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OJHAS Vol. 10, Issue 1:
(Jan-Mar 2011) |
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| Health Needs
of Ashram Schools in Rural Wardha |
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Amol R Dongre, Department
of Community Medicine, Sri Manakula Vinayagar Medical College, Pondicherry,
India,
Pradeep R Deshmukh, BS Garg,
Dr Sushila Nayar School
of Public Health, Mahatma Gandhi Institute of Medical Sciences, Sewagram,
India. |
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Address for Correspondence |
Professor,
Dr Sushila Nayar School of
Public Health,
Mahatma Gandhi Institute of
Medical Sciences,
Sewagram - 442102, India.
E-mail:
prdeshmukh@gmail.com |
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Dongre AR, Deshmukh PR, Garg BS. Health Needs of Ashram Schools in
Rural Wardha. Online J Health Allied Scs.
2011;10(1):2 |
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Submitted: Jan 9,
2011; Accepted: Mar 10, 2011; Published: April 15, 2011 |
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| Abstract: |
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Objective:
To assess the health needs for health promoting Ashram schools in rural
Wardha. Methods:
It was a cross sectional study undertaken in 10 Ashram schools,
using qualitative (SWOT analysis, Transect walks and Semi-structured
interviews of teachers) and quantitative (Survey) methods. Hemoglobin
examination of all children was done by using WHO hemoglobin color scale.
Anthropometric measurements such as height and weight of each child
were obtained. Physical activity score for each child was calculated.
The manual content analysis of qualitative data was done and the quantitative
data was entered and analyzed using Epi_info (version 6.04d) software
package. Results:
Out of 1287 children examined, 724 (56.3%) were boys and 563 (43.7%)
were girls. About 576 (44.8%), 213 (16.6%), 760 (59.1%) children had
untrimmed nails, dirty clothes and unclean teeth respectively. More
girls had (31.6%) lice infestation than boys (18.2%). Eighty six (6.7%),
75 (5.8%) and 110 (8.6%) children had scabies, fungal infection and
multiple boils on their skin respectively and 158 (12.3%), 136 (10.6%)
and 66 (18.3%) children had dental caries, wax in ears and worm infestation
respectively. Notably, 988 (76.8%) children had iron deficiency anemia
which was significantly more among girls (81.9%) than boys (72.8%).
About 506 (39.3%) children consumed any tobacco product in last one
month. About 746 (57.9%) children were classified to have sedentary
physical activity. Among 774 children (>12 years), 183 (23.6%)
and 34 (4.4%) children felt lonely ‘sometime’ and ‘most of the
times’ respectively. About 398 (94.3%) boys and 342 (97.2%) girls
did not know the modes of transmission of HIV/AIDS. Conclusions:
In conclusion, there was high prevalence of risk factors for both communicable
and non-communicable diseases in Ashram school environment. This dictates
the urgent need for teacher driven, needs based and school based intervention
that can screen and identify potentially preventable health conditions
among underprivileged Ashram school children.
Key Words:
Ashram school; Personal hygiene; Morbidities, Tobacco consumption; Physical
activity; Health promoting schools.
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Educational
inequality among tribal and scheduled caste children is the resultant
of the socio-economic backwardness of their home environment and the
illiteracy of their parents.1 Scheduled Castes (SC) and Scheduled
Tribes (ST) are the Indian communities that are explicitly recognized
by the Constitution of India as previously ‘depressed classes’.2
After independence, several educational and welfare attempts have been
made to improve the educational attainments of their children. Ashram
school is one of such input specially designed to suit these underprivileged
children from extremely poor local families. Ashram schools are residential
schools providing lodging and boarding, uniforms, books and notebooks
and educational equipments to its inmates and helping them to remain
in the school system without dropping out. The scheme of Ashram School
Complex for tribal students is under implementation since 1952.3
World Health
Organization (WHO) launched ‘Global School Health Initiative’, in
1995, to mobilize and strengthen health promotion and education activities
at the local, national, regional and global levels. The Initiative is
designed to improve the health of students, school personnel, families
and other members of the community through schools. The goal is to increase
the number of schools that can truly be called "Health-Promoting
Schools". A Health-Promoting School can be characterized as a school
constantly strengthening its capacity as a healthy setting for living,
learning and working .4 The poor background of the Ashram
school children and their poor health status is known.1,5
But the information required for designing a health promoting school
initiative is rarely been studied. The present study was a part of baseline
assessment for World Health Organization funded project titled ‘Health
promoting Ashram schools in rural Wardha’. Hence, the objective of
the study was to assess the health needs for health promoting Ashram
schools in rural Wardha.
