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School health services
School health services
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  1. 1. PRESENTEDBY: Ms. Sameeksha Bhardwaj Asstt. Professor Deptt. Of Community Health Nursing
  2. 2. INTRODUCTION Children between the age of 5-17 years are school age children. They spent most of their time of the day in the school under the direct supervision and guidance of their teachers. They are also exposed to various epidemiological factors in the school which influence their present and future state of health. Hence, school is the best place for giving health education and make a strong foundation to the healthy nation. School Health Services are primarily meant for preserving and promoting health of the students.
  3. 3. DEFINITIONS SCHOOL HEALTH It refers to a state of complete physical, mental, social and spiritual well being and not merely the absence of disease or infirmity among pupils, teachers and other school personnel.
  4. 4. SCHOOL HEALTH SERVICES It refers to need based comprehensive services rendered to pupils, teachers and other personnel in the school to promote and protect their health, prevent and control diseases and maintain their health.
  5. 5. HEALTH PROBLEMS OF SCHOOL CHILDREN There are some health problems which are common in school children. These are: 1. Malnutrition
  6. 6. 2. Infectious diseases
  7. 7. 3.Intestinal parasites
  8. 8. 4. Disease of skin, eye and ear
  9. 9. 5. Dental caries
  10. 10. NEED FOR SCHOOL HEALTH SERVICES These are necessary and important because of the following reasons. Students are: Vital and substantial segment of population and the future citizens. Exposed to various stressful situations .it can cause mental health problems, negative attitudes, affect growth and development, disturb appetite and dietary habits resulting in malnutrition. Vulnerable section of population, exposed to various environmental factors.
  11. 11. Belongs to different socio economic and cultural backgrounds which affect their health and nutrition status . Prone to specific health problems like diarrhoea, constipation, dental caries, bleeding gums, PEM, worm infestation, hepatitis, anaemia, scabies, acne, influenza, measles, mumps, chickenpox, UTI, eye and ear infection, cardiac problems etc.
  12. 12. AIM OF SCHOOL HEALTH SERVICES The ultimate aim of school health service is to promote, protect and maintain health of school children and reduce morbidity and mortality among them.
  13. 13. The specific objectives are to: • Create health consciousness among school children, their parent and teachers. • Provide healthy and safe environment which is conducive to comprehensive development of children. • Impart health information and conduct health education on various aspects of healthful living in school, home and community. • Prevent communicable and non communicable diseases.
  14. 14. • Identify and treat the abnormality and defect as early as possible and do the necessary referral and follow up. • Involve teacher, student and their parents in management of health aspects of children. • Help teachers and children make constructive and productive use of co-curricular and extracurricular activities.
  15. 15. PRINCIPLES OF SCHOOL HEALTH SERVICES School health services should: Planned in coordination with schools, health personnel, parents and community people. A school health council needs to be set up. Be based on health needs of school children. Emphasize on preventive and promotive aspect. Be a part of community health services.
  16. 16. • .Emphasize on health education to promote, protect, improve and maintain health of children and staff. Emphasize on learning through active and desirable participation. Be ongoing and continuous program. Have an effective system of recording and reporting.
  17. 17. COMPONENTS OF SCHOOL HEALTH SERVICES It includes all those aspects which can help to achieve the aim and objectives. (A)Health promotive and protective services i)Wholesome school environment: It is essential for holistic development of school children coming from varying socio economic and cultural backgrounds.
  18. 18. • Location and site: away from the nuisance, traffic, dust etc. easily approachable proper drainage system play ground • The building structure: heat proof single storied building Classrooms should be spacious, well ventilated and attached to verandas inside colour of the classrooms should be white. Minimum space of 10sq. feet should be provided to each child  proper trees and plantation.
  19. 19. • Furnishing of classroom: single desk with chair along with the back rest. desks should be of ‘minus’ type. each classroom should have adequate teaching learning facilities according to the students and resources available.
  20. 20. • Sanitary and other facilities: These facilities includes- Water supply: There should be continuous, potable and safe water supplies from the tap or well and should be chlorinated properly. Use of common glass for water should be avoided. Lavotary: There should be sanitary urinals and latrines with adequate water supply. There should be separate arrangements for boys and girls. One urinal for 60 students and one latrine for 100 students is advocated.
