Evaluation of school health instruction in public primary schools in Bonny Local Government Area Rivers state

Niger J Paed 2014; 41 (4): 365 - 369

ORIGINAL

Alex-Hart BA

Evaluation of school health

Akani NA

instruction in public primary

schools in Bonny Local

Government Area, Rivers state.

DOI:http://dx.doi.org/10.4314/njp.v41i4,15

Accepted: 15th July 2014

Abstract Background: Effective

tween 100-1460 with a mean of

school health instruction in pri-

352±336SD. Teacher/pupil ratio

Alex-Hart BA (

)

mary schools is essential in ad-

per school ranged from 1: 30 to 1:

Akani NA

128. Fourteen (70%) schools had

Department of Paediatrics,

dressing the health risks and

University of Port Harcourt Teaching

needs of school age children and

teacher/pupil ratio less than 1:40.

Hospital, Port Harcourt

adolescents. This study sought to

There was no professional health

Email: balaalexhart@ymail.com

evaluate the status of school

instructor in all the schools. Four

health instruction in public pri-

schools (20%) allotted 3 periods

mary schools in Bonny Local

per week to health teaching, while

Government Area.

the rest (80%) allotted less than 3

Method: This is a cross sectional

periods per week. HIV/AIDS was

school based study carried out in

not in the health education curricu-

20 public primary schools in

lum being used. The only teaching

Bonny Local Government Area,

method used by all the schools was

Rivers State, in March 2006. The

the direct teaching method. No

availability of the various compo-

school used teaching aids; no

nents of the school health instruc-

school went on field trips. Teach-

tion programme was evaluated

ers did not receive in-service train-

using an evaluation scale. Compo-

ing on health education. No school

nents had weighted scores. The

attained the minimum acceptable

minimum acceptable and maxi-

score of 31 points using the

mum attainable scores for school

evaluation scale.

health instruction were 31 and 47.

Conclusion: School health instruc-

Data was analyzed using SPSS

tion was poorly implemented in

version 11.

the primary schools investigated.

Results: There were a total of 100

Teachers were not adequately pre-

teachers in all the schools. The

pared for health teaching and the

teacher population per school

classrooms were overcrowded.

ranged from 2 to 13 with a mean

of 5±2.77SD. The pupil popula-

Keywords: School; Health

tion of the schools ranged be-

instruction, Evaluation

Introduction

environmental health, sexuality education, mental and

emotional health, injury prevention and safety, nutrition,

School health instruction is that component of the school

prevention and control of diseases and substance use and

health programme which deals with classroom instruc-

abuse. The health instructions are tailored to each age

tions that are based on planned, sequential, kindergarten

level, and they are provided by qualified, trained health

education teachers in a formal classroom . The subject

to 12 grade comprehensive health education curricu-

lum, which addresses the physical, mental, emotional

areas are repeated at several grade levels to ensure rein-

and social dimensions of health . The curriculum is de-

forcement of learning and increase in depths of content,

signed to motivate and assist students to maintain and

progressing from simple to complex concepts as pupils

move upward in grades .

improve their health, prevent diseases and reduce health

related risky behaviours. It allows students to develop

The overall effectiveness of school health instruction

and demonstrate increasingly sophisticated health

programme depends on the availability of well, trained

related knowledge, attitudes, skills and practices .

and qualified health education teachers, instructional

materials in form of textbooks, posters and other teach-

ing aids and the time allotted to health teaching . Chil-

The comprehensive health education curriculum

includes a variety of topics such as: personal health,

dren who are taught in primary schools to acquire essen-

family health, community health, consumer health,

tial health related knowledge and skills are not only less

366

likely to engage in health compromising behaviours as

Methodology

adolescents, but they are more likely to carry the knowl-

edge and skills into adulthood and lead healthier life

This is a cross sectional school based study carried out

styles . This fact was corroborated by Studies done by

in public primary schools in Bonny Local Government

Dawson , Frank , and Gold where the effectiveness of

Area, Rivers State in March 2006. The Local Govern-

school health instruction in reducing high risk behav-

ment Area (LGA) is one of the 23 LGAs in Rivers State,

iours, teenage pregnancies and smoking rates among

located in the southern part of Nigeria. The Local gov-

young people was well demonstrated. Similarly, school

ernment consists of Bonny City- its headquarter, 19 sat-

health instruction was advocated in the publication”