Study area:
The present study was done in Wardha district of India (Maharashtra
state). Out of 20 Ashram schools, 10 were selected for the present study.
Three schools were in Wardha block, 4 schools were in Selu block and
one each in Karanja, Arvi, and Samudrapur block. The average distance
of these schools from Wardha city was 39.3 km. The study was carried out from
August to September 2008.
Selection
of Ashram schools: In July 2008,
a one day orientation program was
organized for principal and
teacher from 20 Ashram schools of Wardha district. They were explained the
objectives of the project activities. Out of 18 Ashram schools who were attended
the program and were willing to participate in the study, we selected 10 Ashram
schools depending upon accessibility and available resources.
Study design:
A cross sectional study was carried out using qualitative [SWOT analysis6,
Transect walk7 and Semi-structured interviews of teachers8]
and quantitative (Survey) methods.
Qualitative
data collection: A triangulation of qualitative methods
such as Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis,
transect walk and semi-structured interviews was done to ensure the
better validity of qualitative data. In SWOT analysis exercise, teachers
were asked to describe in their own words and make a free list of perceived
strengths, weaknesses, opportunities and threats for health promoting
Ashram schools. During school health check-up, transect walks in schools
and semi-structured interviews of school principals were carried out.
Transect walk focused on environment sanitation, while semi-structured
interviews explored the current situation of Parent- Teacher Association
(PTA), life skills education, health care seeking behaviors and health
promoting policies, which are the important steps to develop Health
Promoting School (HPS).9 A trained public health specialist after
obtaining the informed consent from the participants, collected the qualitative
data.
Quantitative
data collection: The school health check-up was undertaken in 10
Ashram schools during August - September 2008. All children who were
present in the school were interviewed and examined by a team of trained
medical doctor, medical interns, Auxiliary Nurse Midwife (ANM) and social
workers by using pre-designed and pre-tested questionnaire. The questionnaire
covered information on personal hygiene, physical status, nutrition,
environment, physical activity, substance abuse, risk behavior, life
skills and others. Children with age 12 years or more were also enquired
about feelings and friendships and awareness about HIV/AIDS. The questionnaire
was based on Global School-based Student Health Survey (GSHS)10
and the qualitative information obtained in pre-survey SWOT analysis exercise.
Hemoglobin
examination of all children was done by using WHO hemoglobin color scale,
which is recognized as reliable and rapid method for primary health
care settings in developing countries.11 Free flowing blood
drop was obtained from each subject by finger prick method by using
sterile disposable lancet. Hemoglobin percentage was assessed by trained
medical doctor by matching the color of a drop of blood on approved
test strip with one of the given six shades of red in day light. Based
on their hemoglobin levels, anemia among subjects was then classified
as per the standards of WHO.11
Anthropometric
measurements such as height and weight of each child were obtained. Heights were taken
to the minimum of 1mm and weights were taken to the minimum of 100 gm
with minimum clothing. Weighing scale was calibrated to the zero before
taking every measurement. All the measurements were taken as per guideline
of World Health Organization. Body
Mass Index (Kg/m2) categories were formed using CDC 2000
reference.12 Physical activity score for each child was calculated
and classified to find out status of physical activity. A scoring system by
Ramachandran et al was modified for school children and used to quantify
physical activity.13
The permission
from the district school authorities and school principals was obtained for the
present study. Children with minor ailments were treated and given health
education.
