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Asking questions: how healthy are African school children?

More attention needs to be paid to the health of school-age children in sub-Saharan Africa, and their sense of well-being. The use of questionnaires in schools can help teachers and health care workers identify and assess common health problems.

There are relatively few programmes aimed at combating ill-health among older children and adolescents. Health programmes usually focus on infants and pre-school children. Save the Children, together with the Tanzania Partnership for Child Development carried out a study amongst school children in Ghana, Mozambique and Tanzania to discover whether they had the disease, urinary schistosomiasis, a symptom of which is blood in the urine. Other questions about their health were also asked to take away the focus from the ‘red urine’ question.

These surveys were conducted on a grand scale. 67 000 children, aged between eight and fifteen, took part in questionnaires in primary schools in the three countries between 1994 and 1999. Urine tests were also carried out to check for blood in the urine. Teachers interviewed the children in private and asked them between 15 and 19 questions. The questionnaire covered health problems:

that were well known to the children, such as malaria and stomach ache
that had clear symptoms, such as vomiting and blood in the urine
that affected specific parts of the body, such as the eyes, ears or teeth
that were easily identified such as jiggers (fleas) or a cut or wound.

The study found that African schoolchildren do not feel healthy, a fact which is unsurprising given the burden of different diseases in the region surveyed:

The distributions and ranking of reported health problems were similar in all countries
Over 90% of children had reported at least one health problem in the past few weeks.
Between 30 and 50% reported vomiting or malaria in the past few weeks.
As the children got older, they said they suffered less from headache, cough, vomiting and diarrhoea.
The children on average reported between three and four health problems: in Ghana the average was 3.9, in Mozambique 3.4 and in Tanzania 3.1.
Girls reported more problems than boys, except for having blood in their urine.

More work should be carried out in assessing the health of this age group and in developing school-based health services. The fact that children gather in schools provides an opportunity to develop simple screening methods and deliver health services within an existing infrastructure.

Questionnaires, administered by teachers, are a quick and inexpensive way of assessing health needs of school children and are worthy of further study and validation.

Source(s):
‘Ill-health reported by schoolchildren during questionnaire surveys in Ghana, Mozambique and Tanzania’, Tropical Medicine and International Health 8(11): 967-974, by H. Moestue, B. Mahumane, A. Zacher et al, 2003
'A randomised trial in Mali of the effectiveness of weekly iron supplements given by teachers on the haemoglobin concentrations of schoolchildren', Public Health Nutrition 5: 413–418, A. Hall, N. Roschnik, F. Ouattara, L. Toure, F. Maiga, M. Sacko, H. Moestue & M.A. Bendech, 2002
'Malaria diagnosis and treatment administered by teachers in primary schools in Tanzania', Tropical Medicine and International Health 6: 273–279, P. Magnussen, B. Ndawi, A.K. Sheshe, J. Byskov & K. Mbwana, 2001

Funded by: The Edna McConnell Clark Foundation

id21 Research Highlight: 2 February 2004

Further Information:
Helen Moestue
Nutrition and Public Health Intervention Research Unit
London School of Hygiene and Tropical Medicine
50 Bedford Square
London
WC1B 3DP
UK

Tel: +44 (0) 207 299 4724
Contact the contributor: helen.moestue@lshtm.ac.uk

Save the Children

Partnership for Child Development, Imperial College, UK

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