390 School Update In Bihar.epub

[Janis Shaeffer]

<div>Background: School environments affect health and academic outcomes. With increasing secondary school retention in low-income and middle-income countries, promoting quality school social environments could offer a scalable opportunity to improve adolescent health and wellbeing.</div><div></div><div></div><div></div><div></div><div></div><div>390 School Update In Bihar.epub</div><div></div><div>Download: https://t.co/JFw4KEsgYa </div><div></div><div></div><div>Methods: We did a cluster-randomised trial to assess the effectiveness of a multi-component whole-school health promotion intervention (SEHER) with integrated economic and process evaluations in grade 9 students (aged 13-14 years) at government-run secondary schools in the Nalanda district of Bihar state, India. Schools were randomly assigned (1:1:1) to three groups: the SEHER intervention delivered by a lay counsellor (the SEHER Mitra [SM] group), the SEHER intervention delivered by a teacher (teacher as SEHER Mitra [TSM] group), and a control group in which only the standard government-run classroom-based life-skills Adolescence Education Program was implemented. The primary outcome was school climate measured with the Beyond Blue School Climate Questionnaire (BBSCQ). Students were assessed at the start of the academic year (June, 2015) and again 8 months later at the end of the academic year (March, 2016) via self-completed questionnaires. This study is registered with ClinicalTrials.gov, number NCT02484014.</div><div></div><div></div><div>Findings: Of the 112 eligible schools in the Nalanda district, 75 were randomly selected to participate in the trial. We randomly assigned 25 schools to each of the three groups. One school subsequently dropped out of the TSM group, leaving 24 schools in this group. The baseline survey included a total of 13 035 participants, and the endpoint survey included 14 414 participants. Participants in the SM-delivered intervention schools had substantially higher school climate scores at endpoint survey than those in the control group (BBSCQ baseline-adjusted mean difference [aMD] 757 [95% CI 611-903]; effect size 188 [95% CI 144-232], p</div><div></div><div></div><div>Interpretation: The multi-component whole-school SEHER health promotion intervention had substantial beneficial effects on school climate and health-related outcomes when delivered by lay counsellors, but no effects when delivered by teachers. Future research should focus on the evaluation of the scaling up of the SEHER intervention in diverse contexts and delivery agents.</div><div></div><div></div><div>Methods: We used a cluster-randomized design to test the intervention, which comprised educational efforts, tobacco control policies, and cessation support and was tailored to the local social context. In 2009 to 2011, we randomly selected 72 schools from participating school districts and randomly assigned them in blocks (rural or urban) to intervention or delayed-intervention control conditions.</div><div></div><div></div><div>Considering the nature of our Patna municipal setting where water distribution system is mostly compromised with polluted water seeping into water supplies, it is significant investigating there schools water supply for possible microbial contaminations to prevent infections among students in future.</div><div></div><div></div><div></div><div></div><div></div><div></div><div>Twelve water samples from 9 different government schools were analysed using MPN method 6. After determinant of MPN number of positive sample, for organism identification do the culture & for species identification the biochemical (Indole, Methyl Red Test and Citrate Test) test as per WHO guideline was performed 7. Results are enlisted in Table 2.</div><div></div><div></div><div>MPN and Biochemical test have been used extensively as a basis for regulating the microbial quality of drinking water. In this study regulatory parameters were excessively above the WHO guidelines. The result of this study indicated that most of the sample highly contaminated. Finding of pathogenic microbes in water sample of different schools shows hazardous situation for waterborne epidemics among students. Drinking water source inside school get polluted with bacteria may be either due to malfunctioning of treatment plant or to the infiltration of sewage water through cross connecting leakage prints and back siphonage.</div><div></div><div></div><div>Diarrhea and pneumonia are leading causes of illness and death for children under 5 years old [1, 2] , as well as for school-aged children [3]. The prevalence of both diarrhea [4] and pneumonia [5] can be reduced significantly by proper handwashing with soap. Though handwashing with soap was once considered one of the most cost-effective interventions to reduce high-burden diseases in lower- and middle-income countries (LMICs) [6], more recent analyses have been more hesitant to make such claims due to variations in the effectiveness of such programs [7], and thus it is very important to understand how such programs work through careful evaluations at small and large scales. A national handwashing program in India based on some of the more effective programs identified to date would lead to an estimated US$5.6 billion annual gain in GDP, a 92-fold return on investment [8], suggesting the importance of taking such interventions to scale.