Data analysis:
The manual content analysis of qualitative data was undertaken to get
better understanding of participants’ worldview.14 Quantitative
data was entered and analyzed using Epi_info (version 6.04d) software
package.
Qualitative
assessment: SWOT analysis: From teachers’ viewpoint,
Ashram schools had certain strengths such as building
(infrastructure), availability of safe drinking water, power supply,
play ground and the trained teaching staff. But several weaknesses
were found to limit health promotion in Ashram schools. First, its
poor training of teachers to detect and treat minor ailments. Second,
two schools were run in rented building with overcrowding. Third, it
was prevalent addictions and superstitions among children which they
inherit from their poor socio-economic background. Teachers expressed
their willingness to participate in health promoting school activity
which could be seen as an opportunity. Poor cooperation from the
parents, school children and their deeply rooted faith in cultural
beliefs and practices were seen as the potential threats for future
activities.
Transect
walk in school premises and semi-structured interview with
the school teachers: Out of 10 schools, 8 schools had their own building.
Five schools were private; receiving government grant (except one) and rest five
were state government owned. Two schools, which were run in rented building, did
not have play ground for children.
Parent teacher
association (PTA): Although
PTA is beneficial to foster trusting relationships between teachers
and parents; it was conducted in only three schools. One barrier was
poor socio-economic background of parents who seldom recognizes the
importance of PTA and education. Another obstacle was that the parents,
who take their children home for the celebration of festivals, often
become late to send them back. Hence the concept of parent teacher association
and their regular meetings could be seen as a challenge.
Safe and
healthy environment: All schools had the availability of safe drinking
water. Only one school had well displayed safety instructions in front
of kitchen. Four schools had separate toilets for boys and girls. In
some places, children were seen going out for defecation. We could also
observe the cooking process in kitchen and lunch session in two schools.
Hand washing practice was poor as hands were washed with water only.
There were no dustbins in the classrooms or near the kitchen. The premise
of one of the Ashram schools was clean and had a well developed vegetable
garden. One Ashram school was located in the deep forest and had no
compound wall. The wild animals often entered the campus at night time.
Skill based education: School teachers reported that they organize
essay and drawing competitions at school level for development of hidden
talents. However, there was little emphasis to explore teaching methodologies
which encourages community involvement, encourage group activity and
development of skills such as conflict management, stress management
and interpersonal skills.
Access to health care: The sick children
were often taken to the nearest Primary health centre (PHC). If required
medical officer of PHC further refer the sick patient to rural hospital
or civil hospital. Teachers expressed that they were poorly equipped
with essential drugs, knowledge to recognize danger signs and skills
to impart first-aid in emergency. Noteworthy, Ashram schools have one
male and one female superintendent of social work background for counseling
and health care of boys and girls.
Health promoting policies:
Health promoting policies such as anti-tobacco policy, health promoting
policies are implemented as in the form of health education of school
children.
Quantitative
assessment: Out of 1287 children examined, 724 (56.3%) were boys and 563
(43.7%) were girls. About half of the children were in 6-12 years age group and
rest half were above 12 years (p= 0.089). Majority 1070 (83.1%) of the children
were scheduled tribe (Table 1).
