European Journal of Cardiovascular Medicine

Many schoolchildren confront serious health problems as a result of their familial, environmental, or risk-taking behaviours. These health hazards are frequently linked and may share common underlying determinants, which may impair the child's capacity to learn. Thus, there is a need for comprehensive health care in schools. The school health service is an essential component of the School Health Programme. It is described as a coordinated system that ensures a seamless transition of care from school to home to community health care provider and back. ^[1]

The major purpose of the school health service is to assist students' health for them to succeed academically, as well as to provide comprehensive health services in schools for students who would otherwise lack access to health care. Screening activities and first aid are essential components of school health services. However, because of the rising prevalence of emerging and re-emerging diseases, more components have been introduced. These include vaccines, personalized healthcare plans, emergency treatment, prescription administration, special healthcare procedures, and health education and counselling for pupils, depending on state and local regulations and resources.

The World Health Organization (WHO) and other experts have stressed the importance of schools in students' health and education. According to WHO, schools must try to enhance the health of school personnel, families, and community members in addition to students, and collaborate with community leaders to assist them in understanding how the community contributes to or undermines, health and education ^[2]. Several studies have found a beneficial relationship between excellent school health services and kids' academic achievement worldwide. ^{[3, 4, 5]}

On March 12, 2008, the Indian government launched a school health campaign in 21 states to improve children's health and avoid disease recurrence. The School Health Programme aims to target 12, 88,750 government and private aided schools serving about 22 crore kids across India. ^[6] School health programs have emerged as one of the most efficient, powerful, and cost-effective approaches accessible to practically every nation in the world for dramatically improving the well-being of its people. As a result, such programs could become an important tool for improving humanity's global situation.^[7] School health is a component of an educational program that aims to modify students' knowledge, skills, and behaviour to promote healthy living.^[8] It has evolved from the narrow concept of medical examination of children to a more comprehensive care, an integrated set of planned, sequential, school-related strategies, activities, and services designed to promote students' optimal social and educational development and provide them with a good start in life.^[9]

The teacher is an important figure not just in the school's health and education program, but also in the community. Teachers are renowned leaders and role models for children and families, impacting their learning and actions. They are sometimes referred to as "change agents," influencing others to adopt new ideas that lead to better conditions.^[10] Teachers have a significant impact on schoolchildren's academic performance and play a crucial role in school health programs. ^[11] A teacher's responsibility for children's health is especially crucial in rural locations with minimal medical services. There is a strong emphasis on involving healthcare providers, educational officials, and teachers in developing and designing policies and initiatives to make the school a healthier environment.^[12] Hence the present study aims to assess the present situation regarding the implementation of health services in the schools of Nellore City of Andhra Pradesh.

Aim: To assess the implementation of school health services in the primary schools of Nellore City.

Objective: To study the extent of implementation of various aspects of school health services in the primary schools of Nellore city.

Study Design: Community-based Cross-sectional study.

Study area: The study was conducted in Primary schools which consists of classes I to V, in Nellore city.      

Study Period: 2 years. (Jan 2014 to Jan 2016).

Sample size: The study consisted of a total of 163 schools.

Sampling Technique:  Simple Random sampling.

Ethical consideration: Institutional Ethical committee permission was taken before the commencement of the study.

Study tools and Data collection procedure:

1. A pre-tested, structured questionnaire was used for data collection,
2. Data regarding certain aspects of school health services like Health facilities, Nutrition facilities, Health education and Maintenance of Health records are obtained by interviewing the Head Master of the school who is the key informant.
3. The remaining data regarding the Healthful school environment and sanitation facilities was collected by examining the school environment.
4. A self-retracting tape measure was used to measure the doors, windows and the floor area of classrooms.
5. The collected data was analysed using MS Excel 2007.

Statistical analysis: The data was entered into MS Excel, & the statistical analysis was carried out with IBM SPSS Version 20.0. The data values for categorical variables are expressed as numbers and percentages. The data values for continuous variables are shown as mean & standard deviation

Table 1. Type of Schools (n=163)

In the present study out of 163 primary schools, the majority of schools (60.1%) are managed privately, whereas 46 (28.2%) are government schools. And only 19 (11.7%) schools come under the aided category.

Table 2: Health Appraisal. (n=163)

In our study, we found that Periodic Medical Examination by health personnel and Daily Morning Inspections by teachers were done in 53 (32.5%) schools.

Table 3: Remedial Measures. (n=163)

In the present study 46 (28.2%) schools provided treatment for minor ailments like fever, stomach ache etc., and referred the students to the nearest hospital for health problems that were beyond their purview.

Table 4: Healthful school environment- I (n=163)

In the present study, it was found that the structure of the school buildings is strong in 140 (85.9%) schools.

Table 5: Healthful school environment- II (n=163)

Table 6. Sanitation Facilities (n=163)

In our study, it was revealed that toilets are available in 146 (89.6%) schools and wherever toilets are found they are separate for boys and girls.

Table 7: Special Health services. (n=163)

In the present study, it was revealed that 27 (16.6%) schools provide Eye Health Services by conducting eye health screening and referring students with vision problems to the nearest eye hospital.

Table 8: School health records maintenance. (n=163)

The present study found that school health records were issued in 46 (28.2%) schools. But none of them are being updated properly.