  21. 21. • Disposal of waste water and refuse: proper system of drainage of waste water. In urban areas it should be underground drainage system.  The refuse should be collected in dust bins kept in each classroom and other strategic areas. They should be emptied into compost pit or burnt in one of the corners away from class room especially in the rural areas.  In urban areas the refuse is collected at one place and removed to collecting areas assigned by municipality for further processing.
  22. 22. • Canteen and eating facilities: own sanitary canteen facility on subsidized basis approved vendors in the school premises. A separate room should be there for taking mid day meals. Facility for washing hands
  23. 23. ii)Maintenance of personal hygiene: very essential for the promotion of health of children. Teachers are the role model by following good personal hygiene. Educate children to follow good personal hygiene and should do the inspection to assess the personal hygiene. It includes the care of whole body starting from head to toe. It requires of proper cleanliness, care of head, eyes, mouth and teeth, hands and nails, body folds, private parts, feet, bowel habits.  It also includes behaviour related to diet, sleep, exercise, clothing, drug, smoking, relation with parents, peer group, sibling, friends etc.
  24. 24. iii)Good nutrition: Very essential, not only for optimal health, growth and development of the child but also for his educational achievement. A nutritious mid day meal for children in school is considered as a practical solution to combat malnutrition in children. School meal should provide about one third of daily calorie requirements and half of daily protein requirement.
  25. 25. iv)Physical and recreational activities: promote musculoskeletal development inculcate team spirit help in releasing physical and mental stress promotes mental health, growth and development of scholastic achievements The school health team takes active interest and efforts to ensure that school authority organizes a regular program of physical and recreational activities in the school.
  26. 26. vi)Health education: o very important for school children o It creates awareness, makes them knowledgeable regarding health matters o develops motivation and promotes changes in health behaviour and attitude AIM Its main aim is helping students to develop self reliance and civic sense, take social responsibility and have better quality of life throughout the life span.
  27. 27. Health education areas includes • personal hygiene • environmental health nutrition • prevention and control of communicable and non communicable diseases • first aid and emergency care • home nursing • family life and reproductive health • prevention and control of psychosocial problems etc.
  28. 28. Interactive methods and approaches •Different type of discussion •Demonstration •Problem solving •Issue based learning •Role plays •Competitions •Group projects etc.
  29. 29. vii)Immunization: • Necessary to prevent the occurrence of such communicable diseases. • The immunization schedule is completed by the age of 5-6 years. • It is necessary to find out at the time of admission whether the child has completed the immunization schedule or not. • A proper record of immunization should be maintained which should be handed over to the child at the time of leaving school. Tuberculosis, Diphtheria, Tetanus, Measles, Polio, Hepatitis, Pertusis.
  30. 30. (B) Therapeutic services: i)Health appraisal:  very essential to identify the deviation from normal conditions of body parts and systems.  It requires complete physical and medical check up.  The school health team recommended initial health appraisal at the time of entry in the school and thereafter at four year interval.  The initial appraisal need to be thorough which requires complete health history taking, physical and medical examination.
  31. 31. A minimum of 3 health appraisals are carried out: On passing out from middle school at the age of 13-14 years. On passing out from primary school at the age of 10-11 years. On school entry at the age of 5-6 years
  32. 32. In addition to health appraisal, recording of weight and height at an interval of 3 months should be done at the school by class teachers. They should also do daily inspection of personal hygiene and make observation to detect any deviation in normal behaviour or any change in appearance which may suggest any abnormality.
  33. 33. ii)Treatment and follow up:  Essential for children having any illness or defect.  In urban area the school health clinics can be at selected schools or at local dispensaries.  There should be fixed days and timings which should be known to teachers and parents.  The parents should be informed and explained about any kind of major illness or defect.  Follow up of such children should be done by school health nurse to make sure that regular treatment is taken up and proper care is given to the children.
  34. 34. iii)First aid and emergency care: o Arrangement for providing First aid and emergency care to injured children. o Teachers who are available at the spot can provide such care. o They need to be prepared and should be trained for providing first aid & emergency care. o The basic facilities for providing First aid and emergency care should be in accordance with the standards laid down by St. Johns Ambulance Association of India. o Senior students can also be involved and get trained for the same.