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Table 1:
Age, sex and caste distribution of examined Ashram school children |
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Variables |
Male |
Female |
Total |
p value |
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Age |
| 6-12
years |
391 (54) |
289 (51.3) |
680 (52.8) |
0.089 |
| >
12 years |
333 (46) |
274 (48.7) |
607 (47.2) |
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Caste |
| Scheduled
caste |
40 (5.5) |
33 (5.9) |
73 (5.7) |
0.059 |
| Scheduled
tribe |
594 (82) |
476 (84.5) |
1070 (83.1) |
| Nomadic
tribe |
65 (9) |
29 (5.2) |
94 (7.3) |
| Other
backward class |
25 (3.5) |
25 (4.4) |
50 (3.9) |
| Total |
724 (100) |
563 (100) |
1287 (100) |
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Figures in
parenthesis are percentages |
About 576 (44.8%),
213 (16.6%), 760 (59.1%) children had untrimmed nails, dirty clothes
and unclean teeth respectively. Significantly more boys had dirty clothes
and teeth than the girls (p=0.001). One fourth of children had lice
infestation in their hairs. Girls had more (31.6%) lice infestation
than boys (18.2%) (p=0.001). About 81 (11.2%) boys and 29 (5.2%) girls
had multiple boils (p=0.001). The worm infestation was more among girls
(21.1%) than boys (15.9%) (p=0.015). Eighty six (6.7%), 75 (5.8%) and
110 (8.6%) children had scabies, fungal infection and multiple boils
on their skin respectively and 158 (12.3%), 136 (10.6%) and 66 (18.3%)
children had dental caries, wax in ears and worm infestation respectively
(Table 2).
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Table 2:
Personal hygiene and related morbidities |
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Personal
hygiene and related morbidities |
Male
n= 724 |
Female
n=563 |
Total
n=1287 |
p value |
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Personal
hygiene |
| Uncombed
dirty hair |
32 (4.4) |
39 (6.9) |
71 (5.5) |
0.050 |
| Untrimmed
dirty nails |
327 (45.2) |
249 (44.2) |
576 (44.8) |
0.736 |
| Dirty clothes |
156 (21.5) |
57 (10.1) |
213 (16.6) |
0.001 |
| Unclean teeth |
507 (70) |
253 (44.9) |
760 (59.1) |
0.001 |
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Conditions
related to poor personal hygiene |
| Head lice |
132 (18.2) |
178 (31.6) |
310 (24.1) |
0.001 |
| Scabies |
50 (6.9) |
36 (6.4) |
86 (6.7) |
0.715 |
| Multiple
boils |
81 (11.2) |
29 (5.2) |
110 (8.6) |
0.001 |
| Fungal infection |
45 (6.2) |
30 (5.3) |
75 (5.8) |
0.500 |
| Dental caries |
91 (12.6) |
67 (11.9) |
158 (12.3) |
0.716 |
| Worm infestation |
31 (15.9) |
35 (21.1) |
66 (18.3) |
0.015 |
| Stye in eyes |
5 (0.7) |
5 (0.9) |
10 (0.8) |
0.935 |
| Wax in ears |
83 (11.5) |
53 (9.4) |
136 (10.6) |
0.235 |
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Figures in
parenthesis are percentages |
Notably, 988
(76.8%) children had iron deficiency anemia which was significantly
more among girls (81.9%) than boys (72.8%) (p=0.001). About 577 (44.8%)
children did not consume green leafy vegetables in last seven days and
704 (54.7%) had consumed it once in last one week period. Similarly,
715 (55.6%) children did not eat any fruit in last one week period and
572 (44.4%) children consumed it once in last one week period (Table
3). Noteworthy, 855 (67.5%) children were classified as thin (below
5th percentile) where 536 boys (75.3%) and 319 girls (57.6%) were
thin (p=0.001) (Table 4).
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Table 3:
Status of iron deficiency anemia and food consumption among Ashram school
children |
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Iron deficiency
anemia and food consumption |
Male
n=724 |
Female
n=563 |
Total
n=1287 |
p value |
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Iron
deficiency anemia |
| Presence
of anemia |
527 (72.8) |
461 (81.9) |
988 (76.8) |
0.001 |
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No
of times green leafy vegetables was eaten in last 7 days |
| I did not
eat green leafy vegetables |
331 (45.9) |
245 (43.5) |
577 (44.8) |
0.697 |
| Once
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389 (53.7) |
315 (56) |
704 (54.7) |
| Twice or
thrice |
3 (0.4) |
3 (0.5) |
6 (0.5) |
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No
of times a fruit was eaten in last 7 days |
| I did not
eat fruit in last 7 days |
419 (57.9) |
296 (52.6) |
715 (55.6) |
0.065 |
| Once |
305 (42.1) |
267 (37.4) |
572 (44.4) |
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Figures in
parenthesis are percentages |
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Table 4:
Status of malnutrition
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Categories
of BMI |
Male
n=712 |
Female
n=554 |
Total
n=1266 |
p value |
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Thin (below
5th percentile) |
536 (75.3) |
319 (57.6) |
855 (67.5) |
0.001 |
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Normal (5th
– 85th percentile) |
174 ((24.4) |
234 (42.2) |
408 (32.2) |
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Overweight
(85th > 95th percentile) |
2 (0.3) |
1 (0.2) |
3 (0.2) |
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Figures in
parenthesis are percentages |
Out of 1287
children, 506 (39.3%) consumed any tobacco product in last one month.
