MINISTRY OF EDUCATION &TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY MAC DANG TUAN THE CURRENT SITUATION OF SCHOOL HEALTH IN PRIMARY AND SECONDARY SCHOOLS AT TUYEN QUANG PROVINCE IN THE PERIOD[.]
Trang 1MINISTRY OF EDUCATION &TRAINING MINISTRY OF HEALTH
HANOI MEDICAL UNIVERSITY
MAC DANG TUAN
THE CURRENT SITUATION OF SCHOOL HEALTH
IN PRIMARY AND SECONDARY SCHOOLS AT
TUYEN QUANG PROVINCE IN THE PERIOD 2007 - 2017 AND THE RESULTS OF SOME INTERVENTION SOLUTIONS
Specialization : Public Health
THE PUBLIC HEALTH DISSERTATION SUMMARY
HANOI - 2022
Trang 2THE RESEARCH WAS COMPLETED IN
HANOI MEDICAL UNIVERSITY
Supervisors:
1 Assoc.Prof.Dr LE THI THANH XUAN
2 Assoc.Prof.Dr CHU VAN THANG Reviewer 1: Assoc.Prof.Dr TRAN VAN DAN
At hour , date month year 20
The dissertation can be found at:
- National Library
- Library of Hanoi Medical University
Trang 3LIST OF PUBLISHED RESEARCH WORKS
1 Mac Dang Tuan, Le Thi Thanh Xuan, Chu Van Thang (2017) The situation of school health care in secondary schools in
Tuyen Quang city, Tuyen Quang province 2016 Vietnam
Journal of Preventive Medicine Vol 27, No 7 - 2017: 41 - 49
2 Mac Dang Tuan, Le Thi Thanh Xuan, Chu Van Thang (2020) Effectiveness of intervention measures for prevention of myopia among primary and secondary school pupils in Tuyen
Quang province in 2017 Vietnam Journal of Preventive
Medicine, Vol 30, No 1 - 2020: 138 - 147
Trang 4THE DISSERTATION SUMMARY
1 Introduction
School health (SH) is an important task in general care, protection and improvement of health for students Up to now, there have been many documents, directives and decisions issued by the Prime Minister, the Ministry of Health, the Ministry of Education and Training, directing and guiding its implementation in order to strengthen health work at schools Currently, as of September 30th, 2020, in Vietnam, there are 26,403 schools of all levels from primary to high school with nearly 17.5 million students (up 3.5% over the previous academic year and accounts for 17.9%
of the country's population) This is the young generation, the future of the country, so taking care of, protecting and improving the health of students make a very important contribution to the comprehensive development of the young generation and improving the quality of life of the descendants of the nation in the future
Meanwhile, the network of school health staff (SHS) is lacking in quantity and is not guaranteed in quality The number of schools with SHS accounts for only 74.9% of the total number of schools; the number of educational institutions without SHS is 25.1%; the number of schools with SHS in charge of primary health care with professional qualifications as mandated ( physicians and above) is only about 30% The majority of medical staff are part-time teachers who have not been trained in the specialty of general
medicine, especially in disadvantaged rural areas, remote areas, very few schools have full-time SHS
Tuyen Quang is a mountainous province in Nothern Vietnam, where education and health work has been invested in and paid much attention to, but healthcare work in schools still faces many difficulties and results are still limited Meanwhile, in order to clearly identify the situation of the above difficulties, to help propose feasible solutions, suitable to the local situation and to promote public health activities, there have not been many in-depthstudies on this issue
From the (afore)mentioned fact, we have conducted a study on the topic
"The current state of school health in primary and secondary schools in Tuyen Quang province in the period 2007 - 2017 and the results of some intervention solutions" with 3 objectives:
1 Describe the current situation of school health in some primary schools and secondary schools at Tuyen Quang province in the period 2007 -
2016
2 Describe the knowledge and practice of school health of students in grades 4 and 8 in the 2016-2017 school year at the above schools
Trang 53 Evaluation of results after 1 year of intervention to change knowledge and practice about school health of the above group of students
2 New contributions of the dissertation:
(1) The topic has provided an overview of the current state of school health in 18 surveyed schools with great difficulty in terms of human resources, facilities, funding, and ineffective school health activities (2) The students' knowledge and practice of school health are still limited, which is the basis for providing interventivesolutions to improve knowledge and practice
(3) Research has developed and implemented intervention of health education-communication for students combined with training in school health work for SHS andteachers Initially, the study results have demonstrated the effectiveness of the intervention This result is scientific evidence to justify making further recommendations on maintaining communication intervention, health education for students, as well as improving the quality of school health activities by arranging staff to a full-time medical professional, or contracting with a local medical facility; and organizing regular training Thus it is also the basis for replicating this intervention model to other localities so that school health activities get more attention, improvement and practicality
3 The Dissertation Layout:
The dissertation consists of 147 pages (excluding appendices), 4 chapters including: Introduction: 2 pages; Chapter 1- Overview: 35 pages; Chapter 2
- Research subjects and methodology: 13 pages; Chapter 3 - Results: 47 pages; Chapter 4 - Discussion: 47 pages; Conclusion: 2 pages, Recommendation: 1 page