ellite villages and several fishing settlements attached to

Healthy kids for the year 2000: An action plans for

them. The LGA had a total of 20 public primary schools,

schools” which cited the following benefits: Less school

7 of which are located in Bonny City, 3 in the fishing

vandalism, improved attendance by students and staff,

settlements and 10 in the villages. Each of these schools

reduced health care cost, reduced substitute teaching

was inspected for the availability of the various compo-

cost, better family communication, even on sensitive

nents of the school health instruction using a validated

issues such as sexuality, stronger self-confidence and

school health instruction evaluation scale adapted from”

self-esteem, noticeably fewer students using tobacco,

Introduction To The School Health Programme” by

Akani and Nkanginieme. Components evaluated in-

improved cholesterol levels for students and staff,

increased seat belt use and improved physical fitness .

cluded: Presence of professional health education staff,

time allotted for health teaching, general plan for pro-

Furthermore, globally, there is a growing concern for the

gressive health instruction for all grades, scope/contents

health-related risky behaviors of children of school age.

of health education curriculum, teaching methods and

This is because behaviours established in childhood and

preparation of teachers for health teaching. Items were

adolescent are a significant indicator of the health and

scored according to their relevance. For example the

well-being of the adult population of any country . Ac-

presence or absence of a professional health education

cording to the World Health Organization (WHO),

staff was graded between 0-5 points, 0 point for no

nearly two-thirds of premature deaths and one-third of

health educator and 5 points for 4 health educators in the

the total disease burden in adults globally, are associated

school. A face to face interview method was used to

with conditions or behaviours that began in their youth,

obtain additional relevant information from the head

including tobacco use, a lack of physical activity, unpro-

teachers. The minimum acceptable and maximum attain-

tected sex and exposure to violence .

able scores for school health instruction using the

Consequently, there is a global call for countries to pro-

evaluation scale were 31 and 55 respectively. Data was

mote the health and wellbeing of school age children by

analyzed using SPSS version 11 and results were pre-

implementing a comprehensive health education pro-

sented using descriptive statistics. Analysis of variance

grammes in their primary and secondary schools, capa-

was used to compare mean scores between the three

ble of preventing and controlling these health related

study locations. Only p-value less than 0.05 was re-

risky behaviours. This call is even more pertinent for

garded as statistically significant.

developing countries like Nigeria, where significant

number of parents provide limited information about

Ethical clearance

health to their children due to their own high illiteracy .

The Ethics Committee of University of Port Harcourt

Nigeria responded to this call by developing the Na-

Teaching Hospital, Rivers State Universal Basic Educa-

tional School Health Policy with a well-defined section

tion Board and Bonny Local Government Area gave

on skills-based health education . The objectives of this

ethical approval for the study.

health education included: To provide information on

key health issues affecting the school community, de-

velop skills-based health education curriculum for the

training of teachers and learners, provide participatory

Results

learning experiences for the development of knowledge,

Characteristics of the Schools in Bonny LGA-According

attitudes and skills and desirable habits in relation to

to Location

personal and community health and evaluate learners

progress towards healthy development. The extent to

A total of 20 public primary schools were inspected. The

which this section of the policy is being implemented in

pupil population of the schools range from 100 to 1460

our primary schools is uncertain since published articles

with a mean of 352± 336 SD. The schools in the villages

on evaluation of school health instruction in primary

and fishing settlements had pupil population less than

schools in Nigeria are sparse. This study therefore aimed

300(Table 1).There were a total of 100 teachers in all the

to evaluate the status of school health instruction in pub-

schools. The teacher population per school ranged from

lic primary schools in Bonny Local Government Area,

2 to 13 with a mean of 5 ± 2.77SD. Teacher/pupil ratio

Rivers State using an evaluation scale.

per school ranged from 1:30 to 1:128. Fourteen (70%)

schools had teacher/pupil ratio less than 1:40 recom-

mended by the implementation committee of the Na-

tional Policy on Education (Table 2).Out of the 100

teachers in the schools, 31 (31%) had TCII and below

367

(Table 3). Out of 100 teachers, 50(50%) had 10-19 years

Teaching Methods: The direct teaching method was the

teaching experience, no teacher had less than 10 years’

only method used by all the schools. No school reported

experience (Table 4).

going on field trips. Teaching aids in form of posters

were found in 13(65%) schools but no school reported

Table 1: Population of Schools in Bonny LGA

giving health instruction with these teaching aids. No

Pupil popula-

Number of Schools

Total

school reported receiving health education by visiting

tion

(%)

medical specialists (Table 5).