About 393 (54.3%) boys and 113 (20.1%) girls consumed any tobacco product
in last one month (p=0.001). More boys 118 (16.3%) than girls 60 (10.7%)
used dry snuff for teeth cleaning (p=0.003). Among 506 children who
consumed any tobacco product in last one month, 279 (55.1%), 164 (32.4%),
63 (12.5%) children consumed gutka, dry tobacco, and kharra
respectively (p=0.002). Significantly more boys and girls preferred
Kharra and dry tobacco respectively (p=0.001). Ten boys (2.5%) had consumed
alcohol in last one month. Half of the children said that their father of male
guardian consume tobacco products and alcohol. One fourth of children said that
their parents and guardian consume tobacco products (Table 5).
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Table 5:
Tobacco addiction among examined Ashram school children and addictions
among their parents |
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Consumption
of tobacco and alcohol |
Male
n=724 |
Female
n=563 |
Total
n=1287 |
p value |
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Consumed
any tobacco product in last one month |
393 (54.3) |
113 (20.1) |
506 (39.3) |
0.001 |
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Use of
nus for teeth cleaning |
118 (16.3) |
60 (10.7) |
178 (13.8) |
0.003 |
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Type
of product consumed |
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Kharra |
59 (15) |
4 (3.5) |
63 (12.5) |
0.002 |
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Gutka |
216 (54.9) |
63 (55.7) |
279 (55.1) |
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Dry tobacco |
118 (30) |
46 (40.7) |
164 (32.4) |
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H/O alcohol
consumption in last month |
10 (2.5) |
0 |
10 (1.9) |
- |
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Tobacco
consumption by guardians |
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Father or
male guardian |
371 (51.2) |
248 (44) |
619 (48.1) |
0.010 |
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Mother or
female guardian |
61 (8.4) |
76 (13.5) |
137 (10.6) |
0.003 |
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Both |
184 (25.4) |
156 (27.7) |
340 (26.4) |
0.354 |
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Alcohol
consumption by guardians |
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Father or
male guardian |
378 (52.2) |
239 (42.5) |
617 (47.9) |
0.001 |
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Mother or
female guardian |
3 (0.4) |
1 (0.2) |
4 (0.3) |
0.800 |
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Both |
1 (0.1) |
3 (0.6) |
4 (0.3) |
0.448 |
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Figures in
parenthesis are percentages |
About 746
(57.9%) children were classified to have sedentary physical activity, where
there was 350 (62.2%) girls and 396 (54.7%) boys. About 448 (34.9%) and 93
(7.2%) children were classified to have light and moderate physical activity
respectively. (p=0.022). More than half of the children had no physical
fight with other children in the school in last one month. Notably, 105 (14.5%)
boys and 38 (6.7%) girls had a history of physical fights for two to three times
and 54 (7.5%) boys and 16 (2.8) girls had more than five times fights in last
one month (p=0.001) (Table 6).
