Abstract
Background
Children who spend large part of their lives in primary schools are exposed to varieties of hazards like physical injuries, infections, nutritional and emotional problems. School age is a period of rapid physical and mental developments. Children require healthy environments for appropriate adjustments to benefit maximally from educational systems. School Health Services were established to ensure healthy members of school community. Teachers play major roles in promotion and successful implementation of programmes. This study examined the knowledge, attitude and involvement of public primary school teachers on school health services.
Methodology
This was cross-sectional descriptive study conducted in 24 public primary schools in Isi-ala-Ngwa LGA, Abia State. All the public primary school teachers (264) in the LGA were studied. Data were collected using pre-tested self-administered semi-structured questionnaire. Data were analysed using SPSS version 26 and presented in frequency tables. Chi-square was used to test association between categorical variables. P<0.05 was taken as statistically significant.
Results
Ages of participants were normally distributed with mean, median, mode and standard deviation being 35.7, 35.5, 35.5 and 8.87 respectively. From the findings, 169 (64%) respondents had good knowledge, 120 (38.6%) had positive attitude to school health services while 72 (27.3%) had good involvement. There was statistically significant difference between socio-demographic characteristics and knowledge of school health services and attitude towards school health services except for qualification of teachers and knowledge of and attitude. There was statistically significant difference between socio-demographic characteristics and involvement of health services except for teachers' residential area.
Conclusion
The respondents had good knowledge but poor attitude and involvement to school health services.
Keywords: Knowledge, Attitude, Involvement, Teachers, School health service, Nigeria
Introduction
Children all over the world spend a large part of their lives in primary schools and are exposed to variety of hazards such as physical injuries,1 infections,2,3 nutritional problems4,5 and emotional problems.2,6 Many of the living children still bear the sequelae of the diseases which could be responsible for the death of the dead children.7 School age is a period during which the child is undergoing rapid physical and mental development; therefore a healthy environment is required to provide the child with the best opportunity of making the appropriate adjustments that are required during this critical period.
To benefit maximally from the educational system, children should be physically, mentally and emotionally healthy7 while exposure during school hours to various hazards, such as physical injury, infections and emotional problems, should be minimal if not totally prevented. It is for this reason that the School Health Service was established. A School Health Service should include the following eight components: parents and community involvement, healthful school environment, health services, health education, physical education, nutrition services, counseling, psychological and social services, and health promotion of school staff.8
A school teacher is a person who provides education for pupils9,10. The role of a teacher is often formal and ongoing, carried out at a school or other place of formal education. In many countries, a person who wishes to become a teacher must first obtain specified professional qualifications or credential from a recognized institution, such as University or College of Education. These professional qualifications may include the study of Pedagogy - the science of teaching. Teachers like other professions may have to continue their education after they had qualify, a process known as Continuing Professional Development.11The role of teachers in the school health services is very central. They are the resource people responsible for the promotion and successful implementation of the school health services. Teachers are well respected and viewed as role models by their pupils and they therefore have an important impact on their learning and actions.12,13 One of the objectives of school health policy of Nigeria is the training of teachers on First aid and provision of basic services for diseases prevention and management of injuries.14 To ensure that schools are safe for learning and other extra-curricular activities, it is important there is high level of compliance to this policy.
Materials and Methods
This was a cross-sectional descriptive study from March to June 2019 among public primary school teachers in Isi-ala-Ngwa North Local Government Area (LGA), Abia state, South-east Nigeria. Isi-ala-Ngwa LGA is a local government area in Abia state, Nigeria. It lies within approximately latitude 5.38897 4° and 6° 14° North and longitude 7.446957° 10° and 7° East. It has area of 28,300 hectares, 283.00km2 (109.27 sq. mile) and attitude 111metres (364ft) with a population of 154,083 according to the National Population Census (2006) projected to 234,800 up to March 2019with annual population change of 2.7% (2006 - 2019).17 It is a rural community in the state. Her residents are made up of civil servants, teachers, traders, some engage in vocations such as commercial bus driving, tailing, shoe making, farming, patent medicine operators, employees of private organizations like schools, POS machines operations, hospitals.
Study design
It was a cross-sectional descriptive study conducted in Isi-ala-Ngwa LGA from March to June 2019.