  35. 35. iv)Specialized health services: School children often suffer from dental problems especially caries teeth and periodontal diseases, eye problems such as defective vision, squint, eye infection etc. problem of ear, nose and throat. All these conditions requires specialized services of specialists in these areas. Special clinics should be provided exclusively for school children. specialists should be invited on specific days to hold these clinics in schools for examination and treatment of such disorder and defects.
  36. 36. (C) Rehabilitative services: Required for children who are born with or acquire any disability or handicap due to road accident/serious disease/burn injury etc. These children require special care. Those with minor physical or mental defects can be kept in normal schools. Teachers and workers need to give more attention and care to them. The children with marked physical abnormalities such as blindness, deafness, mutism, marked mental retardation etc. should be trained in special institution and should be rehabilitated.
  37. 37. (D) School health records: essential to maintain complete, accurate and continuous health record of school children useful in providing need based health care and guidance to children evaluate the school health services assist in future development improvement of health services rendered to school children.
  38. 38. Health record should include information on: Identification and personal aspect Personal and family history Findings of routine investigations and screening Services rendered and the prognosis Findings of physical and medical examinations
  39. 39. Various dimensions of school health services Health problems are not just physical, they can be mental and emotional as well. There are three levels of health services for schools. A)First level of prevention
  40. 40. 1. Actions to promote good practices in Hygiene.
  41. 41. 2. Action to make sure that children and their family are immunization against certain diseases.
  42. 42. • If there is no clear history of previous immunization with DPT then two doses of DT need to be given at an interval of 4 weeks at the age of 5-6 years, two doses of TT at one month interval at the age of 10 years and again at 16 years need to be repeated. • If immunization is done completely then one dose of DT need to be given at 5-6 years, one dose of TT at the age of 10 years and again at 16 years of age.
  43. 43. 3. Action to improve the mental health of the school children o The mental health of the child affects his physical health and learning process. o Juvenile delinquency, maladjustment, untoward behaviour etc. are becoming problems among school children. o The school is the most strategic place for shaping the child’s behaviour and promoting mental health. o The school teachers should be concerned with helping all children attain mental health, so that they may develop into mature, responsible and well adjusted adults.
  44. 44. • The school routine should be planned that there is enough relaxation between periods of intense work. • No distinction should be made between race, religion, caste or community, between rich and poor and between clever and dull. • There is a need to have guidance & counseling facilities for students. • Teacher and health personnel can also play important role in guidance and counseling for specific academic and health related problem of students.
  45. 45. B)The second level of prevention and action 1. Checking the physical health of children in school so as to detect health problem early. Physical examination from head to toe Measurement of height, weight, arm and chest circumference Testing of vision, hearing and speech Observation of vital signs such as pulse, respiratory rate and temperature Examination of blood, urine and stool Screening for tuberculosis
  46. 46. Medical examination includes complete and thorough check up of all the systems of body. Vital signs Vital signs are the visual signs that tell us the condition of the victim. They are: Breathing rate Temperature Pulse rate
  47. 47. Normal breathing rate Age Respiration/minute 2-6 years 24 6-12 years 20 12- 15 years 18 15- 21 years 16-20
  48. 48. • Normal pulse rate of a child aged 6-12 year is 60-95/minute. • In a healthy individual, the body temperature may vary between 970 F. ( 36.10 To 37.20 C) • Fever is defined as a rise in the body temperature above 990 F. • Fever is not a disease but it is a sign of infection. Children showing any serious signs and symptoms should be referred to medical officer.
  49. 49. 2. Provision of First Aids and emergency care Definition of first aid First aid is the temporary and immediate treatment given to a person who is injured or suddenly becomes ill, using facilities or materials available at that time before regular medical help is imparted.
  50. 50. Who is the first aider? The first aider is just a common person who may have learnt a standard method at application of first aid best suited to his skill.
  51. 51. When the responsibility end? The responsibility of the first aider ends when the causality is handed over the care of doctor, a nurse or other appropriate person. Later on, he may assist the doctor.