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Table 6:
Status of physical activity score and physical fights |
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Physical
activity and physical fights |
Male
n=724 |
Female
n=563 |
Total
n=1287 |
p value |
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Quartiles of Physical activity |
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Sedentary
(1-17) |
396 (54.7) |
350 (62.2) |
746 (57.9) |
0.022 |
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Light (18-34) |
269 (37.2) |
179 (31.8) |
448 (34.9) |
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Moderate
(35-51) |
59 (8.1) |
34 (6) |
93 (7.2) |
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Physical
fights in last one month |
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Never |
398 (54.9) |
303 (53.8) |
701 (54.5) |
0.001 |
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One time |
125 (17.3) |
84 (14.9) |
209 (16.2) |
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2 or 3 times |
105 (14.5) |
38 (6.7) |
143 (11.1) |
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4 or 5 times |
42 (5.8) |
22 (3.9) |
64 (5.0) |
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More than
5 times |
54 (7.5) |
16 (2.8) |
70 (5.4) |
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Figures in
parenthesis are percentages |
Among 774 children of age 12 years or more, 183 (23.6%) and
34 (4.4%) children felt lonely ‘sometime’ and ‘most of the times’ respectively.
The feeling of loneliness among boys and girls had similar percentages
(p=0.188). During past one month, 108 (13.9%) children and 5 (0.6%) children
felt worried and did not sleep on some or most of the time respectively. It was
slightly more among girls (p=0.075). About half of the children had one to two
or more friends. There was no sex difference. Thirteen (1.7%) children said that
they had no close friends. About 398 (94.3%) boys and 342 (97.2%) girls did not
know the modes of transmission of HIV/AIDS (Table 7).
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Table 7:
Feelings, friendships and knowledge about HIV/AIDS among children (12
years or more) |
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Feelings,
friendship and knowledge about HIV/AIDS |
Male
n=422 |
Female
n=352 |
Total
n=774 |
p value |
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Feeling
of loneliness in past 12 months |
| Never |
117 (27.7) |
78 (22.2) |
195 (25.2) |
0.188 |
| Rarely |
195 (46.2) |
167 (47.4) |
362 (46.8) |
| Sometimes |
90 (21.3) |
93 (26.4) |
183 (23.6) |
| Most of the
times |
20 (4.7) |
14 (4) |
34 (4.4) |
|
During
past one month felt worried and did not sleep |
| Never |
194 (46) |
131 (37.2) |
325 (41.9) |
0.075 |
| Rarely |
174 (41.2) |
162 (46) |
336 (43.4) |
| Sometimes |
51 (12.1) |
57 (16.2) |
108 (13.9) |
| Most of the
times |
3 (0.7) |
2 (0.6) |
5 (0.6) |
|
Number
of close friends |
| No close
friends |
8 (1.9) |
5 (1.4) |
13 (1.7) |
0.831 |
| One or two |
211 (50) |
181 (51.4) |
392 (50.6) |
| Three or
more |
203 (48.1) |
166 (47.2) |
369 (47.7) |
|
Knowledge
about modes of transmission of HIV infection |
| Do not know |
398 (94.3) |
342 (97.2) |
740 (95.6) |
0.292 |
| Knows one |
15 (3.6) |
6 (1.7) |
21 (2.7) |
| Knows two |
7 (1.7) |
3 (0.9) |
10 (1.3) |
| Knows three |
2 (0.5) |
1 (0.3) |
3 (0.4) |
|
Figures in
parenthesis are percentages |
Overall, the
status of personal hygiene among Ashram school children was poor. It
led to high prevalence of morbidities related to poor personal hygiene.
All these can be prevented by simple health education and selective
treatment. Teachers found it difficult to recognize minor ailment and
treat it. The first aid box was available in all schools but it was
poorly maintained. Hence, formal training of teachers regarding health
education, first aid and treatment of minor ailment is crucial. A quasi
experimental study in rural Wardha had also reported poor status of
personal hygiene and its related morbidities among Ashram school children.
As a result of teacher driven, school based health education intervention;
there was improvement in personal hygiene and reduction of related morbidities.5
Nayar et al had already reported the teachers’ superior role over
community health volunteer in imparting health education to school children.15
A need based, focused, skill based child to child hygiene education
could effectively bring behavior change among school children in rural
Wardha.16 Noteworthy, in year 2004, the government of India
has started a Total Sanitation Campaign (TSC) and Hygiene Education,
which emphasizes skill based child to child health education for behavior
change among school going children.17
The prevalence
iron deficiency anemia among Ashram school children was high, which
was more among girls than boys. Its adverse effect on work productivity,
mental performance of children and outcome of pregnancy is well documented.
