Assessment of availability, adequacy and factors affecting provision of school health services in primary schools of Mukono County in Mukono District
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Introduction and background. Health related causes contribute significantly to school dropout and absenteeism. Sixty percent of school dropouts are due to sickness (MOE, 2003). This has resulted into low primary school completion rate of 64% (UBOS, 2006) despite the increased enrollment as a result of UPE. In HSSP 1 of 2001, the school health programme was introduced to create an enabling environment for delivering quality education (MOH, 2006). This was aimed at improving the health of learners there by reducing absenteeism and dropout. Goal of the study This study was aimed at assessing the availability and adequacy of school health services and factors affecting their provision in primary schools of Mukono County so as to make recommendations for effective interventions to improve school health, academic performance and reduce dropouts and absenteeism due to health related causes. Methods. It was a cross-sectional study carried out in Mukono County. Seventy one Schools were selected through multistage stratified sampling. A person in charge of pupils’ health was the respondent. Questionnaires and observation checklists were used to collect quantitative data. This was triangulated with focus group discussions for pupils. Quantitative data was analyzed using SPSS version 17. Associations between dependent and independent variables were tested using Pearson’s Chi-square test and Odds ratios. Charts and graphs were generated by MS-Excel. FGD results were analyzed using a master sheet and results presented as text along with quantitative results. Results. All school health services were available in over 90% of schools. Nutritional services were significantly more available in non-government schools than government schools (P = 0.04). Availability of essential drugs and supplies in first aid kit (Odds ratio (OR) 0.31, 95% CI 0.11-0.86), regular visits by medical personnel (OR 2.70, 95% CI 1.00-7.30) and immunization programme for adolescent girls (OR 4.54, 95%CI 1.65- 12.49) were significantly associated with school ownership. While more than two-thirds of the schools had most of their health services assessed as adequate, only 30% and 41% of schools had adequate nutrition and medical services respectively. Medical and xiii nutrition services were significantly more adequate in boarding schools than other schools (P = 0.01 and P<0.001 respectively) and nutrition services were more adequate in non-government schools (P=0.03) and those with teachers trained in health (P=0.02). Government owned schools were also significantly less likely to have a water source nearby (OR=0.17, 95% CI 0.05-0.56) and clean classrooms (OR=0.34, 95% CI 0.11- 0.99) but more likely to have fire-fighting equipment (OR=4.24, 95% CI 1.56-11.52). A majority of the teachers (79%) assessed were not knowledgeable about school health. The level of knowledge was significantly higher in teachers who received training in school health (χ 2 = 39.56, 1 df, P = 0.02). Lack of funds, trained health teachers, space and commitment were some of the factors that affected availability and adequacy of school health services, with lack of commitment and space being significantly lower factors in non-government schools compared to government schools (OR=0.14, 95% CI 0.30-0.69 and OR=0.09, 95% CI 0.01-0.73). Conclusion. School health is available in over 90% of the schools assessed, which is above the target of 75% set by ministry of health in the health strategic plan 1. Medical and nutrition services were adequate in only 41% and 30% of the schools. This is below the national set target of 75%. Government schools lack nutrition services while physical education services are lacking in non-government schools due to lack of space. Government should consider providing meals to pupils at school and Mukono District Health Team should provide training in school health to all teachers in the district.