Knowledge attitude and practice of school health among primary school teachers in Ogun State Nigeria

Niger J Paed 2015; 42 (4): 340 – 345

ORIGINAL

Odeyemi KA

Knowledge, attitude and practice

Chukwu EE

of school health among primary

school teachers in Ogun State,

Nigeria

DOI:http://dx.doi.org/10.4314/njp.v42i4.11

Accepted: 10th August 2015

Abstract :

Background:

The

gramme,

(Ifo

97.4%,

Ikenne

School health programme is de-

97.3%), more than half of the re-

Odeyemi KA

(

)

signed to promote the optimal

spondents, (Ifo 57.0%, Iken-

Chukwu EE

ne54.5%) had poor knowledge of

Department of Community Health,

physical, emotional, social and

College of Medicine, University of

educational development of stu-

school health. Majority of the re-

Lagos. Nigeria

dents. Teachers play a major role

spondents in Ifo (98.7%) and

Email: kofoodeyemi@yahoo.com

in the

promotion and successful

Ikenne(98.3%) felt that the school

implementation

the

Pro-

health programme is desirable and

gramme.

necessary. School health pro-

Objective: To determine and com-

gramme is in place in most schools

pare teachers knowledge, attitude

in both LGAs ( Ifo 77.3%, Ikenne

and practice of the school health

73.2%). However many key com-

programme in urban and rural

ponents are poorly practiced.

schools in Ogun state, Nigeria.

Conclusion: There was no statisti-

Methodology : This cross sec-

cally significant difference in the

tional descriptive study was con-

knowledge (p= 0.209) and practice

ducted in public primary schools

(p=0.313) of school health in rural

in Ifo (urban) and Ikenne (rural)

and urban LGAs. In service train-

Local Government Areas (LGAs)

ing on school health should be

of Ogun State. A multistage sam-

provided for teachers and the

pling method was used to select

needed resources should be made

teachers in

each Local Govern-

available for the full implementa-

ment Area. Data was collected

tion of all components of school

using self administered question-

health in all schools.

naires and analysed using the EPI-

Info 6 statistical software.

Key words: School health, teach-

Results: Although majority of the

ers, primary school, knowledge

respondents in both LGAs were

and practice

aware of the school health pro-

Introduction

their health status and indices are useful in determining a

nation’s state of development. A school age child in a

School Health Programme (SHP) refers to all aspects of

developing country like Nigeria with high infant and

the school programme which contributes to the under-

under-five mortality rate is a survivor of the major child-

standing, maintenance and improvement of the health of

hood diseases. If they are to attain their maximum po-

the school population. Children spend a considerable

tential and development, their quality of life must be

improved upon. Supporting school health programs to

part of their life in school exposed to a variety of envi-

ronmental, physical, emotional and social influences.

improve the health status of our nation's young people

isvery important.

With an increasing number of students with health con-

A large proportion of the mortality

ditions requiring health services during the school day,

and morbidity in school-age children is preventable.

the school health service programme works in ensuring

Schools are the only institutions that can reach nearly all

1,2, 3

that efficient and standard care are implemented.

young people; they are in a unique position to improve

effective school health programme is one of the most

the health status of young people throughout the nation.

cost effective investments a nation can make .It is there-

fore a strategic means to preventing important health

The role of teachers in the school health programme is

risks among children and youths.

very central. They are the resource people responsible

for the promotion and successful implementation of the

School-age children account for about 23 percent of the

school health programme. Teachers are well respected

population in the average community in Nigeria and

and are viewed as role models by their students and they

341

therefore have an important impact on their learning and

selected by balloting while in Ikenne LGA , 12 schools

action.

7, 8

The success of school based health programme

were selected to make up the sample size . In the se-

relies on their personal knowledge, attitude and perspec-

lected schools, all the teachers were recruited into the

tive on the health needs of students.This study examines

study

the knowledge attitude and practice of school health

programme among teachers in rural and urban LGAs in

Data collection and analysis

Ogun State.

