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Open Access Research article

The Fit for School health outcome study - a longitudinal survey to assess health impacts of an integrated school health programme in the Philippines

Bella Monse1, Habib Benzian2*, Ella Naliponguit3, Vincente Belizario4, Alexander Schratz5 and Wim van Palenstein Helderman6

Author Affiliations

1 Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, GIZ Office Manila, PDCP Bank Centre, V.A. Rufino cor. L.P. Leviste Str, Makati, Metro Manila, Philippines

2 Senior Advisor, Fit for School Inc./The Health Bureau Ltd., The Little Barn, Haversham Manor, MK19 7DZ, Haversham, Milton Keynes, UK

3 Health and Nutrition Department, Department of Education, Manila, Philippines

4 National Institutes of Health, University of the Philippines, 623 Pedro Gil Street, Ermita 1000, Metro Manila, Philippines

5 Fit for School Inc., Makati Office, PDCP Bank Centre, V.A. Rufino cor. L.P. Leviste Str, Makati, Metro Manila, Philippines

6 Dental Health International Nederland(DHIN), Korte Linschoten, OZ 14, 3461CG, Linschoten, Netherlands

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BMC Public Health 2013, 13:256  doi:10.1186/1471-2458-13-256

Published: 21 March 2013

Abstract

Background

Child health in many low- and middle-income countries lags behind international goals and affects children’s education, well-being, and general development. Large-scale school health programmes can be effective in reducing preventable diseases through cost-effective interventions. This paper outlines the baseline and 1-year results of a longitudinal health study assessing the impact of the Fit for School Programme in the Philippines.

Methods

A longitudinal 4-year cohort study was conducted in the province of Camiguin, Mindanao (experimental group); an external concurrent control group was studied in Gingoog, Mindanao. The study has three experimental groups: group 1—daily handwashing with soap, daily brushing with fluoride toothpaste, biannual deworming with 400 mg albendazole (Essential Health Care Program [EHCP]); group 2—EHCP plus twice-a-year access to school-based Oral Urgent Treatment; group 3—EHCP plus weekly toothbrushing with high-fluoride concentration gel. A non-concurrent internal control group was also included. Baseline data on anthropometric indicators to calculate body mass index (BMI), soil-transmitted helminths (STH) infection in stool samples, and dental caries were collected in August 2009 and August 2010. Data were analysed to assess validity of the control group design, baseline, and 1-year results.

Results

In the cohort study, 412 children were examined at baseline and 341 1 year after intervention. The baseline results were in line with national averages for STH infection, BMI, and dental caries in group 1 and the control groups. Children lost to follow-up had similar baseline characteristics in the experimental and control groups. After 1 year, group 1 showed a significantly higher increase in mean BMI and lower prevalence of moderate to heavy STH infection than the external concurrent control group. The increases in caries and dental infections were reduced but not statistically significant. The results for groups 2 and 3 will be reported separately.

Conclusions

Despite the short 1-year observation period, the study found a reduction in the prevalence of moderate to heavy STH infections, a rise in mean BMI, and a (statistically non-significant) reduction in dental caries and infections. The study design proved functional in actual field conditions. Critical aspects affecting the validity of cohort studies are analysed and discussed.

Trial registration

DRKS00003431 WHO Universal Trial Number U1111-1126-0718

Keywords:
School health; Soil-transmitted helminth infection; Child growth; Dental caries; Hand washing; Toothbrushing; Deworming