4.1. The prevalence of myopia, spinal deformity and dental caries in primary school students in 6 provinces in 2012:
4.1.1. Prevalence of myopia
The general percentage of students acquiring myopia in 6 provinces was 5.8%, the highest was at 10.5% in Hai Phong, followed by Ho Chi Minh city at 6.5%, the lowest was Kontum and Hoa Binh at 0.9% and 1.1% respectively. The prevalence of myopia increased with grade, grade 1 had the lowest percentage of 2.9%, grade 5 had the highest percentage of 8.3% (more than 3 times), and differences were statistically significant. The study results fit with other studies in the world and Vietnam. Dang Anh Ngoc’s research in 2004 in Hai Phong, Thai Nguyen showed school myopia percentage increases by grade, age, there is a difference between the downtown and suburban areas.
4.1.2. The percentage spinal deformity:
The percentage of student with spinal deformity was 3.6%, of which Hoa Binh had the highest percentage of 7.9%, followed by Kontum at 7.1%. Percentage of students with spinal deformity increases with grade, the percentage of students with spinal deformity in grades 1 was 2.1%, students in grades 5 is 4.4%, the percentage of female students with spinal deformity is 3.0% and that of male students is 4.1%. The difference was statistically significant. The prevalence of spinal deformity in our research was lower than in the previous research by local authors, but the trend that the percentage of spinal deformity increases with age is suitable.
4.1.3. Percentage of dental caries
General percentage of students with dental caries in 6 provinces were 73.4%, including Thua Thien Hue decay percentage of students is 86.6% highest and the lowest was 63.0% in Ho Chi Minh City. Th proportion of female students 75.4% of dental cavities is higher than the 71.6% male students, the difference was statistically significant. The percentage of dental cavities in grade 5 students (10-11 years old), lower grade 1 (6-7 years old), we believe that the higher the age of the children, baby teeth would gradually switch to permanent teeth, along with better knowledge of oral sanitation, caries percentage among older students will be less.
4.2. Several factors related to to myopia, spinal deformity and dental caries among primary school students:
Research results have shown a strong correlation between knowledge and practice of students, teachers and students’ parents and the prevalence of myopia, spinal deformity curve and dental caries among children. Lack of knowledge, wrong practice of students, teachers and parents increased with statistical significance the risk of myopia among students from 1.5 - 2.1 times. Lack of knowledge, wrong practices of students and parents increased with statistical significance the risk of spinal deformity of students from 1.4 - 1.7 times. Lack of knowledge, wrong practice of students, parents and teachers increased the risk with statistical significance of dental cavities among children from 1.5-1.9 times. This shows the importance of improving knowledge for students, teachers, and parents in prevention school diseases, the results are specifically analysed below:
4.2.1. Knowledge and practices of students, teachers, and parents about causes and prevention of myopia, spinal deformity and dental caries:
The percentage of students with knowledge, practice graded Pass in the prevention of myopia, spinal deformity was from 46.9% to 62.4% Knowledge and practice graded Pass in the prevention of dental caries was from 65.0% to 79.3%. There were still
around 6.3% to 41.4% of teachers, parents graded Fail on KAP of prevention of myopia, spinal deformity, and caries. 52.9% of parents did not prompt their children to sit correct posture. Lack of knowledge, wrong practice of students, parents increased the risk of myopia, spinal deformity, and caries among students 1.4 - 2.1 times with statistical significance. This result is consistent with results of previous studies which indicated that KAP of students, teachers and students’ parents in school disease prevention is limited.
4.2.2. Current status of school health care in a number of primary schools in 6 provinces in 2012.
4.2.2.1. Current status of school health personnel:
The percentage of schools with full-time school health staffs was 50%, the rest are with part-time staffs. Among full-time staffs with intermediate medical level, only 50.0%
acquired intemediate level is in general health. Percentage of school health staffs knowing six main areas of medical professional fields only accounts for 25.5%, 29.2%
of staffs know eight duties of school health staffs and 33.3% know 04 important school health documents. There were differences between full-time and part-time staffs. This result also describes the general situation of school health resources nationwide according to other studies. This can significantly affect school health care activities for students.
4.2.2.2 Class hygiene conditions and medical equipment:
The percentage of classes with standard average area/students is very low accounting for 22.2%, the class with standard size is 55.6%, percentage of class with standard artificial lighting is 55.2%; percentage of classes with appropriate desk and chair arrangement is low at 18.4%; 100% of classes has standard anti-glare boards. There are 66.6% of schools with medical departments, but only 41.6% of medical rooms and 54.1% of schools having essential medicine cabinets. This result is consistent with the findings of the Department of Preventive Medicine in 2010 nationwide, studies show that school hygiene conditions in many places still have not met requirements.