Data was collected using pre-tested, self administered,

semi – structured questionnaires. Informed consent was

obtained from each teacher. Ethical approval was ob-

Materials and method

tained from ethical committee of the Lagos University

Description of study area

Teaching Hospital. The data obtained was analysed us-

ing the EPI – Info 6 statistical software. To assess

Ogun State is a state in South-western Nigeria and com-

knowledge, a scoring system was used based on 25

prises of 20 Local Government Areas (LGAs). The

questions. Grades were assigned based on marks scored.

study was conducted in two LGAs; Ifo LGA which is

Chi Square test was used for comparison. Level of sig-

predominantly urban and Ikenne LGA which is pre-

nificance was set at 0.05

dominantly rural. Ifo LGA has 95 public primary

schools and 10 public secondary schools with a teacher

population of 930.Ikenne LGA has 22 public primary

schools and 11 public secondary schools with 475 teach-

Results

ers.

There were 228 respondents in Ifo LGA and 231 respon-

Study population

dents in Ikenne LGA. Majority of the respondents were

females (Ifo 81.1%, Ikenne 77.1%), and majority of the

The study population were school teachers working in

respondents in both LGAs had professional training in

public primary schools in Ifo

and

Ikenne

education. (Ifo 85.5%, Ikenne 87.0%). There was no

LGAs .Teachers who were less than one year on the job

statistical difference in the kind of professional training

were excluded.

they received (p=0.052).

Study design

Almost all the respondents in both LGAs were aware of

school

health

programme

(Ifo

97.4%,

Ikenne

This study was a comparative, cross sectional study.

97.3%).The major component of school health pro-

Sample size determination -To calculate n the formula

gramme known was school health services (Ifo75.3%,

used was

Ikenne 65.3%), followed by school health instruction

n = (p 1 q 1 +p 0 q 0 ) + (Z α +Z β )

(Ifo 36.7%, Ikenne 41.5%). Healthful school environ-

___________________

ment was the least known (Ifo38.6%, Ikenne 43.8%).

(p 0 -p 1 )

Where:

More teachers in Ifo (35.8%) than in Ikenne (24.0%)

n =

the desired sample size

knew that one of the benefits of school health pro-

Z α =

the percentage point of the normal distribution

grammes was promoting the development of school

corresponding to the (two sided) 5% signify

children (p=0.007). Slightly more teachers in Ifo

cance level = 1.96

(48.8%) than in Ikenne(46.5%)knew that school health

Z β =

critical value corresponding to the power of the

programme prevent health risks in children . (p = 0.633)

study at 80%

= 0.84

The overall knowledge on school health was poor in

p 0 = teachers with good knowledge of school health

both LGAs. More than half of the respondents in Ifo

programme in a study carried out in an urban area

(57.0%) and Ikenne (54.5%) had poor knowledge of

= 0.72

school health programme Only 18.4% of respondents in

q 0 =

1.0 – p 0

Ifo and 14.3% of respondents in Ikenne had good

p 1 =

teachers with good knowledge of school

knowledge of school health programme. There was no

health programme in a study carried out in a rural area

statistical difference in the level of knowledge of school

= 0.52

health programme in the LGAs.(p=0.209)

n (minimum acceptable sample size)= 207 per group

Majority of the respondents in both LGAs had a positive

Sampling procedure

attitude to school health programmes. ( Ifo 98.7% and

Ikenne 98.3%). In both LGAs, teachers felt that school

A list of the schools in the two LGAs was obtained and

health programme was desirable and necessary. All the

served as sampling frame. Simple random sampling

respondents in Ifo and 96.5% of the respondents in

method was used to select the schools in both LGAs.

Ikenne

agreed that school health programme will im-

Schools were selected from the listed schools till the

prove the academic performance of school children.

sample size was attained. InIfo LGA, 14 Schools were

342

More than half the respondents in both LGAs (Ifo

Table 1: Respondents’ Knowledge, attitude and practice of

77.3%, Ikenne 73.2%) had school health programme in

School Health

operation in their school. There was no statistical differ-

Variable

Ifo

Ikenne

P value

ence between the two LGAs (p=0.313). In Ifo 68.9% of

Level of knowledge

the respondents had a school health curriculum com-

Poor

130 (57.0)

126 (54.5)

Fair

56 (24.6)

72 (31.2)

3.1

0.209

pared to the 89.5% in Ikenne.(p=0.000). In Ifo local

Good

42 (18.4)

