Controlling schistosomiasis: the cost-effectiveness of alternative delivery strategies.
Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at school-children and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero District. (+info)
Clinical and subclinical vitamin D deficiency in Bradford children.
A survey of the vitamin D status of Bradford schoolchildren was carried out in April 1973, employing conventional biochemistry, radiology, and measurement of 25-hydroxycholecalciferol levels. Biochemical evidence of rickets was present in 45% of the Asians. When re-examined in September, several children showed spontaneous biochemical resolution; nevertheless, radiological abnormalities were present in 12% of the original sample. No evidence of rickets was detected in the smaller White sample. Minor biochemical abnormalities were present in 9 of the 40 West Indian children. A study of admissions of Bradford hospitals in the 4 years 1969-1972 inclusive confirmed that clinical vitamin D deficiency was confined to Asians except for a few cases of infantile rickets in White children. The probability that one Asian child in 40 may require admission during the period from birth to adolescence emphasizes the urgent need for the introduction of prophylactic measures. (+info)
Is peer tutoring beneficial in the context of school resuscitation training?
First year pupils at a Cardiff comprehensive school were trained in cardiopulmonary resuscitation, 106 by the teacher only and 137 by the teacher assisted by older pupils (peer tutoring). Scores in a multiple choice theory test and in practical skill assessment showed no significant difference between instruction methods, but boys taught by the teacher assisted by older pupils expressed less willingness to resuscitate in an emergency than girls instructed by either method (P < 0.01). Girls had higher scores in the multiple choice paper (P < 0.025) and in the skills assessment (P < 0.01). Those pupils who reported some prior knowledge of resuscitation techniques performed better during skill assessment than novice trainees (P < 0.025). (+info)
Critical thinking: a central element in developing action competence in health and environmental education.
In the field of educational philosophy, health and environmental education share many common goals and challenges on the level of curriculum theorizing as well as the level of pedagogical practice. One of these challenges is to develop a radical philosophy of education which is critical and takes a controversial point of departure rather than the one of accommodation. It highlights, in other words, the socially critical role of education. From this point of view some key concepts are discussed in the paper in relation to health and environmental education: democracy as means and end, critical thinking, the critical orientation, and the action perspective. One of these concepts, critical thinking, is elaborated in particular as it is considered to be essential to pupils' development of action competence. A description is given how it can be seen from four perspectives: the epistemological, the transformative, the dialectical and the holistic. (+info)
Formative research in a school-based obesity prevention program for Native American school children (Pathways).
This paper describes how formative research was developed and implemented to produce obesity prevention interventions among school children in six different Native American nations that are part of the Pathways study. The formative assessment work presented here was unique in several ways: (1) it represents the first time formative research methods have been applied across multiple Native American tribes; (2) it is holistic, including data collection from parents, children, teachers, administrators and community leaders; and (3) it was developed by a multi-disciplinary group, including substantial input from Native American collaborators. The paper describes the process of developing the different units of the protocol, how data collection was implemented and how analyses were structured around the identification of risk behaviors. An emphasis is placed on describing which units of the formative assessment protocol were most effective and which were less effective. (+info)
Behavioural intervention trials for HIV/STD prevention in schools: are they feasible?
OBJECTIVE: To assess the feasibility of conducting a large randomised controlled trial (RCT) of peer led intervention in schools to reduce the risk of HIV/STD and promote sexual health. METHODS: Four secondary schools in Greater London were randomly assigned to receive peer led intervention (two experimental schools) or to act as control schools. In the experimental schools, trained volunteers aged 16-17 years (year 12) delivered the peer led intervention to 13-14 year old pupils (year 9). In the control schools, year 9 pupils received the usual teacher led sex education. Questionnaire data collected from year 9 pupils at baseline included views on the quality of sex education/intervention received, and knowledge and attitudes about HIV/AIDS and other sexual matters. Focus groups were also conducted with peer educators and year 9 pupils. Data on the process of delivering sex education/intervention and on attitudes to the RCT were collected for each of the schools. Analysis focused on the acceptability of a randomised trial to schools, parents, and pupils. RESULTS: Nearly 500 parents were informed about the research and invited to examine the study questionnaire; only nine raised questions and only one pupil was withdrawn from the study. Questionnaire completion rates were around 90% in all schools. At baseline, the majority of year 9 pupils wanted more information about a wide range of sexual matters. Focus group work indicated considerable enthusiasm for peer led education, among peer educators and year 9 pupils. Class discipline was the most frequently noted problem with the delivery of the peer led intervention. CONCLUSION: Evaluation of a peer led behavioural intervention through an RCT can be acceptable to schools, pupils, and parents and is feasible in practice. In general, pupils who received the peer led intervention responded more positively than those in control schools. A large RCT of the long term (5-7 year) effects of this novel intervention on sexual health outcomes is now under way. (+info)
The effects of a health education intervention initiated at first grade over a 3 year period: physical activity and fitness indices.
A health education intervention was carried out for three consecutive years on primary school Cretan children. Baseline measures were obtained from 962 pupils (509 boys and 453 girls) registered in first grade in 1992. The health education intervention programme was directed at both the children of the intervention group and their parents, and has a projected duration of 6 years. After the completion of the 3 years of intervention and while pupils were in fourth grade, measures were obtained for evaluation purposes on a random subsample of 393 pupils of the original cohort. Statistically greater improvements in the intervention, as opposed to the control group, were observed for both children's and parents' health knowledge, and children's standing broad jump, sit-ups (SUP), sit-and-reach, handgrip and endurance run test (ERT). Furthermore, time spent on moderate to vigorous physical activities out of school significantly increased for intervention group children compared to the control group. Statistically smaller increases in the intervention as opposed to the control group were observed in suprailiac skinfold and body mass index. The degree of improvement in both SUP and ERT related positively to parent's baseline physical activity score. Finally, the parental attitude of health-related hedonism related negatively to SUP improvement. (+info)
Cost of school-based drug treatment in Tanzania. The Partnership for Child Development.
It has been argued that targeting delivery of anthelmintics to school-children by taking advantage of the existing education infrastructure and administrative system can be one of the most cost-effective approaches in minimizing the intensity of infections with both schistosomiasis and major intestinal nematodes in many developing countries. The study was conducted in January 1997, shortly after the completion of the drug intervention programme. This paper provides an analysis of the costs of providing age-targeted treatment of school-children for urinary schistosomiasis using praziquantel and for intestinal nematodes using albendazole as an integral part of the School Health Programme in Tanga Region, Tanzania. The analysis shows that the total financial cost of the intervention programme in 1996 prices was US$54 252.28 (exchange rate: TSH 573 = US$1). Of this amount, the cost of drugs constitutes 80.6%, while the delivery cost appears relatively low, representing just below 20%. Even when the opportunity cost of unpaid days of labour input is included, the cost of drugs still remains the highest cost component of the intervention (55.8%). In the current epidemiological and logistic setting of Tanzania, the financial cost per child treated using praziquantel, which involved prior screening at the school level, was US$0.79, while treatment using albendazole was as low as US$0.23, of which US$0.20 was drug purchase cost. It is concluded that the base cost of delivering a universal, standard, school-based health intervention such as albendazole can be as low as US$0.03 per child tested, but even a very slight increase in the complexity of delivery can have a very significant impact on the cost of intervention. (+info)