Sample size
264 teachers
Sample size determination
Sample size was calculated using the following formulae.15
N = z2pq/d2 when the studying proportion greater than 10,000, In case of Isi-ala-Ngwa North LGA where the population of teachers is less than 10,000; nf = n/(1+ n/N);
Where:
n – the desired sample size (when the population is greater than 10,000)
z – The standard normal deviate, usually set at 1.96 (more simply at 2.0), which corresponds to the 95 percent confidence level
p – the proportion in the target population estimated to have a particular characteristic. If there is no reasonable estimate, then use 50% (i.e.; 0.50)
q – 1.0-p
d – degree of accuracy desired, usually set at 0.05 or occasionally at 0.02 but 0.05 was used in this study, n = z2pq/d2 = (1.96) (0.50)(0.50)/ (0.05)2 = 384.1.
Using 10% as non-response rate, sample size for population greater than 10,000 will be: 384.1 + 10/100(348.1) = 422.51.
For population less than 10,000 with estimated sample size of 1000 as it applied to number of teachers in Isi-ala-Ngwa North LGA.
The sample size will be: 422.51/ 1+ (422.51/1000) = 422.51/1.423 = 297
However, there are only 264 public primary school teachers in Isi-ala-Ngwa LGA16 and so, sample size 264 was used in this study.
Subjects and selection method
There are total of 24 public primary schools and the number of teachers in these schools vary from 8 to 15 teachers as the size of the schools are not the same and so all the teachers were selected.
Statistical analysis
Data collected was analysed using Statistical Package for the Social Sciences (SPSS) software version 26.0. Data is presented in frequency tables. Chi-square was used to test association between categorical variables, P – value of <0.05 was taken to be a statistically significant.
Ethical consideration
Informed consent of the study was obtained from Abia State University Teaching Hospital, Aba, Informed consent was also obtained from the head teachers and all the teachers of the 24 public primary schools who participated in the study. Meetings with the participants from various school were held, they were briefed on the objectives of the study. They were counseled and thereafter their consents obtained prior to beginning of the study.
Results
Two hundred and sixty-four teachers participated in in the study. Majority of the participants 132 (50.0%), ≤ 39 year, 90 (34.1%) were in 40 – 49 years of age, 42 (15.9%) were in 50 years and above in age. Majority of them 200 (75.6%) were females and 64 (24.4%) were males. Majority of them 204 (77.3%) were married and 60 (22.7%) were single. Majority of them had qualification equal and less than National Certificate of Education 200 (75.8%) and 64 (24.2%) of them had qualification greater than National Certificate of Education. Majority of them 144 (54.5%) had years of teaching experience greater ten while 120 (45.5%) had years of teaching experience equal and less than ten. Majority of them 140 (53.0%) live within the community where they were located while 124 (47.0%) live outside the community. Majority of them 169 (64.0%) had good knowledge of school health service while 95 (36.0%) had poor knowledge. Majority of them 162 (61.4%) had negative attitude towards school health services while 102 (38.6%) had positive attitude. Majority of them 192 (72.7%) had poor involvement of school health services while 72 (27.3%) had good involvement. Association of socio-demographic characteristics and knowledge of school health service were found to be statistically significant with p-value of 0.000 except for qualification of teachers and knowledge that was not statistically significant with a p-value of 0.556. The same association were found for attitude to health service. Association of socio-demographic characteristics and involvement of health services were statistically significant with p-value of 0.000 except for association of teachers' residential area and school health services which was not statistically significant with a p-value of .615.
Table 1 shows measure of central tendency from their ages as at their last birthday as follows; mean 35.7, median 35.6, Mode 35.5, standard deviation of 8.87, Minimal age is 29 years, maximum age is 54 years with a range of 25. The table shows that their ages of last birthday was normally distributed.
Table 1:
Measurement of central tendency from age of last birthday
| Variables | Mean | Std Error of mean | Median | Mode | Std Dev | Variance | Range | Min | max |
|---|---|---|---|---|---|---|---|---|---|
| Age as at last birthday | 35.7 | 0.4544 | 35.6 | 35.5 | 8.87 | 78.677 | 25 | 29 | 54 |
Table 2 shows socio-demographic characteristics and their distribution: Majority of the participants 132 (50.0%) were equal and below 39 year, 90 (34.1%) were in 40 – 49 years of age, forty-two (15.9%) were in 50 years and above in age. Majority of them 200 (75.6%) were females and 64 (24.4%) were males. Majority of them 204 (77.3%) were married and 60 (22.7%) were single. Majority of them had qualification equal greater than National Certificate of Education 200 (75.8%) and 64 (24.2%) of them had qualification greater than National Certificate of Education. Majority of them 144 (54.5%) had years of teaching experience greater ten while 120 (45.5%) had years of teaching experience equal and less than ten. Majority of them 140 (53.0%) live within the community where were located while 124 (47.0%) live outside the community.