33 (14.3)

government 43.8% of the respondents said health educa-

Total

228 (100)

231 (100)

tion is taught as a separate subject compared to 71.6% in

SHP is desirable

Ikenne. There was a statistically significant difference

Positive

222 (98.7)

226 (98.3)

Negative

3 (1.3)

4 (1.8)

0.1

1.000*

between the LGAs (p= 0.000)

Total

225 (100)

230 (100)

SHP will improve the

There was a statistically significant difference in the

academic performance of

practices of pre admission medical examination in the

school children

228 (100)

223 (96.5)

Agree

0 (0.0)

7 (3.0)

8.0

0.000*

LGAs (p= 0.010).Majority of the respondents in Ifo

Disagree

0 (0.0)

1 (0.4)

(70.4%) said pre admission medical examination was

Uncertain

228(100)

231 (100)

not compulsory compared to the 57.7% in Ikenne .

Total

Have SHP in the school

Yes

174 (77.3)

167 (73.2)

The main school health services available were; having

51(22.7)

61 (26.8)

1.0

0.313

a functional first aid box (Ifo 95.6%; Ikenne 79.6%) ,

Total

225 (100)

228 (100)

and having a nurse/ staff in charge of the school clinic

Have a school health

(Ifo 72.2%; Ikenne 67.0%). There was a statistical dif-

education curriculum

Yes

155 (68.9)

204 (89.5)

ference in the availability of functional first aid box in

68 (30.2)

16 (7.0)

42.

0.000*

the schools in Ifo and Ikenne LGAs (p=0.000)

Don’t know

2 (0.9)

8 (3.5)

Total

225 (100)

228 (100)

Food is provided mainly by food vendors in the schools

How Health Education is

taught

in the study sites. ( Ifo 99.6%; Ikenne 99.6%). There

Not taught at all

was no statistical difference in the type of school meal

As a separate subject

7 (3.1)

99 (43.8)

1 (0.4)

service in Ifo and Ikenne LGAs (p = 0.993). More than

Integrated into other

85 (37.6)

161 (71.6)

46.

0.000*

half of the respondents (63.0%) in Ikenne said they carry

compatible subjects

35 (15.6)

Both as a separate subject

out screening of food vendors as part of their infection

& integrated

35 (15.5)

24 (10.7)

control

practices compared to the 42.1% in Ifo LGA.

Others

0 (0.0)

226 (100)

4 (1.8)

(p=0.000)

Total

225 (100)

Physical education/sport

is in the timetable

Pipe borne water supply to schools in both LGAs was

Yes

227 (100)

230 (99.6)

very poor. However pipe borne water was available in

0 (0.0)

1 (0.4)

1.0

0.504*

more schools in Ifo (14.0%) than in Ikenne (3.9%). Bore

Total

227 (100)

231 (100)

hole was that main source of water in

both Ikenne

(40.8%) and Ifo ( 20.0%). Majority of the schools in

*fishers exact test

both LGAs disposed their refuse by burning (Ifo 92.9%;

Table 2: School Health Services in Respondents’ school

Ikenne 93.9%).

Variable

IFO

Ikenne

P value

In both LGAs there was a statistically significant asso-

School health services

N=227

N=231

Have a clinic/health post

124 (57.9)

106 (46.7)

5.6

0.018

ciation between the respondents’ sex and their knowl-

Have a functional first aid box

217 (95.6)

184 (79.6)

28.5

0.000

edge of school health programme. Male teachers had

Have a nurse/staff i/c of SHP

164 (72.2)

155 (67.0)

1.0

0.315

better knowledge than the females. (Ifo,p=0.023; Ikene,

Maintain Health records

146 (64.3)

149 (64.5)

0.1

0.703

Type of school meals

p=0.046).However sex was not significantly associated

Free school meal services

1 (0.4)

0.0

0.993*

with their attitude to school health programmes and

Food vendors

225 (99.6)

228 (99.6)

there was no statistically significant association between

Total

226 (100)

229 (100)

type of professional training and knowledge of school

Pre-admission medical exam

is compulsory

health programme. Similarly, there was also no statisti-

Yes

58 (26.7)

79 (35.6)

