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Indian Journal of Community Medicine

Some Neglected Aspects of School Health Checkups

Author(s): S. Bhagwat1, N. Kulkarni2, S. Raje1, R.D. Prayag1

Vol. 29, No. 3 (2004-07 - 2004-09)

Abstract

Objectives: 1. To assess the health status and problems in two schools. 2 To identify aspects of health that are often neglected.

Study Design: Cross-sectional.

Setting: 2 schools.

Participants: All the students in the schools.

Statistical analysis: Chi square test.

Results: Height and weight of most students were within normal range. Many cases of Undescended testes and ENT problems were detected.

Conclusions: Special emphasis should be on any one health problem in each of the school health checkups in addition to the routine checkups to ensure optimum utilization of the school health services.

Key words: School health, Undescended testes, Hearing defects, ENT problems

Introduction

School Health services provide an ideal platform to detect the health problems early and treat them. Health departments have been conducting health checkups for a long time now but the effectiveness has not been as per expectations. The health checkups are carried out perfunctorily and remedial measures are not followed up. Significant number of school children are in need of health services1.

One fifth of the population in every country constitutes school age children (5-15 yrs.). About 200 million children belong to this group and majority of them reside in underprivileged areas in rural India2. Therefore comprehensive health care of this section will fulfil the health needs of 1/5 the population. Therefore this study was carried out to assess the health status of school children in our field practice area.

Aims and Objectives:

To assess the health status of children in two schools, one in rural and another in an urban area, to suggest remedial measures for problems identified during the study and to identify certain aspects of school health services which are hitherto getting neglected and require more attention.

Material and Methods:

The study was carried out in 2 schools, one, a Zila Parishad School (ZP School) located in a village called Induri and another, Municipal School, Sant Dhyaneswar School (SD School) located in Talegaon Town, in the month of December, 2000. A proforma was filled up collecting information regarding the name, date of birth and other relevant detail with the help of the teacher. Information was also collected regarding any health complaints in the past or at present. Height and weight of all the students were measured using the standard precautions. General examination of all the students were carried out in good natural light. In the ZP School, special emphasis was laid on ENT checkups with the help of an ENT surgeon. Wherever any problem was detected, the parents were met and explained the problem and guided about the further course of action. Referral was made to out Medical College Hospital for further confirmation and management. Minor illness were treated there and the teachers were explained the treatment properly.

Results:

A total of 438 students were examined, 257 in the ZP school and 181 in the SD school. The age and sex distribution of the 2 schools are shown in Table I. The number of boys and girls were equal in the ZP school while the girls were lesser in number in the SD school, more so in the higher groups.

The mean heights and weights are shown in Table II and III. The mean height was lower in almost all age groups in the SD School as compared to the ZP School.

The same is true for the mean weight also. But both were corresponding with reference standards of ICMR as shown in Table II and III.

On general examination, the proportion of students with Caries and Pallor was high in both the schools as shown in Table IV. There were 17 cases of Vit A Deficiency (6.6%) in the ZP School as compared to 23 (12.7%) in the SD School. The difference was statistically significant. (c2 = 4.75, df=1, p<0.05). All these students were given health education along with Vit. A.suspension. The teachers were made aware of the condition too. Refractive error as detected by the Snellen's chart examination was common in both the schools and they were referred for further management.

Table I: Age and sex distribution of the school children.

  Z P School S D School
Age groups Male Female Male Female
  No. (%) No. (%) No. (%) No. (%)
6- 34 (53.9) 29 (46.1) 17 (53.1) 15 (46.9)
7- 28 (63.6) 16 (36.4) 21 (41.1) 30 (48.9)
8- 25 (37.3) 42 (62.7) 15 (38.5) 24 (61.5)
9- 32 (60.4) 21 (39.6) 14 (66.7) 7 (33.3)
10- 10 (33.3) 20 (66.7) 27 (71.1) 11 (28.9)
Total 129 128 94 87

Undescended testes were detected in 16 students (7%) in the 2 schools and 5 of them were bilateral. On referral to the Paediatrics Department, 4 were found to be retractile testis thereby giving a prevalence of 12/223 (5.38%). All these students had undergone health checkups by the Zila Parishad earlier and none of them were diagnosed. The parents of only one student got convinced and the child has already undergone orchiopexy at our hospital. The others are yet to come for the follow up.

ENT checkup: We took the help of an ENT surgeon in the ZP school and the findings are shown in Table IV. Cerumen was found in 20 students which was cleared. Abnormal Tuning Fork test indicating hearing deficit was seen in 16 boys and 7 girls in the ZP School. Out of these 23, 5 had normal hearing after the impacted wax was cleared. All those with abnormal TFT underwent the Pure tone audiometry.

The school environment was found to be unsatisfactory on almost all counts. The Medical Social Workers gave health education to the teachers and the students. The students from our college put up a street play in the local language incorporating the health messages which elicited very good response from the children.

Table II : Comparison of mean height with ICMR standards

Age group ZP School SD School ICMR
  Male
N=129
Female
N=128
Male
N=94
Female
N=87
Male Female
  (cm.) (cm.) (cm.) (cm.) (cm.) (cm.)
6-7 112.5 112 113 109.5 108.4 107.3
7-8 116.5 118 114 114 114 113
8-9 125 120 120 119.5 119.8 117.9
9-10 126.5 126 125 123.35 123.8 122.5
10+ 134.5 131.5 132 130 128.9 128.1

Table III : Comparison of mean weight with ICMR standards.