Table 2:
Socio-demographic characteristics
| Variables | Frequency | Percentage (%) | |
|---|---|---|---|
| Age group | Equal and less than 39 | 132 | 50.0 |
| 48-49 | 90 | 34.1 | |
| Greater than 50 | 42 | 15.9 | |
| Total | 264 | 100.0 | |
| Male | 64 | 24.2 | |
| Female | 200 | 75.8 | |
| Total | 264 | 100.0 | |
| Equal and less than national certificate of education | 200 | 75.8 | |
| Greater than national certificate of education | 64 | 24.2 | |
| Total | 264 | 100.0 | |
| Marital status | Single | 60 | 22.7 |
| Married | 204 | 77.3 | |
| Total | 264 | 100.0 | |
| Years of experience years | Equal and less than 10 | 120 | 45.5 |
| Greater than 10 years | 144 | 54.5 | |
| Total | 264 | 100.0 | |
| Teacher’s residential | Within the community | 140 | 53.0 |
| area | Outside the community | 124 | 47.0 |
| Total | 264 | 100.0 | |
Table 3 shows the level of knowledge of school heal service of the participants: Majority of them 169 (64.0%) had good knowledge of school health service while 95 (36.0%) had poor knowledge. Majority
Table 3:
Knowledge level of school health services
| Variables | Frequency | Percentage (%) | |
|---|---|---|---|
| Level of knowledge | Poor knowledge | 95 | 36.0 |
| Good knowledge | 169 | 64.0 | |
| Total | 100.0 |
Table 4 shows the level of attitude of the participants towards school health services: Majority of them 162 (61.4%) had negative attitude to school health services while 102 (38.6%) had positive attitude.
Table 4:
Level of attitude towards health services
| Variables | Frequency | Percentage (%) | |
|---|---|---|---|
| Level of attitude towards school health services | Negative attitude to school health services | 162 | 61.4 |
| Positive attitude to school health services | 102 | 38.6 | |
| Total | 264 | 100.0 |
Table 5 shows the level of involvement of the participants on the school health services: Majority of them 192 (72.7%) had poor involvement of school health services while 72 (27.3%) had good involvement.
Table 5:
Level of involvement of school health services
| Variables | Frequency | Percentage (%) | |
|---|---|---|---|
| Level of involvement of school health school | Poor involvement of school health services | 192 | 72.7 |
| Good involvement of school health services | 72 | 27.3 | |
| Total | 264 | 100.0 |
Table 6: shows the association of socio-demographic characteristics and knowledge of school health service: Association of socio-demographic characteristics and knowledge of school health service were found to be statistically significant with p-value of 0.000 except for qualification of teachers and knowledge that was not statistically significant with a p-value of 0.556.: Association of years of experience and teacher's residential area and knowledge of school health service were found to be statistically significant with p-value of 0.000.
Table 6:
Association between socio-demographic characteristics and knowledge of school health services
| Variables | Knowledge of school health services | Total N (%) | χ2 | P — value | ||
|---|---|---|---|---|---|---|
| Poor knowledge N (%) | Good knowledge N (%) | |||||
| Age group | Equal and less than 39 | 40(15.2) | 92 (34.8) | 132 (50.0) | .000 | 31.328a |
| 40-49 | 51 (19.3) | 39(14.8) | 90 (34.1) | |||
| Equal and greater than 50 | 4(1.5) | 38 ()14.4 | 42 (15.9) | |||
| Total | 95 (36.0) | 169 (64.0) | 264(100.0) | |||
| Sex | Male | 9 (3.4) | 64 ()24.2 | 73 (27.6) | .000 | 47.489a |
| Female | 85 (32.6) | 105 (39.8) | 191 (72.4) | |||
| Total | 95 (36.0) | 169 (64.0) | 264(100.0) | |||
| Married status | Single | 10 (3.4) | 60(23.1) | 70 (26.5) | .000 | 43.648a |
