Comprehensive school-based health programs to improve child and adolescent health: Evidence from Zambia

Wei, Dorothy; Brigell, Rachel; Khadka, Aayush; Perales, Nicole; Fink, Günther

doi:10.1371/journal.pone.0217893

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…On the other hand, high-income households tend to spend more resources on nutrition and tend to have better access to healthcare, which in turn has a diverse impact on the health and nutritional status of the child [ 1 , 41 ]. Primary school feeding programs have been implemented to reduce childhood malnutrition [ 42 ]. However, in areas where the rates of preschool and primary school dropouts are high, the impact of these programs may not be significant.…”

Section: Discussionmentioning

confidence: 99%

Contextual factors and spatial trends of childhood malnutrition in Zambia

Phiri

Mulemena²,

Kalinda³

et al. 2022

PLoS ONE

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Background Understanding the national burden and epidemiological profile of childhood malnutrition is central to achieving both national and global health priorities. However, national estimates of malnutrition often conceal large geographical disparities. This study examined the prevalence of childhood malnutrition across provinces in Zambia, changes over time, and identified factors associated with the changes. Methods We analyzed data from the 2013/4 and 2018 Zambia demographic and health surveys (ZDHS) to examine the spatial heterogeneity and mesoscale correlates of the dual burden of malnutrition in children in Zambia. Maps illustrating the provincial variation of childhood malnutrition were constructed. Socio-demographic and clinical factors associated with childhood malnutrition in 2013 and 2018 were assessed independently using a multivariate logistic model. Results Between 2013/4 and 2018, the average prevalence of stunting decreased from 40.1% (95% CI: 39.2–40.9) to 34.6% (95% CI:33.6–35.5), wasting decreased from 6.0% (95% CI: 5.6–6.5) to 4.2% (95% CI: 3.8–4.7), underweight decreased from 14.8% (95% CI: 14.1–15.4) to 11.8% (95% CI: 11.2–12.5) and overweight decreased from 5.7% (95% CI: 5.3–6.2) to 5.2% (95% CI: 4.8–5.7). High variability in the prevalence of childhood malnutrition across the provinces were observed. Specifically, stunting and underweight in Northern and Luapula provinces were observed in 2013/14, whereas Lusaka province had a higher degree of variability over the two survey periods. Conclusion The study points to key sub-populations at greater risk and provinces where malnutrition was prevalent in Zambia. Overall, these results have important implications for nutrition policy and program efforts to reduce the double burden of malnutrition in Zambia.

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Section: Discussionmentioning

confidence: 99%

Contextual factors and spatial trends of childhood malnutrition in Zambia

Phiri

Mulemena²,

Kalinda³

et al. 2022

PLoS ONE

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“…Considering that Ghana is presently in the nutrition transition, this holistic approach including both under- and over-nutrition programs is required to make a meaningful impact; schools may be a viable place for such comprehensive school-based health intervention programmes. Wei et al [ 59 ] recently reported the approach effective in reducing stunting and illness among 4–16 years Zambian children.…”

Section: Discussionmentioning

confidence: 99%

Malnutrition, Hypertension Risk, and Correlates: An Analysis of the 2014 Ghana Demographic and Health Survey Data for 15–19 Years Adolescent Boys and Girls

et al. 2020

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The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes.

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“…School-based health programs could offer a highly effective platform for improving access to care and the health status of school-age children [ 50 ]. The school teacher could be an expedient source of health information for the students.…”

Section: Discussionmentioning

confidence: 99%

“…As regards community outreach, a Hong Kong study described that the schools under Healthy Schools Award scheme were more likely to be better school health policy, higher degrees of community participation, and better hygienic environment [ 63 ]. Community outreach in the schools’ activities is vital for the effectiveness of the HPS program and so, the school teachers should involve the school health activities closely with parents and the community [ 50 , 64 , 65 ]. In the benefits of the training and research activities, a qualitative study done in Bangladesh stated that the teachers’ training program related to school health had a positive impact on the ability, skills, and self-confidence of the teachers, who received training compared to the teachers who did not receive it [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

Involvement of high school teachers in Health Promoting School program in selected township, Yangon Region, Myanmar: A cross-sectional mixed methods study

Naing¹,

Htun²,

Tun³

et al. 2022

PLoS ONE

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Background Schools provide a big opportunity for promoting the student’s health, life skill, and behavior. Teachers play a fundamental role in the promotion and successful implementation of school health services. This study aimed to assess the level of involvement in the Health Promoting School program and its associated factors and to explore the benefits and barriers to involvement among high school teachers in Myanmar. Methods A mixed methods explanatory sequential study was conducted among 194 high school teachers in Thanlyin Township, Yangon Region, Myanmar, from June to August 2020. Quantitative data were collected with the pretested structural questionnaire and analyzed by Chi-square tests and Fisher’s exact tests. A qualitative strand was added by conducting in-depth interviews (n = 15, five teachers from each level of involvement: poor, medium, and good), analyzed by thematic content analysis. Results Of the 194 teachers, 23.7% had a good level of involvement in the Health Promoting School program. The factor associated with involvement in Health Promoting School program were age (p value < 0.001), duration of services (p value = 0.001), and a number of accomplished training-related school health (p value = 0.008). Qualitative data revealed that improvement of the health knowledge and awareness on health problems, the progress of healthy behaviors, development of physical and mental health, prevention of the disease spread, achievement of healthy and productive learning environment, and development of academic achievement were major benefits of teachers’ involvement. Moreover, the main barriers to involvement were insufficient materials and human resources, time constraints, incompetence of the teachers, poor cooperation of school health partnerships, and insufficient awareness of parents. Conclusions The proportion of good involvement in the Health Promoting School program among high school teachers was low in this study area. Providing sufficient human resources and material, conducting the on-the-job and refresher training, enhancing parent-teacher cooperation, and strengthening the community partnerships were crucial to improve the level of involvement and reduced the barriers for the achievement of the Health Promoting School program.

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Comprehensive school-based health programs to improve child and adolescent health: Evidence from Zambia

Cited by 8 publications

References 26 publications

Contextual factors and spatial trends of childhood malnutrition in Zambia

Contextual factors and spatial trends of childhood malnutrition in Zambia

Malnutrition, Hypertension Risk, and Correlates: An Analysis of the 2014 Ghana Demographic and Health Survey Data for 15–19 Years Adolescent Boys and Girls

Involvement of high school teachers in Health Promoting School program in selected township, Yangon Region, Myanmar: A cross-sectional mixed methods study

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