In a recent survey of the hemoglobin concentration of school children
in Africa and Asia, in five of six African countries, 40% or more schoolchildren
aged 7-11 years were anemic. But in the two Asian countries that took
part in the survey, Indonesia and Viet Nam, the prevalence was lower
at 27% and 12% respectively.18 The present study found that
76.8% children were anemic. In Philippines, weekly iron supplementation
given by teachers could prevent fall in the hemoglobin concentration
among school children.19 Hence, weekly iron supplementation and
improvement in variety and quality of diet of the children is necessary. It also
requires education of kitchen cook regarding healthy cooking practices and
hygiene to be maintained while handling the food items.
About 67.5%
children were classified as thin (75.3% boys and 57.6% girls). Other
studies in India have reported high prevalence of malnutrition among
school age children and adolescents.20, 21 Poor
nutrition of children not only adversely affects the cognitive development
of children, but also likely to reduce the work capacity in future.
Hence, urgent steps should be taken to improve the nutritional status
of school children. Promotion of proper nutrition is one of the eight
essential elements of primary health care. Hence, periodic monitoring
of nutritional status of school children is required.
In the present
study, the prevalence of tobacco addictions was found to be 39.3% (54.3%
boys, 20.1% girls). The consumption of tobacco related products among
parents was also high. The source of money for tobacco products were
parents. Hence, intense education of parents and children is required.
A study from rural Wardha has reported high prevalence of smokeless
tobacco consumption among adolescents and their parents and recommended
multi-pronged strategy for tobacco control.22 According to
school-based Global Youth Tobacco Survey in Maharashtra, 12.9% adolescents
(13-15 years) currently consumed any tobacco products.23
The physical
activity of the children was found poor. Hence, regular physical training
is required. The improvement in nutrition and physical activity of the
children need to be addressed together. The schools should formulate
and adhere to physical-education and activity requirements and standards.
Schools should facilitate changes to increase physical activity and
parent teacher associations can help to educate parents as to the dangers
of childhood malnutrition. Introduction of ‘nutrition and physical
education’ in the school curriculum with these activities should become
compulsory and /or a ‘scoring subject’ with marks to be added to
total grades. The importance of enhancing physical activity and improving
the dietary habits from childhood itself has been emphasized, as the
major step towards prevention of Non Communicable Diseases (NCDs).24
Ashram schools
are residential school for children. Hence, along with the physical
health status of children their emotional needs and their capacity to
adjust in school environment are also important. Ashram schools have
the posts of superintendents (One male and one female) of Masters in
social work background. Hence, building the counseling skills of school
superintendents to encourage community involvement, encourage group
activity, health education and development of skills such as conflict
management, stress management and interpersonal skills. Recently,
WHO has taken up an initiative of Health Promoting Schools which emphasize
integration of educational officials, teachers, students and parents
to promote health in the schools. It also envisioned formation of school
health committee at school level and strengthen Parent teacher association,
provision of safe and healthy environment, skill based education, access
to health care and health promoting policies.4 In India,
the responsibility of school health program was given to primary health
centre who considered it as extra burden. Hence, the program is non-existent
and its implementation requires political commitment.25
In conclusions,
there was high prevalence of risk factors for both communicable and
non-communicable diseases in Ashram school environment such as poor
personal hygiene, high prevalence of related morbidities, iron deficiency
anemia, malnutrition, tobacco addictions, poor physical activity and
poor awareness of HIV/AIDS. This dictates the urgent need for teacher
driven, need based and school based intervention that can screen and
identify potentially preventable health conditions among underprivileged
Ashram school children in rural Wardha
The authors are thankful to World Health Organization (India Country
Office) for providing financial assistance to the study under APW IND
FFA 00108.
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