Age group ZP School SD School ICMR
Male Female Male Female Male Female
N=129
(Kg.)
N=128
(Kg.)
N=94
(Kg.)
N=87
(Kg.)
(Kg.) (Kg.)
6-7 17.5 16.5 17 18 16.7 15.8
7-8 19 19 18.75 20 18.4 17.3
8-9 20 20 22 20.5 19.6 19.2
9-10 22 20 21 21 21.2 21
10+ 25 22 22 23 22.9 23.2

Table IV: Morbidity

Morbidities Zila Parishad School Sant Dhyaneswar School
  Male (%) Female (%) Male (%) Female (%)
  N=129 N=128 N=94 N=87
Pallor 9 (6.9) 11 (8.5) 14 (14.8) 13 (14.9)
Vit. A deficiency 11 (8.5) 6 (4.6) 17 (18.1) 6 (6.8)
Vit. B deficiency. 4 (3.1) 2 (1.5) 8 (8.5) 1 (1.2)
Worm Infestation 24 (18.7) 21 (16.4) 42 (44.6) 37 (42.5)
Tonsillitis 12 (9.3) 18 (14.1) 6 (6.4) 1 (1.2)
CSOM/ASOM 5 (3.8) 5 (3.7) 1 (1.1) 1 (1.1)
Abnormal TFT 16 (12.4) 7 (5.4) 0   0  
Cerumen 11 (8.5) 7 (5.4) 1 (1.1) 1 (1.1)
Refractive errors 23 (17.8) 28 (21.8) 22 (23.4) 23 (26.3)
Caries 33 (25.6) 39 (30.4) 13 (13.8) 29 (33.3)
Undescended testes 7 (5.4)     9 (9.6)    

Discussion:

Our study revealed that there were equal number of boys and girls in the ZP School while in the Sant Dhyaneswar School, there were lesser number of girls especially in the higher age groups. This phenomenon is quite common across India due to the higher dropout rates among girls. The mean height of the students corresponded with those of the ICMR standards in both the schools and so did the weights. Overall, they were lower among the students of S.D. School. Partially, the reason for this could be the fact that the students of ZP School receive 3 kilos of rice per capita per month while the SD School doesn't. P. Panda et al reported that the mean height and weight of their students was lower than the ICMR Standards3.

Vit. A Deficiency was more common in the SD School again. The rates are comparable with those reported by Kumar D et al4 in ZP School and with that reported by Urmil A.C. et al5 in the Z.P. School4, 5. B Complex Deficiency was not very common with 6 cases in Z.P. School (2.3%) and 9 cases in S.D. School (4.9%).

Our survey detected 30 cases of tonsillitis, acute and chronic in the ZP School while only 7 cases were found in SD School. Number of otitis media detected were also higher here. The tuning fork test was abnormal in 23 students, (8.9%), indicating hearing deficit. Since upper respiratory tract infection is found to be a common precursor condition for otitis media it is important that they are detected early6. Hemant Chopra reported deafness in 12.16% of school children7. The fact that the other school detected fewer cases is because there was a special emphasis on ENT Checkup in the ZP School which was not there in the other. This goes to prove that it is possible to miss many cases of hearing disorders if special care is not exercised.

Undescended testes were found in 12 students (5.4%). Umakanth Khatwa had reported a relatively constant prevalence of 0.8%8. Complications and sequelae of undescended testes are many and any testes not descended into the scrotal sac by the age of 3 years needs to be treated. In the common course of a school health checkup, genital lesions are not examined due to lack of privacy and sometimes lack of time and patience. In our study also, the school health checkups through the Government had just concluded and these were not detected then. Such checkups are carried out every year in the month of October. The chances of over diagnosis does exist, but it's better to err on the excess. Problems like phimosis, hernia and hydrocele were not seen in our study. Surprisingly, there were no cases of heart disease in the study.

Conclusions and Recommendations:

The study has succeeded in highlighting the need for a focussed health checkups. Providing school health services has became more of a ritual where anthropometry and general checkups are done and adequate attention is not paid to vital aspects. A lot of resources in the form of manpower, material, money and time are utilized. A scheme may be worked out wherein every checkup may include one aspect of health that may be given special emphasis along with the routine checkups so that the efficacy of this essential service can be increased. Also, since both the schools were deficient in all the aspects of the proper environment for school, methods may be worked out to provide facilities to the schools either through actual involvement or through increasing the awareness of the staff and the students. Thus, school health services should be made more fruitful and useful.

References:

  1. UNICEF. The State of the World's Children, 1999.
  2. Udani PM. (Ed) Text Book of Paediatrics, Vol. 2 edn. 1.
  3. Panda P, Benjamin AI, Singh S et al. Health Status of School Children in Ludhiana City. Indian Journal of Community Medicine, Vol. XXV, No. 4, Oct.-Dec. 2000.
  4. Kumar D, Singh JV, Ahuja PC et al. Ocular Morbidity among school children in Sarojini Nagar Development Block of Lucknow, Indian Journal of Community Medicine 1992 : 17(30).
  5. Urmil AC, Dutta PK, Ahmed KA et al. A prevalence Study of Eye Diseases among school children in a school in Pune. Indian Journal of Community Medicine Vol. XIII, No. 3, 1998.
  6. Das C, Sanasam JC, Chukhu N et al. A study of incidence and Causation of deafness among the children in the tribal population in Manipur, Indian Journal of Otolaryngology and Head and Neck Surgery, Vol. 51, No. 3, July-Sept. 1999.
  7. Chopra H, Munjal M, Gupta S. Deafness in Paediatric Age Group. Indian Journal of Otolaryngology and Head and Neck Surgery. Vol. 51, No. 3, July-Sept. 1999.
  8. Khatwa Umakanth A, Menon PS. Management of Undescended Testes. Indian Journal of Paediatrics 2000; 67(6) : 449.
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