Status of school health programs in Asia: National policy and implementation.

BACKGROUND: The WHO's Health Promoting Schools (HPS) framework is based on an understanding of the reciprocal relationship between health and education, and the need to take a holistic approach to health promotion in schools. We aim to clarify the degree to which the HPS framework is reflected in the national policies of eight target countries and the issues surrounding its successful implementation. METHODS: Date were collected through two expert workshops with participants from eight Asian countries: Cambodia, China, Japan, Korea, Lao PDR, Nepal, the Philippines, and Thailand. In the first workshop, data collected on national policy were mapped against the HPS framework. From this, key issues were identified, and follow-up data collection was conducted in each country for a second workshop. RESULTS: We identified a policy shift toward the HPS framework in six out of the eight countries. Neither Japan nor Korea had changed their national policy frameworks to reflect an HPS approach; however, in the latter, model programs had been introduced at a local level. We identified various barriers to successful implementation, especially in relation to mental health and wellbeing. CONCLUSION: Given the recent shift toward the HPS approach in six out of the eight countries in this study, there is a need to conduct research to assess the impact of this framework on the health and wellbeing of students and school staff. At the same time, we call for more dialog in the context of Japan to explore the possible benefits of introducing the HPS framework into schools.

Obesity prevalence and contributing factors among adolescents in secondary schools in Pemagatshel district, Bhutan.

Background The prevalence of obesity has increased globally, with childhood and adolescent obesity being more common in developed countries. There has been no study on teenage obesity in Bhutan. In this study, we aimed to assess the prevalence of obesity in Bhutan for the first time in order to provide a baseline for future researchers. Methods The investigation, which included 392 adolescents, aimed to identify the prevalence of overweight and obesity and its contributing factors. Anthropometric measurements, food recall and knowledge, attitude, behaviour and environment questionnaires were administered. The body mass index (BMI) cut-off points for adolescents matched with those of the US Centers for Disease Control and Prevention. Results The prevalence of overweight and obesity among the participants were 7.1% and 1.5%, respectively. The prevalence of obesity was 1.0% in females and 0.5% in males (p < 0.001). There were significant (p < 0.001) correlations between BMI and other variables; however, Pearson's χ2 test uncovered no significant associations. BMI also had no significant associations with attitude, behaviour, environment and distance travelled to school. Food recall results revealed the following findings for average food consumption: total energy intake, 3522.6 kcal; fat, 47.6 g; carbohydrate, 690.2 g; protein, 90.5 g; fibre, 20.3 g; and sodium, 12.5 g. Conclusion The results of this study clarified the prevalence of obesity among adolescents in Bhutan, who require appropriate strategies for combating overweight and obesity.

Keys to success for a school-based malaria control program in primary schools in Thailand.

School-based malaria control has been recognized as a new approach for the control of this disease in the Greater Mekong Subregion since 2000. We evaluated a school-based malaria control program near the western border of Thailand using a before-after intervention study. The major intervention activities included teacher training with specialized malaria teaching materials and participatory learning methods. The target population was 17 school principals, 111 teachers and 852 schoolchildren of grade 3, 4, and 5 in 17 schools. After the intervention, the teachers taught about malaria more actively than before. The teachers who could design a lesson plan on malaria increased from 30.7% to 47.7% (p=0.015) and the teachers who had taught about malaria increased from 71.9% to 84.3% (p=0.035). As a result of the program, the schoolchildren changed their behavior positively towards malaria prevention with significant difference in 6 of 7 questions. For example, the schoolchildren 'who always took care of mosquito bites' increased from 42.7% to 62.1% (p<0.001) and the schoolchildren 'who always reported their parents or teachers when they had fever' increased from 36.0% to 56.0% (p<0.001). In conclusion, the keys to a successful intervention lie in good teaching materials and a participatory approach utilizing the well-established Thailand's school health system. Beyond Thailand, school-based malaria control could be applied to other Greater Mekong Subregion countries with careful analysis of school health context in each country.

Risk factors of helminthiases among schoolchildren in southern Thailand.

School-age children are particularly at risk of soil-transmitted helminthiasis (STH), which affects their growth and development. Hence, school-based helminthiasis control has been discussed and conducted as one of cost-effective ways in developing countries. A parasite control program is to be planned and conducted in an evidence based way as one of practical medical fields. However, a prevalence is likely to be influenced by various factors such as local environment and residents' behavior and so on. As few reports mentioning the relation of the prevalence and children's behavior and practice have been published, we conducted a survey to investigate such relation by asking children directly. Two hundred and eighty pupils in grade 3 to grade 5 were enrolled, who were in the two schools in Nakhon Si Thammarat Province, southern Thailand. A cross-sectional study was conducted in February and in November 2001, on the relationship between helminthiasis and children's knowledge and practice by using Kato-Katz method and a questionnaire, respectively. Hookworm (Hw) was the most predominant helminth followed by Trichuris. Boys had more intensive Hw infection than girls (p = 0.022), and wore shoes less frequently than girls (p < 0.001). The pupils who nearly acquired Hw infection after the first stool examination had lower levels of the knowledge of STH comparing to those who did not (p = 0.011). This study suggests that a prior survey can identify unique local factors as a part of diagnostic process, the results of which are useful for teachers to understand some points of health education at schools and can be applied as indicators for monitoring and evaluation.