Bonny City

Villages

Fishing

Preparation for Health Teaching: No school reported

Settlements

that the teachers received in-service training during the

100-299

15(75)

period of evaluation (Table 5).

300-499

0(0)

500& above

5(25)

Table 5: Health Instruction Assessment of the Schools

Total (%)

7(35)

10 (50)

3(15)

20(100)

School Health Instruction

No of Schools

Professional health instructor

Table 2: Teacher-Pupil Ratios of Primary Schools in Bonny

Time allotted to health teaching

LGA

3periods per week

Teacher-

Number of Schools

Total

2 periods per week

Pupil ratio

(%)

1 period per week

Bonny City

Villages

Fishing

Teaching methods

Settlements

Direct teaching method

100

≤ 1:40

6(30)

By visiting medical specialists

1:41-1:80

8(40)

Use of teaching aids

>1:80

6(30)

Preparation for health teaching

Total (%)

7(35)

10(50)

3(15)

20(100)

In-service training of teachers

Policies and recommendations

of health department interpreted

Table 3: Qualification of Teachers in Bonny LGA

to teachers

Qualifications

Number of Teachers

Total (%)

Bonny

Villages

Fishing

Scores for School Health Instruction: The scores for

City

Settlements

school health instruction ranged from 15 to 17 (mean

Degree

23(23)

15.4 ± 0.64 SD). All the schools had below the mini-

NCE

46(46)

mum required score for school health instruction of 31

TC II

30(30)

points (Table 5).

A comparison of the mean school

CTR

1(1)

health instruction scores by location of the schools

Total (%)

50(50)

32(32)

18(18)

100(100)

showed that there was no significant difference in the

mean scores of the schools in Bonny City, villages and

Degree = University Degree, NCE = National Certificate of

Education, TCII = Teachers Grade II Certificate, CTR =

fishing settlements (p=0.18) ( Table 6).

Certified Teacher Referred Certificate

Table 6: School Health Instruction scores of the schools

Table 4: Number of years of experience of Teachers in Bonny

Schools

Location

Scores

LGA

Bonny Govt school

Bonny City

27.3

Experience (Yrs)

Number of Teachers

Total (%)

Central school

Bonny City

30.9

Bonny

Village

Fishing

St Michaels school

Bonny City

30.9

City

Settlements

Boyle Memorial

Bonny City

30.9

10-19

50(50)

Model Primary

Bonny City

27.3

20-29

45(45)

CPS Finima

Bonny City

27.3

30& above

5(5)

CPS Abalamabia

Bonny City

27.3

Total (%)

50(50)

32(32)

18(18)

100(100)

CPS Banigo

Village

27.3

CPS Kuruma

Village

27.7

School Health Instruction

CPS Dema Abbey

Village

27.3

CPS Oloma

Village

27.3

ST Baths

Village

27.3

Staffing: No professional health instructor was found in

CPS Agbalama

Village

27.3

the schools during the period of evaluation.

CPS Peterside

Village

27.3

Time Allotted to health teaching: Four (20%) schools

CPS Kalaibiama

Village

30.9

allotted three periods per week to health teaching. The

CPS Greens Iwoma

Village

27.3

remaining 16(80%) schools allotted less than three peri-

CPS Dan Jumbo

Village

27.3

ods per week to health teaching (Table 5).

CPS River Seven

Fishing settlement

27.3

Scope of Content: The 20(100%) schools used the old

CPS Iwokiri

Fishing settlement

27.3

health education curriculum

which had the following

CPS Agaja

Fishing settlement

27.3

topics: Growth and development, personal health, com-

munity health, social and emotional health, safety educa-

tion and first aid. The curriculum however had nothing

on HIV/AIDS.

368

Table 6: A Comparison of Mean School Health Instruction

two periods per week is more convenient, and allows for

Scores by School Location

the accommodation of the other aspect of the child’s

Mean Scores

Variance

study in the total school day period.

