Children’s health key as schools open

This week, the long school holidays come to an end and our children return to school. With the challenges we experienced during and after the Covid-19 pandemic and the recent Ebola epidemic, a concern of many parents is the health of their children while at school. Beyond good nutrition and concerns about transmission of infections, other critical issues should include adequate physical activity, rest and sleep. So, what important health measures and tests should parents and schools have for children returning to school? What should school authorities be encouraged to support?  

Child health problems are age-related. Usually, expectant mothers are tested for HIV and after birth, babies born to HIV-positive mothers are tested and given treatments to prevent HIV infection.

Today, given the huge problem of sickle cell anaemia in the country, newborn testing should be expanded and babies testing positive may have treatment interventions started early. In high-income countries, over 10 tests of newborn screening are carried out. In Uganda, the two - HIV and Sickle Cell Anaemia tests - should be our minimum.

Third, at birth, and at 6, 10 and 14 weeks and then 6, 9, 12 and 18 months, we have different vaccines and vitamins administered to all babies including BCG against TB, the five-valent DPT/HiB/HBV vaccine against diphtheria, whooping cough, tetanus, haemophilus and Hepatitis B virus, the Rotavirus vaccines against rotavirus diarrhoea, the PCV vaccine against pneumococcal infections and Measles and Rubella vaccines. A child who receives all the vaccines is protected against the diseases and will also not transmit or put other children at risk. The school should ensure all children 0 to 5 years joining nursery and primary schools from baby class up to P1 have child health cards showing up-to-date and completed vaccination. 

While at school, many health problems are associated with overcrowding and poor personal hygiene. Respiratory infections are a leading cause of ill health in children. A child can get up to six attacks a year. Exclusive breastfeeding for six months, zinc and vitamin A are protective. Parents should give nursery school children a dose of vitamin A once every six months. 

In schools, crowding, poor ventilation and nutrition are the most important risk factors. As we learned during Covid-19, inclusion of a fruit in each meal, together with some green leafy vegetables and hand washing will carry us along. Let us support each school to collect rain water and have as many water stands as possible so that children can wash hands multiple times a day and after every activity. Hand washing will also reduce intestinal upsets and infections and episodes of tummy aches, vomiting and diarrhoea.     

Parasite infestations such as body lice – infesting hairs and clothing. The situation in some overcrowded boarding schools is really bad. It is the reason schools encourage children to have short hair. In boarding schools, there should be a mechanism to ensure that all students bath daily and wash their cloths and bed sheets every weekend, dry it in the sun and hot-iron them.

Fungal and bacterial infections of the hair and the skin. Especially in children undergoing puberty, troublesome pustules can grow repeatedly in the arm pits and pubic area. This is made worse with poor personal care. A daily bath and hygienic environment is critical.

Let us also say no to malaria in schools. We should all say no to malaria parasites in the blood of our children. Ill health from malaria not only leads to loss of school days but malaria also impairs learning. At home, let all children sleep under a bed net and let all those in boarding schools also go to school with a bed nets. We should work with schools to promote in door residual spraying of the dormitories and to have the beds in the dormitories be able to take bed nets.  

As doctors, we are concerned about some of the uninformed and unrealistic health checks and tests some schools force on children before they return every term. We request schools to stop issuing these useless test requests such as Widal test. A check-up and a report by a health worker is sufficient. Uganda Paediatrics Association is working on a draft school health card that will be made available after consensus building with the relevant ministries. Also, it is important that all schools have a school nurse to attend to the immediate health needs of the children. 

Dr Richard Idro is a consultant and Paediatric Neurologist at Mulago hospital.