| Married | 85 (32.6) | 109 (40.9) | 194 (73.5) | |||
| Total | 95 (36.0) | 169 (64.0) | 264(100.0) | |||
| Qualification | Equal and less than NCE | 70 (26.5) | 130(49.3) | 200 (75.8) | .556 | .347a |
| Greater than NCE | 25 (9.5) | 39 (14.7) | 64 (24.2) | |||
| Total | 95 (36.0) | 169 (64.0) | 264(100.0) | |||
| Years of experience | Equal and less than 10 years | 100 (37.9) | 20 (7.6) | 120 (45.5) | .000 | 12.477a |
| Greater than 10 years | 92 (34.9) | 52 (19.6) | 144 (54.5) | |||
| Total | 192 (72.8) | 72 (27.2) | 264 (100) | |||
| Teachers’ residential area | Within the community | 72 (27.2) | 68 (25.8) | 140 (53.0) | .000 | 30.861a |
| Outside the community | 23 (8.8) | 101 (38.2) | 124 (47.0) | |||
| Total | 95(36.0) | 169 (64.0) | 264 (100.0) | |||
Table 7: shows the association of socio-demographic characteristics and attitude towards school health service: Association of socio-demographic characteristics and attitude towards school health service were found to be statistically significant with p-value of 0.000
Table 7:
Association between Socio-demographic characteristics and attitude towards school health services
| Variables | Attitude school health services | Total | χ2 | P - value | ||
|---|---|---|---|---|---|---|
| Negative attitude N (%) | Positive attitude N (%) | |||||
| Age group | Equal and less than 39 | 82(31.4) | 30(11.0) | 112(42.4) | .000 | 91.273a |
| 40-49 | 30 (11.0) | 60(23.1) | 90 (34.1) | |||
| Equal and greater than 50 | 20 (7.6) | 42 (15.9) | (62(23.5)) | |||
| Total | 132 (50.0) | 132 (50.0) | 264 (100.0) | |||
| Sex | Male | 60 (23.1) | 4(1.1) | 64 (24.2) | .000 | 64.680a |
| Female | 72 (26.9) | 128 (48.9) | 200 (75.8) | |||
| Total | 132 (50.0%) | 132 (50.0%) | 264 (100.0) | |||
| Marital status | Single | 40 (15.2) | 20 (7.6) | 60 (23.1) | .000 | 77.647a |
| Married | 92 (34.9) | 112(42.4) | 204 (76.9) | |||
| Total | 95 (36.0) | 169 (64.0) | 264 (100.0) | |||
| Qualification | Equal and less than NCE | 102 (39.0) | 98 (36.8) | 200 (75.8) | .566 | .330a |
| Greater than NCE | 30(11.0) | 34 (13.2) | 64 (24.2) | |||
| Total (NCE-National Certificate of Education) | 132 (50.0) | 132 (50.0) | 264 (100.0) | |||
| Years of experience | Equal and less than 10 years | 90(34.1) | 30(11.0) | 120(45.1) | .000 | 55.000a |
| Greater than 10 years | 42 (15.9) | 102 (39.0) | 144 (54.9) | |||
| Total | 132 (50.0) | 132 (50.0) | 264 (100.0 | |||
| Teachers’ residential area | Within the community | 70 (26.5) | 70 (26.5) | 140 (53.0) | .000 | 16.234a |
| Outside the community | 92 (34.5) | 32 (12.5) | 124 (47.0) | |||
| Total | 92 (34.5) | 32 (12.5) | 264 (100.0) | |||
Association of socio-demographic characteristics and attitude towards school health service were found to be statistically significant with p-value of 0.000 except for qualification of teachers and knowledge that was not statistically significant with a p-value of 0.556.
Table 8 shows the association of socio-demographic characteristics and involvement of school health service: Association of socio-demographic characteristics and involvement of school health service were found to be statistically significant with p-value of 0.000. the table also shows the association of socio-demographic characteristics and involvement of school health service: Association of years of experience and involvement of school health service was found to be statistically significant with p-value of 0.000. However, association of teachers' residential area and school health services was not statistically significant with p-value of .615.
Table 8:
Association between socio-demographic characteristics and involvement of school health services.