9.2

0.010

cally significant association between the respondents’

153 (70.4)

128 (57.7)

professional training and their attitude towards school

Don’t know

6 (2.8)

15 (6.8)

Total

217 (100)

222 (100)

health programme. (Ifo,p=0.096; Ikenne,p=0.258)

Type of infection control

N=228

N=230

practices

None

25 (11.0)

27 (11.7)

0.1

0.794

Exclusion of sick pupils

79 (34.6)

67 (29.1)

1.6

0.205

Closure of school during

epidemic

5 (2.2)

1 (0.4)

2.7

0.098

Screening of food vendors

96 (42.1)

145 (63.0)

20.1

0.000

Periodic medical exams of

staff

26 (11.4)

10 (4.3)

7.9

0.005

Don’t know

5 (2.2)

10 (4.3)

1.7

0.195

*fishers exact test

343

Table 3: School Health Environment

adequate training increases the likelihood that they

Variable

IFO

Ikenne

P value

would fully implement the curriculum. Trained teachers

Mean no. of toilets for stu-

2.3 (1.9)

4.7 (3.6)

8.8

0.000

are more likely to continue implementing the pro-

dents’ use per school (SD)

Mean no. of toilets for staff’s

1.3 (1.0)

2.8 (2.8)

7.5

0.000

gramme later than teachers who receive programme

materials but are not trained. In the United States,

use per school (SD)

School source of water

evaluation of a comprehensive health education curricu-

None

140 (62.8)

88 (38.6)

Pipe-borne

9 (14.0)

9 (3.9)

0.000

lum showed that trained teachers were better prepared,

Dug well

13 (5.8)

6 (2.6)

implemented the curriculum with more fidelity and

Bore hole

49 (22.0)

93 (40.8)

achieved more positive effects on students.

.49

Others

12 (5.4)

32 (14.0)

Similarly,

Total

223 (100)

228 (100)

a study carried out in Northern Ireland highlighted the

Method of refuse disposal

need for ongoing in-career development for teachers. A

None

4 (1.8)

2 (0.9)

Burying

6 (2.7)

5 (2.2)

0.362*

Jordanian study showed that only 20% of teachers were

Burning

210 (92.9)

215 (93.9)

37.1

officially trained in school health .

PSP

4 (1.8)

1 (0.4)

Others

2 (0.9)

6 (2.6)

Total

226 (100)

229 (100)

In order for a school health programme to be effective,

Mean Max. student/class

56.4 (29.1)

29.0 (6.7)

13.7

0.000

(SD)

’

the teachers must make sincere efforts at implementing

it. The programme must be acceptable to the teachers

*fishers exact test

before they would be willing to implement such a pro-

gramme. In both local governments under study, most of

the teachers, had a positive attitude towards the school

Discussion

health programme. This is a desirable finding.

School health programmes are a critical means of im-

The traditional model of a school health program, con-

proving both educational performance and the well-

sist of the following three basic components; health edu-

being of children and the adults they will become. The

cation, health services and healthful environment. In

school health programme has been part of the educa-

Nigeria like in most countries in Sub Saharan Africa,

tional system in Nigeria for decades.In Ogun State,

there is the need for a well organized school health pro-

School Health Services Programme under the State Min-

gramme. A study carried out in Edo State, Nigeria

istry of Health has been in place since 2007 in all public

showed that only 38.3% of the schools had a school

health programme in place. In this study, majority of

primary and secondary schools in all the 20 LGAs in

Ogun State. Therefore it was not surprising that almost

the respondents said they had a school health pro-

all the teachers in both Ikenne (94.3%) and Ifo (94.7%)

gramme in their school. However, some of the compo-

were aware of the school health programme. In a study

nents of school health programme were not fully imple-

conducted in Edo state ,Nigeria, fewer teachers (76.7%)

mented. For example, 11.0% of the respondents in Ifo

were aware of school health programme.

local government area said they did not practise any

form of infection control in their school similar to the

The school health programme is a promising framework

11.7% of teachers in Ikenne. About half the schools in

which would enable schools

and teachers integrate

Ifo and Ikenne had a clinic/health post.