  52. 52. 3. Follow up programmes • It is necessary to ensure that the child complies with the advised health interventions. • The efficient follow up programme begin with careful planning. • Once the defect is discovered, the parents should be informed. • Notice to the parents, notifying from the suspected difficulty. • The clinics days and time should be initiated to all the consumed schools.
  53. 53. 4. Training of teachers The objectives of the teachers training should be to equip the teachers to observe the children under their care for: • Such defects or deviation from normal health • Help children to develop clean personal habits • Educate the teachers, parents and children about healthful school environment • Ensure a healthful school environment • Provide first aid in emergencies
  54. 54. C) The third level of prevention and action Often children who attend school have health problems which will not go away quickly. There are 4 main categories: • Long term medical problem such as Asthma or Epilepsy • Disabilities • Poverty, which often leads to under- nourishment • Long term emotional problems at home such as those which affect children whose parents are very ill.
  55. 55. SCHOOL HEALTH TEAM The members are as follows: 1.The school principal: Responsibilities are: • Ensure that school health program has the approval and support of school administrative authority. • Set up a school health committee to work out the school health plan and plan for its implementation. • Ensure that teachers are adequately trained for health care of school children. • Make sure that proper health records are maintained. • Ensure that parents are involved and follow up of the children is done.
  56. 56. 2.The school teacher: Teacher is a key person because she is in continuous contact with the students in a position to make observation of their health. Functions are as follows: • Daily inspection of children for personal hygiene and cleanliness • Daily observation of children for detecting any evidence from deviation from normal health, behaviour, any communicable disease, malnutrition etc. • Help in control of communicable disease • Referral of child having any problem to school health clinic for further action
  57. 57. • Informing the parents and maintaining follow up • Maintaining record of anthropometric measurement and other health record of children • Giving first aid and emergency care to children • Imparting health education on healthful living habits and behaviour etc. • Participate in investigation of epidemic or any communicable disease etc.
  58. 58. 3. The parents: • They can help in making assessment of health of children providing information regarding past and present history of medical problems not only of the child but also of other members of the family. • They can participate and cooperate in physical and medical examination and immunization of children. • They can help in correction of defects if any and follow up of the children if found sick. • They can help in foundation of good healthful living habits and behaviour.
  59. 59. • Through parent ‘teacher association’ the parent can be involved in planning, organizing and implementation of school health programme. • Above all the parent must relieve the child’s work pressure at home so that the child can take advantages of school. • They need to be prepared for such participation in school health programme, they can be educated while having Parent Teacher Association meetings.
  60. 60. 4. The community The community can contribute by supporting school health program by: • Providing suitable land for school building. • Providing funds and labour in building proper school. • Participation in school health committees or councils and contribute in formulation of school health policies and plans. • Participation in implementation of programme activities e.g. Conduct of medical examination, immunization of children, maintenance of environmental sanitation, health education activities. • Motivating parents to send their children to school and take care of their health.
  61. 61. 5. The children The child has the responsibility to: • Learn values of medical and health examinations, personal hygiene, good nutrition, environmental sanitation etc. • Cooperate in various aspects of school health programme. • Develop positive habits and healthful living activities as educated upon • Extends this knowledge to other members of the family, neighbourhood etc.
  62. 62. 6. The medical officer As being one the member of the team he is responsible for: • Medical examination of the students • Making diagnosis • Prescribing treatment • Making referral to services • Ensuring follow up of children
  63. 63. • Initiating promotive and preventive programme • Inspection of school environment and sanitation • Holding meetings with parents and teachers • Ensuring maintenance of records and reports • Evaluation of the programme and redefining programme objectives and activities
  64. 64. 7.The school health nurse/community health nurse • The community health nurse working in school health setting is responsible for comprehensive health of the child.
  65. 65. • She takes care of all the factors which influence health of the child such as biological aspect of the child, school and family environment, living activities, personal habits, health behaviour followed by the child and his family members, family and individual health history, family and community resources and their utilization etc.
  66. 66. CONCLUSION School health services are offered to the students so that they can attain a healthy living including physical examination, treatment of minor ailment and common diseases. It is the responsibility of the teachers and other school staff to find out any deviation from the normal condition and take appropriate steps in this direction.