</div><div></div><div></div><div>The primary outcome of the study was the overall proportion of times that children performed handwashing with soap at key occasions, defined for the study population as after defecation and before eating. These occasions were elicited using sticker diaries [32], where participants recorded a variety of behaviors from the previous day, divided into the three time periods of before, at, and after school, and were then prompted whether and with what they washed their hands before and after key occasions. Sticker diaries were found to be more accurate than some other self-reported measures of handwashing with soap [32], and have the advantage over structured observation that they can capture behavior in a larger time window and in different settings where structured observation may be constrained by logistical, cultural, or privacy considerations.</div><div></div><div></div><div>Log-binomial regression was used to analyze the difference in the primary outcome between the two study arms, with clustering at the individual and school levels. Sub-group analysis was also conducted by type of key occasions and by setting (school vs. home).</div><div></div><div></div><div>Consent was initially sought from head teachers at each school. The market research firm told mothers that they were conducting a study of the day-to-day activities of households in the village and that their information would be kept confidential and only analyzed in the aggregate. Mothers and children were told that their participation was voluntary. Verbal consent was obtained from each principal, mother, and child due to high levels of illiteracy in the area in keeping with local market research guidelines. The research agency conducting the study followed the procedures and guidelines mandated by the Market Research Society of India [33] and followed standard internal procedures to ensure ethical research standards. An independent research agency collected data for this evaluation. Data received for analysis for this manuscript was fully anonymized. This data was collected initially for company use, and secondary analysis was conducted on anonymized data, and thus the study was considered exempt from the university IRB.</div><div></div><div></div><div>The main objective of the school-based handwashing promotion program was to increase handwashing with soap on key public health occasions in the school setting. We find evidence that it succeeded in changing behavior overall, with large impacts before eating (which was very low to begin with) and both in schools and at home among children, though the impact was greater in the school setting than in the home. However, there was no difference between treatment and control arms for rates of handwashing with soap after defecation.</div><div></div><div></div><div>Given that this program was delivered in schools, the higher impact in schools than in the home is not surprising. However, a goal of the program was to impact behavior of children in school, and through them in the home as well, potentially spreading to the rest of the family, which was not found in another evaluation of a similar program delivered by an outside agency (non-teacher led) [31]. Future iterations of the program should pay particular attention to what approaches are most appropriate to address the different settings within which handwashing takes place.</div><div></div><div></div><div>In schools, infrastructure improvements along with triggering social norms may lead to large increases in rates of handwashing with soap [26], but designing effective systems for ensuring on-going provision of soap and water in schools is key. There is good evidence suggesting that school-based programs can drive sustainable behavior change even when delivered with low intensity [34], and so the target rates of handwashing with soap to see the desired public health impact should be weighed carefully against the cost of more intensive, even infrastructure providing interventions.</div><div></div><div></div><div>In homes, many of the behavioral determinants present in targets schools will not be present- social pressures will likely not have changed and infrastructure changes or material provision not made. This may be one of the reasons that structured observation, limited to the home setting, has detected little impact in some school-based hygiene promotion programs [24, 31]. School-based program should consider carefully how to give a role to schoolteachers, incorporate mothers, other family members, school authorities (who may communicate trustworthiness of the messages to those family members [16]), and maybe even whole communities in handwashing promotion programs to see behavior change among key groups such as children too young to attend school. But, the importance of the school-based setting should also not be ignored in community-based handwashing promotion programs.</div><div></div><div></div><div>A few key limitations of this study should be noted. First, no data was collected on the available handwashing infrastructure either from mothers or children in homes or from schools (as there was no data collection at all from schools). Second, the sample size was not sufficient to draw implications about specific sub-behaviors of interest. Both of these limit the inferences that can be drawn about, for example, whether increases in handwashing in schools were more driven by those performing it before eating (where peer pressure before a common meal may be strong) or after defecation (which may be less visible to other students) or whether rates of handwashing in the home increased greatly in homes where infrastructure was present, while remaining the same in less-well-equipped homes. Finally, the small number of clusters (schools), despite being controlled for statistically, limits the strength of the evidence as the distribution of rates of handwashing with soap within schools varied greatly.</div><div></div><div> dd2b598166</div>