| Variables | Involvement of school health service | Total N (%) | χ2 | P - value | ||
|---|---|---|---|---|---|---|
| Poor Involvement N (%) | Good involvement N (%) | |||||
| Age group | Equal and less than 39 years | 100 (37.9) | 32 (12.1) | 132 (50.0) | .000 | 132.175a |
| 40-49 | 70 (26.5) | 20 (17.6) | 90(34.1) | |||
| Equal and greater than 50 years | 2 (.7) | 40 (15.2) | 42 (15.9) | |||
| Total | 172 (65.1) | 92 (34.9) | 264 (100.0) | |||
| Sex | Male | 34 (12.8) | 30 (11.4) | 64 (24.2) | .000 | 16.366a |
| Female | 158 (60.0) | 42 (15.8) | 200 (75.8) | |||
| Total | 192 (72.8) | 72 (27.2 | 264 (100.0) | |||
| Marital status | Single | 30(11.5) | 30 (11.6) | 60(23.1) | .000 | 20.221a |
| Married | 162(61.3) | 42 (15.6) | 204 (76.9) | |||
| Total | 192 (72.8) | 72 (27.7) | 264 (100.0) | |||
| Qualification | Equal and less than NCE | 128 (48.6) | 72 (27.2) | 200 (75.8) | .000 | 31.680a |
| Greater than NCE | 44 (16.6) | 20 (7.6) | 64 (24.2) | |||
| Total | 172 (65.2) | 72 (27.2) | 264 (100.0) | |||
| Years of experience Equal and less than 10 years | 100 (37.9) | 20(7.6) | 120(45.5) | .000 | ||
| Greater than 10 years | 92(34.9) | 52(19.6) | 144(54.5) | |||
| Total | 192(72.8) | 72(27.2) | 264(100.0) | |||
| Teachers’ residential area Within the community | 100(37.9) | 40(15.2) | 140(53.0) | .615 | ||
| Outside the community | 92 (34.9) | 32 (12.0) | 124 (47.0) | |||
| Total | 192 (72.8) | 72 (27.2) | 264 (100.0) | |||
Discussion
School health services are important means of improving educational performance of children as well adults. These children will eventually become as a healthy person who will play active role in educational activities. The measure of central tendency from their ages as at their last birthday of the participants showed a mean of 35.7, median of 35.6, Mode of 35.5, standard deviation of 8.87, Minimal age is 29 years, maximum age is 54 years with a range of 25 and it was observed that their ages of last birthday was normally distributed among the participants. Majority of the participants 169 (64.0%) had good knowledge (Participant who got each stem of the questionnaire was scored 1 and those who failed the stem question were scored zero “0” total score was computed and participants who got ≥50% were considered to have good knowledge and those who scored <50% were considered to have poor knowledge, same was done for attitude and involvement of health services) in this study, however, in a study by Odeyimi and colleagues in Ogun state, they recorded a high level of knowledge (94.7%) of school health services.18In a study conducted in Edo state, Nigeria by Ofovwe and Ofili, fewer teachers (76.7%) were aware of school health services,19 the levels of knowledge were higher than the one in this study, the differences may be due to differences in academic background and the environment. However, in a study in Myanmar, south East Asia the knowledge level was found to be lower (62.9%)20 than that of this study even though it was conducted in urban setting and in another study in Myanmar among teachers to the findings in Yangon city, knowledge level was lower (61.5%).21 In a study in Lagos by Adeyinka and Sonachi, they recorded high level of awareness (92.9%) due to the fact the respondents were trained professionally in education.22 0ne hundred and two (38.6%) had positive attitude to school health services and this is comparable in Yangon city where fewer (42.3%) had positive attitude,21 however, attitude towards school health service was higher (69.6%) in a study carried out by San-san Htway in Myanmar20 where teachers had higher attitude towards school health services as a result of training and retraining of the teachers on school health services. In this study 72 (27.3%) participants had good involvement in school services which is poor when compared to San-san Htway who recorded high (52.6%) involvement20 of school health services by teachers. This study had good knowledge but poor involvement of school service and low in positive attitude towards health services and this is comparable in a study in Edo state by Ofovwe and Ofili which reported good knowledge poor involvement (38.3%)19in school health services and this may be due to inadequate training in school health services. Association of socio-demographic characteristics and knowledge, attitude and involvement of school health services were found to be statistically significant at p-value of <.001 except for the qualification of teachers that was not statistically significant with p-value of .556 while in study in Myanmar20 there was a statistically significant difference in involvement of health services between the age group but there was no statistically significant between years of experience in school health services and age group.
Conclusion
This study recorded good knowledge (64.0%), high negative attitude (61.4%) and poor involvement (72.7%) of school health service among teachers in Abia State. The school health service is to promote the health of the learners to achieve quality education for all and health for all. Teachers' training curriculum has to be revisited by Ministry of education at the federal and state levels to address the inadequacies, challenges and differences with regards to school health services.
Recommendations
There may be further study to assess teachers' training in school health services and this may inform training intervention to upgrade teachers' knowledge, attitude and involvement in school health service. Government should regularly organize workshops, seminars on school heal services for the public primary school teachers. There should be a legislation in the state and country requiring prospective teachers to obtain a diploma or Certificate course in school health services before engaging in teaching profession. More studies on knowledge, attitude and involvement of school health services among teachers in many more local government areas and states should be encouraged to enhance policy makers to make for more involvement of teachers in school heal activities.
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