Bonny City

Villages

Fishing. S

An important observation during the study was that

15.86 ±1.07

15.20 ±0.63

15.00 ±0.00

0.67

0.18

teachers in the schools studied were still using the old

primary school syllabus which had a well-defined

health instruction curriculum, but lacked a subject like

HIV/AIDS. Since teachers are expected to follow the

Discussion

scheme of work as outlined, it became obvious that the

subject of AIDS was not being taught to primary school

This study has revealed the poor implementation status

children in Bonny Local Government Area. The impli-

of school health instructions in the public primary

cation of this is that reduction in the transmission of the

schools in Bonny Local Government Area. The fact that

disease may not be effective if the facts are not ade-

none of the schools studied had up to the minimum re-

quately presented to the children, especially as young

quired score of 31 points in school health instruction

people between the ages of 15 to 24 years accounted for

40% of new infections in 2006.

using the evaluation scale shows that the programme is

being minimally implemented in these primary schools.

This poor implementation status cuts across the schools

Like any other subject, health instruction in classroom

in the three study locations. The implication of this is

should be given directly, incidentally and correlated or

that the objectives of the comprehensive health educa-

integrated with other subjects. However, in this study,

tion section in the National School Health Policy can-

the only method of instructing reported was the direct

not be achieved.

teaching method. Even among the educators, direct

teaching method alone is recognized as inadequate. Ak-

inyele

Teacher/pupil ratio is an indicator of education quality

observed that behavior cannot be changed by

. In this study 70% of the schools had very low

telling alone. Pupils must be led into an understanding,

teacher/pupil ratio, lower than the 1:40 recommended by

appreciation and internalization of those positive effects

the implementation committee of the national policy on

and attitudes we want them to develop. Hence the lec-

education . In such crowded classrooms with high num-

ture method alone should not be used. The enquiry

ber of pupils per teacher, the quality of education suf-

method, role playing and dramatization and field trips

fers. The pupils will have difficulty following the course

are some of the tested methods needed for effective

and the teachers will have less time dedicated to the

teaching. Unfortunately in this study, no school taught

needs of each individual child. Consequently there will

health education beyond the classroom by going on field

be low academic achievement and increased dropout

trips. The lack of use of teaching aids by the teachers is

rate. Other studies done in Afghanistan, Tanzania and

very surprising, because in 13 (65%), schools teaching

Rhwanda also reported a low teacher/pupil ratio.

aids in form of posters were found. Lack of awareness of

The National Education Research Council recommended

the importance of the use of teaching aids may be possi-

that the minimum qualification for teachers should be

ble contributory factor.

NCE (National Certificate of Education) . However, in

Tanner and Okonkwo had advocated for a regular and

this study, 31% of the teachers had academic qualifica-

tions lower than NCE. Two previous studies

15,16

done in

well planned in-service training for all teachers to

Rivers State had demonstrated that academic qualifica-

improve their professional competence. Their advocacy

tion has a positive relationship with adequate health

was based on the fact that pre-service training alone

knowledge. One therefore wonders whether these teach-

cannot adequately equip them with all the knowledge,

ers with academic qualifications lower than NCE were

skills and attitude they need to be competent on their

passing on accurate and quality health information to the

job. This is especially true for the teachers in this study

children.

where none majored in health education. Regular in-

service training on health education would have helped

The absence of professional health instructors in the

to equip them with adequate health information to pass

schools studied is similar to the report of a previous

on to the children. Unfortunately in-service training for

study . However, Imogie

found health educators in

teachers was not reported by any school.

63.3% of the schools he visited, though his study was

done in secondary schools. The findings in this study is

not surprising because in Nigeria, the primary school

teacher is a generalist and is expected to teach all the

Conclusion

subjects irrespective of what he/she studied in the

Teachers Training Institution.

In conclusion, school health instruction in public pri-

The two periods per week allotted to health teaching by

mary schools in Bonny local Government Area was

majority of the schools in this study is consistent with

poorly implemented. The classrooms were overcrowded,

findings in a previous report . It however fell short of

increasing the workload of the teachers and compromis-

the three periods per week recommended by the

ing learning. No health educator was found in any

National Education Research Council . It could be that

school, majority of the schools dedicated less period per

369

week for health teaching and the health education cur-

Recommendations

riculum being used omitted a very important topical

issue such as HIV/AIDS. Furthermore the in-service

More classroom teachers should be sent to the public

training needs of the teachers were neglected by the

primary schools in Bonny Local Government area.

Ministry of Education.

Regular in-service training on health education should

be organized for the teachers. Teachers should be trained

Conflict of Interest: None

on how to use the new health education curriculum to

Funding: None

avoid the omission of currently topical issues. Health

education should be made compulsory in teachers train-

ing institutions.

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