Authors:Dr Megha Luthra, Dr Surekha Kishore, Dr Pankaj Mishra, Dr Jairaj Hanspal Department of Community Medicine, SGRRIM&HS, Dehradun

Presented at IAPSM UP UK Conference 2011 held at Subharti Medical College, Meerut

Healthy children have higher daily school attendance, learn better, take full advantage of learning opportunities, excel academically as well as socially and have better chance of a balanced development

WHO global school health initiative was launched in 1995 with primary goal of increasing “Health Promoting Schools” [Schools that constantly strengthen their capacity as healthy settings for living, learning and working]

School health services have tended to focus on nutritional support and clinical assessment. It is now known that the state of personal hygiene is directly or indirectly related to nutritional status and health problems

In schools health education regarding important aspects of hygiene, environment and sanitation, as well as social customs can be imparted

There are 6.3 lakh schools in India, 128.3 million children in primary schools. Only 44% have water supply, 19% have urinals and 8% have lavatory facilities. For girls, 19% have separate urinals and 4% separate lavatories

Diarrhoea, typhoid, dysentery, gastroenteritis, hepatitis-A, intestinal worms and malaria contribute to the high rates of morbidity, mortality and malnutrition among young children in the country

There is also poor cognitive performance Majority of these diseases are preventable by promotion of hygienic practices

We interviewd and examined 139 students of classes I to IV in two schools (Government Primary School and Sri Guru Ram Rai School) in catchment areas of RHTC Mothrowala

Period of study was April to May 2009 Design of study was Cross Sectional After taking necessary permission from school authorities, a team of doctor and health workers interviewed class teacher as well as students

Class teachers were interviewed about performance of students over last 6 months, any recent changes noted and history of illness during last 15 days

The children were also interviewed about history of illness during last 15 days & personal hygiene practices

General and systemic examination of students including weight and height measurements were carried out

Nutritional status of children was charted using IAP method

Any morbidity suffered by the student during the last 15 days was recorded

Data thus collected was analyzed using suitable statistical tests with the help of Microsoft Excel 2007 and spss version 10.0

Name of School GPS GRRIC

Total Number of Students Examined 72 67

Age group of students 5- 12 years 6-10 years

Percentage of female students 40.30% 43.20%

Percentage of Hindu students 91.70% 98.50%

Percentage of students with Father's Education Matric & Below 33.30% 82.0%

Percentage of students with purely Vegetarian Dietary Habits 29.20% 22.40%

Name of School GPS GRRIC

Prevalence of caries 31.94% 29.0%

Prevalence of Flourosis 9.70% 6.0%

Prevalence of Missing Teeth 43.27% 39.0%

Prevalence of Under Weight (IAP Classification) 45.82% 42.70%

Prevalence of Poor Personal Hygiene (score < 2/5) 30.60% 25.21%

Prevalence of Refractive Error 18.06% 15.80%

Personal Hygiene Level

(Score)

No. of Boys No. of Girls

Very Poor (0) 11 06Poor (1) 23 09

Average (2) 14 15Good (3) 13 12Excellent (>=4)

16 16

Total 81 58Chi Square value= 0.544P > 0.05

The study included 81 boys and 58 girls Personal hygiene was considered poor, average, good or excellent as per scoring. The maximum and minimum possible scores were 5 and 0, respectively

Mean personal hygiene score of girls (2.63+0.98) was not significantly higher than that of boys (2.02+1.4), P >0.05

No. of Girls (Percentage)

No. of Boys (Percentage)

Clean & Combed Hair

39 (67.4) 39 (48.5)

Clean Hands 49 (84.6) 47 (57.9)Clean & Cut

Nails48(82.9) 62 (76.3)

Regular hand Washing after

visiting Toilet

54(92.6) 63 (78.3)

Use of Toothpaste and Toothbrush

37 (64.2) 47 (57.8)

Personal hygiene among girls was better as compared to boys when it came to clean& combed hair (67.4% vs. 48.5%, P<0.05) and clean hands (84.6% vs. 57.9%, P<0.05)

Clean and cut nails were found more in boys as compared to girls (82.9% vs. 76.3%)

Girls fared better than boys regarding regular hand washing after visiting toilet (92.6% vs. 73.8%), P<0.05

However, more boys used toothpaste and toothbrush regularly (64.2%) as compared to girls (57.8%)

No. of Girls (Percentage)

No. of Boys (Percentage)

Morbidity Experienced in Last 15 Days

43 (74.2) 62 (76.3)

Pallor 32 (55.85) 42 (51.4)History of

Worms24 (42.1) 29 (36.4)

Under nutrition

27 (46.3) 28 (35.6)

76.3% of the boys and 74.2% of the girls were suffering from one or more morbidities

For boys, the most common morbidity was clinically detected pallor (51.42%), followed by history suggestive of worm infestation (36.43%)

The most common morbidity for girls was, again, clinically detected pallor (55.85%), followed by under nutrition (46.28%)

Those who did not suffer from any morbidity over the last 15 days had significantly higher personal hygiene scores (P<0.05) as compared to those who suffered from one or more morbidities

Nutritional StatusNormally Nourished

Under- nourished

Mean Personal Hygiene Score

Girls 3.06 2.45Boys 2.78 2.13

Chi Squre value= 0.001P > 0.05

Girls were more under nourished as per IAP weight for age classification than the boys (46.28% vs. 35.61%), and this difference was statistically significant (P<0.05)

Those normally nourished did not have significantly higher personal hygiene scores (P>0.05) as compared to the undernourished

Improvement of nutritional status and some aspects of personal hygiene (cleanliness of hair, hands and regular use of toothpaste and tooth brush) are the major thrust areas for future action

It was observed that the overall status of personal hygiene was not better among girls as compared to boys

Morbidity was significantly higher in the group with poor personal hygiene score (<2)

Improvement in status of personal hygiene of school children through coordinated primordial and primary preventive measures like health education is a must

The onus lies on teachers and parents. Both need to be trained adequately

Simple measures like improvement of personal hygiene and following safe, hygienic practices by these children can go a long way in reducing morbidities and thus break the vicious cycle of infection and malnutrition

Thank You