear.
• Dental caries 

Objectives of School health services

• The promotion of positive health
• The prevention of diseases
• Early diagnosis, treatment & follow up of defects
• Awakening health consciousness in children
• The provision of a healthful environment

Aspects of School health services

• Health appraisal of school children & school personnel
• Remedial measures & follow up
• Prevention of communicable diseases
• Healthful school environment
• Nutritional services
• First aid & emergency care
• Mental health
• Dental health
• Eye health
• Health education
• Education of handicapped children
• Proper maintenance & use of school health records

1. Health appraisal:

It consists of periodic medical examinations & observation of children by the class teacher.

(a) Periodic medical examinations: 

• The school health committee (1961), recommended medical examination at the time of entry & thereafter every 4 years.
• Initial examination- History & physical examination with tests for vision, hearing, and speech. 
• Routine blood & urine examination. 
• Clinical examination for nutritional deficiency & examination of faeces (for intestinal parasites). 
• Medical inspection (quarterly) should be helped by teachers & should be done in presence of parents.

(b) Medical examination of school personnel & teachers.

(c) Daily morning inspection: by the teacher & children with any sign & symptoms for any disease should be referred to the school medical officer. 

2. Remedial measures & follow up: 

The medical examination is followed by appropriate treatment & follow up. 

• Special clinics are conducted for school children exclusively at PHCs in rural areas & for a population of 5000 in urban areas. 
• These are conducted considering the high prevalence of dental, eye, ear, nose & throat defects in school children in India.

3. Prevention of communicable diseases:

• A well-planned immunization program is emphasized for school children & all records are maintained. 

4. Healthful school environment:

It is necessary for the best emotional, social, and personal health of the students. The minimum standards for sanitation of the school & its environment are as follows

(a) Location: 

• The school should normally centrally situated with proper approach roads, at a fair distance from busy places, roads, cinema houses, factories, railway tracts & market places. 
• Premises should be properly fenced & kept free of all hazards.

(b) Site:

• The school should be situated at a suitable high land with proper drainage. 
• 10 acres of land should be provided for higher elementary schools & 5 acres for primary schools with an additional one acre per 100 students. 

(c) Structure: 

• Nursery & secondary schools should be single storied as far as possible. 
• Walls should have a minimum thickness of 10 inches & should be heat resistant.

(d) Classroom: 

• Verandahs should be attached to classrooms. 
• No classroom should accommodate >40 students. 
• Per capita space for students in a classroom should not be <10 sq. ft.

(e) Furniture: 

• Should suit the age group of the students. Single desks & chairs should be provided. 
• Desks should be 'minus type' & chairs should be provided with proper 'backrests'.

(f) Doors & Windows: 

• Windows should be at a height of 2'-6'' from the floor level. 
• The combined door & window area should be at least 25% of the floor space. 
• Cross ventilation should be present. The ventilators should not be <2% of the floor area.

(g) Colour: 

• Inside of the classroom should be white & should be periodically whitewashed.

(h) Lighting: 

• Classrooms should have sufficient natural light, preferably from the left & should not be from the front.

(i) Water supply: 

• A safe & potable water supply should be there. It should be continuous & distributed through taps.

(j) Eating facilities: 

• There should be a separate room for mid-day meals or lunch. 
• Unapproved vendors should not be allowed inside the school premises.

(k) Lavatory: 

• One urinal for 60 students & one latrine for 100 students. 
• Arrangements should be separate for boys & girls.

5. Nutritional services: 

The diet of school child should contain all the nutrients in proper proportion, adequate for the maintenance of optimum health. Deficiencies relating to proteins, vitamin A, C, thiamin & riboflavin, calcium, and iron are widely prevalent among school children.

(a) Mid-day school meal: 

• School meals should provide at least 1/3rd of the daily calorie requirement and about 1/2 of the daily protein requirement of the child.

(b) Applied nutrition programme:  

• Under this school, gardens are developed with the help of facilities provided by UNICEF (in the form of implements, seeds, manure & water supply). 
• The produce may be utilized in the school feeding programme as well as for nutrition education.

(c) Specific nutrients: 

• Are indicated where nutritional disorders are problems in the community e.g dental caries, endemic goitre, night-blindness, PEM, anaemias, etc.  

6. First aid & emergency care: 

The emergencies commonly met in the schools are 

(a) Accidents leading to minor or serious injuries

(b) Medical emergencies such as gastroenteritis, colic, epileptic fits, fainting, etc.

• Every school should be well equipped with First-aid as per regulations of St. John ambulance association of India.
• Training for first aid should be given during the teacher's training programmes & in-service training programmes. 

7. Mental Health: 

The mental health of the child affects the physical health & learning process.

• Problems among school children are juvenile delinquency, maladjustment, drug addiction, etc.
• A good school environment helps children to develop into mature, responsible & well-adjusted adults.
• There should be enough relaxation between periods of intense work.
• No distinction should be made between race, religion, caste or community, rich & poor, clever & dull.

8. Dental health:

• School children frequently suffer from dental diseases & defects (e.g dental caries, periodontal disease).
• Dental examination should be done once in a year & dental hygiene should be taught by teachers.

9. Eye health services:

• Basic eye health services should be provided in schools.
• Schools should be responsible for the early detection of refractive errors, treatment of squint, amblyopia & trachoma.
• Administration of vitamin A should be done to children at risk.

10. Health education:

This is the most important element of the school health programme. It is a function of the school teacher with the assistance of health officers, nursing staff health worker or health assistant.

The goal is to bring about desirable changes in health knowledge, in attitude & in practice, and not merely teaching the rules of hygiene. 

(a) Personal hygiene:

• Need for the hygiene of skin, hair, teeth & clothing should be impressed & attention to the posture should be given.

(b) Environmental health:

• Young people should be encouraged to keep their environment clean & participate in health activities (e.g vaccination, fly control campaigns, construction of Sanitary wells & latrines

(c) Family life:

• School health services are not only concerned with the development of healthy lives but also with healthy attitudes towards human reproduction.

11. Education of handicapped children:

It requires the co-operation of health, welfare, social & educational agencies.

• The goal is to assist the handicapped child (& his family)  to reach his/her maximum potential, lead a normal life, to become independent, productive & self-supporting member of the society.

12. School health records:

Health record of each student should be kept & maintained which gives cumulative information on health aspects of children & contains:

• (a) Identifying data- Name, date of birth, parent's name & address, etc.
• (b) Past health/ medical history.
• (c) Record of findings of physical examination, screening tests & services provided.

These records will be useful in analysing & evaluating school health programmes & providing a useful link between home, school & the community.

References:

1. Park, K. (2019). Park's textbook of preventive and social medicine. 25th. Jabalpur, India: M/S Banarsidas Bhanot.
2. Kadri AM. (2019). IAPSM's Textbook of Community Medicine. 1st. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
3. https://depositphotos.com/312116234/stock-illustration-doctor-doing-medical-examination-and.html photo credit