health initiatives in such a way as to address many of

society’s health issues. This would only be possible if

The proportion of respondents who said pre admission

teachers have adequate knowledge of school health such

examination was compulsory in their school was low in

that they understand the programme, can interpret it and

both LGAs. The practice of this important school health

shape it to meet the needs of their school community.

component needs to be improved upon as pre admission

Many teachers rely on their initial teacher education for

school based screening is important for early detection

most of their knowledge with regard to school health.

of anomalies and treatment to prevent impairment and

Despite their high level of awareness, over half of the

health complications. In another study conducted in Ni-

respondents in this study had poor knowledge of school

geria only 11.6 % of schools were reported to carry out

pre-school medical examination.

health. There was no statistical difference in knowledge

Schools that provide

between teachers in the two LGAs. This is similar to

health services not only benefit school-age children, but

findings in another study in Nigeria in which majority of

also the entire community. Screening of food handlers is

the teachers had poor knowledge of school health. This

important to protect staff and students from food borne

poor level of knowledge among teachers about school

illnesses. Not all food vendors in the studied schools

health could be due to the fact that aside from their pro-

were screened. However, the number of respondents in

fessional training in education, the teachers receive no

Ikenne who said that food vendors were screened in

special training on school health issues. Appropriate

their schools was significantly higher than those in Ifo.

training in school health needs to be provided for school

Similar to our finding that some components were not

teachers to fill their gaps in knowledge. A study carried

fully implemented, a study conducted in Denmark re-

out in Australia showed that while teachers have some

ported that the schools under study did not fully imple-

ment all the components of school health programme.

understanding of school health programmes, much

needs to be done in helping teachers play their role in

In contrast, a study in schools in a province in China

the implementation of school health programme. Since

found the schools used their full organizational poten-

teachers are programme implementers, the provision of

tials to implement all components of school health pro-

344

gramme.

In a study conducted in Lao, urban and

water supply infrastructure will help improve the social

rural schools were compared, there was a statistically

well-being of the population directly. It has been shown,

significant difference between urban and rural schools

for example, that better access to potable water can re-

for all three components of school health.

In this

lieve about the same total burden of disease (measured

study , there was no difference in the overall practice of

in daily-adjusted life years) as do improvements in pub-

lic health care.

school health programme in urban and rural schools.

Availability of sanitary

facilities is a pre-requisite for

creating a healthy environment in a school. Provision of

Safe clean drinking water, appropriate toilet facilities

Conclusion and recommendation

adequately spacious classrooms, comfortable seating

arrangements and playgrounds contribute in creating a

There was a high level of awareness of school health

conducive environment for the children in the

among all respondents. However, more than half of the

school. Access to safe water and sanitation remains a

respondents in both urban and rural schools had poor

major challenge in Nigeria. Majority of the respondents

knowledge about school health. Majority of the respon-

said there was no regular source of water for their school

dents had a positive attitude to school health. The

compounds. Similarly in other

studies in Nigeria the

School health programme is being run in most schools

school environment in most of the schools was reported

however, in both LGAs, not all components of school

to be poor.

11, 17

This is not surprising as water and sani-

health programme were fully implemented. In- service

tation coverage rates in Nigeria are amongst the lowest

training programmes on school health should be pro-

in the world. Estimates show that improved drinking

vided to better equip the teachers to play their role in

water and sanitation coverage rates are low nationwide

implementing school health programmes. All compo-

and Ogun state has one of the highest coverage rates at

nents should be fully implemented

65.1 %, above the national average of 51.4% .

This

lack of water supply hinders proper practice of hygiene

and puts the school children at risk of infectious dis-

Authors contribution

eases. Many

childhood diseases endemic throughout

KAO: Contributed to the concept, design , definition of

the country are generally associated with unsatisfactory

intellectual content, literature search/review , data analy-

drinking water supplies, poor sanitation conditions and

sis and manuscript preparation

inadequate health education. These include diarrhoea,

CEE: Contributed to the concept, design, literature

dysentery, gastro-enteritis, infectious hepatitis, hook-

search/review, data collection, data analysis and manu-

worm, guinea worm, and other parasitic infections. The

script preparation

direct health repercussion the situation imposes, espe-

Conflict of interest: None.

cially on children, is often underestimated. Improving

Funding: None

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