This study was conducted in 163 primary schools of Nellore City, to assess the implementation of School Health services. In the present study out of 163 primary schools, the majority of schools (60.1%) are managed privately, whereas 46 (28.2%) are government schools. And only 19 (11.7%) schools come under the aided category. In our study, we found that Periodic Medical Examination by health personnel and Daily Morning Inspections by teachers were done in 53 (32.5%) schools. Similar to our study, Chaturvedi S et.al¹³, in their study done in Delhi (2000) found that in 27% of the schools, the visits were made by the school health team. Jamra V. et.al¹⁴, in their study done in Bhopal City, reported that periodic health check-ups were done in 80% of government schools and 100% of private schools. This difference may be because of the political commitment of the local health authorities of Bhopal City.

In the present study  46 (28.2%) schools provided treatment for minor ailments like fever, stomach ache etc., and referred the students to the nearest hospital for health problems that were beyond their purview. Bhatia V. et.al¹⁵, in their study done in Chandigarh, revealed that 64% of schools had the facility of referring sick children to the government health centre, 16% to private clinics and 3% to both within a distance of 1 km of the school. The remedial measures are better in the schools of Chandigarh than in the schools of Nellore. In a study done on the status of school health services in Chalous¹⁶, Iran, it was indicated that except for first aid for minor disorders, schools took no further measures to treat sick children other than informing their parents and conveying them to hospitals. The remedial measures are poor in Iran when compared to Nellore.

In the present study, it was found that, preventive aspects of school health services like immunization by administering appropriate vaccines as per immunization schedule and deworming of school children by administering Tab. Albendazole 400mg single dose biannually, was performed in 45 (27.6%) schools. In Bhopal city Jamra V. et.al¹⁴, found that the immunization status of children is confirmed by 40% of government schools and 20% of private schools. Only one government school and all private schools have held immunization camps for Hepatitis-B. This contrast may be due to the better motivation of health personnel and teachers towards school health services.

In our study, we found that almost all the schools were located and cited appropriately. Similarly in Mangalore city, Joseph N. et.al¹⁷, also found the majority of schools (83.3%) were well-located & cited. Majra JP. et. 31 in rural Karnataka, found that the majority of schools (75%) were properly located & sited. This is similar to our study. In Bhopal city Jamra V. et.al¹⁴, found that 40% of government schools and 60% of private schools are located at the appropriate site.

In the present study, it was found that the structure of the school buildings is strong in 140 (85.9%) schools. In rural Karnataka, Majra JP. et.al¹⁸, found that only 50% of the schools had adequate structure. This difference may be because their study is done in rural areas whereas our study is done in urban areas. In the present study, we found that the classrooms are adequately spacious, with doors & windows and lighting & ventilation as per the norms. Similar to our study, Joseph N. et.al¹⁷, found in their study done in Mangalore city that the majority of schools (66.7%) had adequate per percapita space in classrooms. In almost all schools (96.7%) lighting and ventilation were adequate. And the windows were properly placed in all the schools.

In our study, it was found that separate eating place is provided in 67 (41.1%) schools. In a study done in secondary schools of Assam¹⁹, they have reported that common room and canteen facilities are only available in one school out of three. This study's results are almost similar to our study. In our study, it is revealed that toilets are available in 146 (89.6%) schools and wherever toilets are found they are separate for boys and girls. Kumar A. et.al²⁰, in their study done in rural areas of Uttarakhand, found that only 56.93% of primary schools had toilet facilities. This difference may be because their study is done in rural areas whereas, our study is done in urban areas. In our study, we have found safe drinking water is available in all (100%) schools. It is given by UNICEF⁴¹ that the number of schools having drinking water facilities has increased from nearly 83% in 2005-06 to 95% in 2012-13. Hence our study findings match with the National average.

In the present study, it was found that First-Aid kits were available in 117 (71.8%) schools. Fire extinguishers were available in 112 (68.7%) schools. Bhatia V. et.al¹⁵, reported in their study done in Chandigarh that only 62% of schools had first-aid/ health kits. This is similar to our study findings. In a study done in Mangalore city, Joseph N. et.al¹⁷, have reported that 96.7% of schools had first-aid kits. This difference is because Mangalore city is more developed when compared to Nellore city. Hence better results are expected in the study done in Mangalore city.

Our study reveals that Health education activities like teaching about healthy habits and healthy life skills are part of the students’ curriculum which is provided by either the State Board of Education or the National Board of Education. Similarly in Tamil Nadu²², under the Modified School Health Programme (MSHP) teachers of Grades 1 to 8 are trained annually on emerging health issues and supported to learn how to teach standardized skills-based health education curriculum with up-

to-date materials, across all districts as part of Life Skills Programme. In a study conducted in the primary schools of Gizan²³ while assessing the school's physical environment, it was shown that there was no professional health educator in all the schools

The present study found that school health records were issued in 46 (28.2%) schools. But none of them are being updated properly. In a study conducted In Mangalore city, Joseph N. et.al¹⁷, found 90% were maintaining school health records or anthropometry registers. This study's results are better than our results. The reason may be because Mangalore is a more developed city than Nellore. In an evaluation study conducted on school health services in Sagamu²⁴, Nigeria, it was revealed that a total of 59 (64.8%) schools kept no records of school health services at all. The study findings in this study are just better than our study 

The current study's findings emphasize the need for the government and health organizations to make the required efforts to improve school health services to establish a healthy community. As a result, emphasis should be placed on a multidisciplinary approach to improving school health care. Aside from a multidisciplinary approach, social and political commitment is essential to improve the quality of school-based health services

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