The dissertation includes: 50 tables, 3 charts, 16 information boxes, diagrams and 143 references
Chapter 1 INTRODUCTION 1.1 Model of organization and management of school health activities
Some models of school health are as follows: Model 3 content; Model 8 content; Model of full-service schools; Health promoting schools
Trang 61.1.2 In Viet Nam
From 2016 onwards, the assessment of public health work is carried out according to Circular 13/2016/TTLT-BYT-BGDĐT replacing the old circular 18/2011/TTLT-BGDĐT-BYT Currently, the management of SC is being coordinated by the Ministry of Health and the Ministry of Education and Training, and the management model of traditional health activities is increasingly consolidated and improved from the central to the grassroots level
1.2 Some studies related to school health
1.2.1 In the world
Jones SE et al (2015) conducted a descriptive observational study that compared the outcomes of SH activities among countries in the United States that have policies requiring SH activities to be associated with the management of chronic diseases (asthma, diabetes) and requiring to have these conditions consulted with countries that do not have the above policy The results show that in districts with the above policy, the number of students with chronic diseases managed is 53.8% compared with 29.9% in the districts without the above policy; physical activity and sports counseling (28.8% vs 12.6%); health status self-management education (51.3% vs 23.6%); and referral for chronic diseases (47.2% vs 19.9%) (p<0.05) Thus, it is clear that when there is a policy that specifically requires SH activities associated with the management of chronic diseases
as well as the requirement to have a consultant on these diseases at schools, the general activities of the SH system will be markedly enhanced Or on the rescue role of SHS when a natural disaster occurs, as shown in a study by author Sakou K with the topic "School health activities of yoga-teachers and functions of school health offices in Niigataken Chuetsu-oki earthquake Qualitative analysis of interview data for yoga-teachers''
1.2.2 In Viet Nam
In Vietnam, although there are many studies on SH having been/being published, these studies mainly focus on the health conditions of students as well as learning conditions affecting the health of students In
2014, Nguyen Thi Hong Diem and colleagues conducted a study on "The current situation of capacity of primary SHS" which also showed that the capacity of SHS is still limited: 79.1 % of schools have medical staff, in which 53.3% are full-time staff Some other studies show that the actual results and practices of students on school health are still limited and this issue requires a lot more attention from the school, family and society
Chapter 2 RESEARCH METHODOLOGY
2.1 Research subjects
- Teachers at selected primary and secondary schools
- Officials and leaders in school health at all levels of the province
- School health staff at selected primary and secondary schools
- 4th and 8th grade students at selected schools
- Representative of the parents association of selected schools
Trang 7- Reports, available data, documents on school health from 2007 onwards Facilities, equipment, drugs and conditions for implementing school health at schools selected for the study
2.2 Research location: 18 primary and secondary schools in Tuyen Quang
province
2.3 Research period: from August 2016 to November 2020
2.4 Research Methods
2.4.1 Research design: descriptive study and intervention study at 18
primary schools, secondary schools representing 3 socio-economic regions
collected
Students
Description and Evaluation of the same
students after 1 year of intervention
Number of students in primary school
students: 824
Number of students in secondary school: 833
1,657
Sampling method
Step 1: Purposefully select a district/city representing 03 socio-economic
geographical regions of the province (01 district for the northern mountainous area, 01 city to represent urban areas and 01 district for the southern mountainous area) A total of 03 districts/cities were selected in the province
Step 2: Randomly select representatives of 03 communes/wards in 01
district/city Randomly select 1 primary school and 1 secondary school A total of 18 schools were selected
Step 3: Purposefully select grade 4 in primary schools and grade 8 in
secondary schools of the commune Each grade at each school selects 80 students
Step 4: Randomly select classes in grade 4/grade 8 from each selected
school until there are 80 students at each school, then stop The classes participating in the study were selected by random lottery according to the class name in the grade
Trang 8- City Medical Center
- Department of Education and Training
3 interviews
District
/city
02 officials x 03 districts/city
- District/city Health Center
- Education and training room
6 interviews
- Group of variables about knowledge and practice of students about myopia, scoliosis and dental diseases
Qualitative research: Group of variables about difficulties and
advantages when implementing school health work, group of variables
about proposed solutions
2.6 Techniques and tools for data collection
2.6.1 Quantitative research
Tools: Pre-designed question sets Checklists and information collection
sheets are available
- Collect available data on local SH activities in the form available
Trang 9to participate: 02 training sessions at Tuyen Quang Medical School; 03 training sessions at 03 districts health stations Conducting face-to-face talks with teachers and students in flag salutations and 18 thematic talks on school myopia, scoliosis disease, and dental disease
2.8 Data management and analysis
- Quantitative data: using medical statistical algorithms: Quantitative
variables are described by mean, standard deviation, and median Qualitative variables are described by frequency and percentage Testing the statistical difference with qualitative variables between groups by the χ2 algorithm yields a statistically significant difference with p<0.05
- Qualitative data: removing tapes and synthesizing, presenting the
results of in-depth interviews with matrix tables
- Efficiency index (EI) is calculated according to the formula:
𝐸𝐼 =|𝑝2−𝑝1|
𝑝1 x 100 p1 is the percentage before the intervention and p2 is the percentage after the intervention
2.9 Ethics in research
The study was approved by the 2016 Proposal Review Board and the Ethics Committee of Hanoi Medical University in 2017 (certificate No 25/HDĐĐHYHN dated January 6, 2017 on the approval of biomedical research by the Ethics Council in biomedical research)
2.10 Errors and remedies
The main errors are information errors: due to the misunderstanding of the questionnaire by the investigator, the question set uses ambiguous words, causing misunderstandings; because the research subjects answered incorrectly: due to sensitive questions, not knowing, or not remembering answers; misinput by the user Fix: compose a clear and easy to understand information collection table; enumerators were trained on how to collect data before the survey; trial investigation on research subjects; re-enter 10%
of questionnaire to check
Trang 10Chapter 3: RESEARCH RESULTS 3.1 General characteristics of research subjects
Our research was conducted in 18/18 primary and secondary schools representing 3 socio-economic regions of Tuyen Quang province The number of students participating in the survey before the intervention was 1,657 and 1 year after the intervention was 1,657 students (in the same target group) The ratio of male students interviewed to female students is 1.1/1 The total number of SHS working at the school filling out the answer sheet is 18 Period 2007 - 2016: there is no SHS at the school with medical expertise In 2011-2016, there were 1/18 contract employees with medical expertise The rest are mostly part-timers and do not have medical expertise
3.2 The current state of school health in some primary schools and secondary schools at Tuyen Quang province in the period 2007 - 2016
3.2.1 The current state of conditions and facilities
Table 3.1 Actual situation of arranging school health rooms in schools
Trang 11Table 3.4 Actual situation of essential drugs at the school health room
N/A N/A N/A N/A N/A N/A 0/18 0/18 0/18 0/18
N/A: no data available
* Compared with Decision No 1221/QD-BYT dated April 7, 2008 of the Minister of Health promulgating the list of essential equipment and drugs used in school health rooms of primary and secondary schools offices, high schools, high schools with many levels of education
Period 2007 - 2016: no school had enough essential drugs compared to the regulations of the Ministry of Health with more than 10 groups to 14 groups Only 6/18 schools had the number of essential drugs under 5 groups
as prescribed by the Ministry of Health (since 2013)
3.2.1 The current state of the school's organization and human resources Table 3.7 Actual situation of the number of staff participating in school
health work in the period 2007 - 2016
Year
Content 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
full-time
(payroll) 0/18 0/18 0/18 0/18 0/18 0/18 0/18 0/18 0/18 0/18 contract,
The rest are mostly part-time officers (accountants, teachers, ) with 18/18 schools (from 2007 - 2010) and 17/18 schools (from 2011 - 2016) There is only one secondary school that had a contracted school medical staff in charge of school health and medical expertise (from 2011 to 2016)
Trang 123.2.3 The current state of student health insurance
Table 3.11 Student's participation in health insurance period 2007 – 2016
3.3 Knowledge and practice about school health of students in grades 4 and 8 in the 2016-2017 school year at the above schools
*Correct: Only see close objects clearly
The table above shows that the percentage of students who have correct knowledge about myopia is only seeing objects that are close to them clearly The overall rate of both classes is 80.4%, in which 8th grade has a higher percentage of students with correct knowledge of the concept of myopia than this rate in 4th grade (85.2% versus 75.5% )
Table 3.24 Students' knowledge about the causes of myopia
Students
Cause
4th (N=824)
8th (N=833)
General (N=1,657)
Trang 13The percentage of students who believe that the cause of myopia is lack
of light when reading is 67.6% In which, this rate in 4th graders is 51.8% lower than in 8th graders at 83.2%
Table 3.28 The rate of students' practice on learning activities,
daily entertainment
Students
Practice
4th (N=824)
8th (N=833)
General (N=1,657)
Lying down reading books
and reading stories 117 14.2 236 28.3 353 21.3 The majority of students study in a place with enough light, accounting for 80.2% (of which 80.9 percent of students and 79.5%) of fourth graders Children who regularly sit and study neatly account for 72.1%
Table 3.30 Students' knowledge about risk factors for scoliosis
Students
Risk factors
4th (N=824)
8th (N=833)
General (N=1,657)
Sitting sideways 649 78.8 749 89.9 1,398 84.4 Not eating enough
Regular heavy work in