4.2.2.3. School health activities at schools:
Only 41.6% of schools had health care committees, 70.8% of schools organized student health examination, 45.8% of schools had student health record management, only 37, 5% of students had communication on myopia, spinal deformity, and dental diseases.
Only 16.6% of public schools well coordinating with authorities, families in student health care. School-based health care activities depended much on the capacity of school health staffs, this result is consistent with previous studies and resources for implementing health activities in schools is a matter of concern.
4.3. Effectiveness of intervention through health-promoting school model at 04 schools in Hai Phong in 2013:
4.3.1. KAP of students, teachers, students’ parents in disease prevention:
The percentage of knowledge, practice of students graded Pass in disease prevention have increased compared to that before the intervention. After intervention, proper knowledge on prevention of myopia, spinal deformity, dental cavities increased with PI of 53.2%, 47.1%, and 22.6% respectively. Similarly, right practice with performance index increased to 71.2%, 96.9%, and 32.0% respectively.
After the intervention, percentage of teachers remind their students to learn in correct sitting posture, brush their teeth properly increased with performance index of 17.5%
and 16.2% respectively. Similarly, the right practice of parents increased with performance index of 89.4% and 47.6 respectively.
The study results fit with other intervention studies and showed that communication interventions were effective, positively changed knowledge and behaviors of students, teachers and students’ parents, contributing to control school disease prevelance.
4.3.2. Current status of school health activities:
4.3.2.1. Class hygiene conditions:
After interventions, all of the classrooms at schools were rearranged with furniture, equipped with tables, lights. The standard of the table, lighting was 100%
passed, however regarding the condition on appropriate furniture size, only about 50%
of students can achieve due to the fact that schools are only equipped with 2 sizes of desks and chairs, changing completely new furniture in accordance with standards is cost consuming and schools themselves can not meet the requirements and need support from sources.
4.3.2.2. School health activities after intervention:
The school building has developed clear regulations to facilitate all teachers and school health staffs to implement intervention contents. After the intervention, 100% of the school conducted health examination, management, consultation and organized health mouth rinse with 0.2% sodium fluoride once / week for students; checked class hygiene conditions and coordinated with local authorities in student health care.
Schools have integrated topics on the prevention of myopia, spinal deformity, and caries during curricular lessons and communicated to students’ parents through parent conferences. Local authorities have actively joined schools in the student health care.
4.3.3. Percentage of myopia, spinal deformity, and dental caries after 1 year of intervention:
After one years, general incidence of myopia at 4 schools increased with performance index of 18.1% (from 10.5% to 12.4%). The percentage of myopia in schools has increased by grade, the higher grade, the higher the prevalence of myopia. The percentage of myopia among primary students before and after the intervention in this study is consistent with the study of Dang Anh Ngoc in 2014 at 02 elementary schools in Hai Phong, the results also showed that the percentage of students with myopia is higher in the inner city than that in the suburbs, the overall percentage of students at 02 primary schools with myopia was 8.8% and percentage of myopia prevalence after 03 years of intervention tends to decrease but in grade 2, 3 increased. This suggests that reducing the percentage of myopia after 01 year of intervention was a very difficult problem and needed more time to monitor.
The percentage of spinal deformity at 4 schools after intervention decreased with performance index of 30.7% as compared to that before intervention (from 1.3% to 0.9%), but the difference was not statistically significant. Compared to the percentage of students getting spinal deformity according to research by Dao Thi Mui, 2009 at 04 primary schools in Hanoi of 17.6%, the percentage in this study was much lower, which explained our success in years making efforts in implementing prevention interventions of spinal deformity among students. Dao Thi Mui Research also showed the incidence of spinal deformity decreased by 3.5% after 2 years of intervention (from 23.0% to 19.5%). In this study, the prevalence of spinal deformity decreased after intervention (from 1.3% to 0.9%).
The percentage of caries at 4 schools after false intervention with performance index of 22.4% as compared to that before intervention (from 66.0% to 51.2%), the difference was statistically significant. The prevalence of dental caries before and after intervention tended to decline by grade. After the intervention, dental cavities percentage at grade 1 was 56.6 % and that of students in grade 5 was 39.0%, the difference was statistically significant with p <0.05, χ2 = 34.74. Nguyen Ngoc Nghia study in 2011 in Yen Bai among primary students showed that the prevalence of dental caries was 69.6% before the intervention, after 2 years of intervention the efficacy against dental cavities was remarkable: baby teeth 7.2%, permanent teeth 10.6%.
4.3.4. Proposals on main activities in prevention of myopia, spinal deformity, and cavities among students through health-promoting school model:
Referencing model from countries and from lessons learned during the implementation activities leading to effective intervention, we propose the main
activities in the prevention of myopia, spinal deformity, dental caries among students through the model of health promoting schools recommended by WHO, depending on local and schools features in terms of illness, physical facilities, financial capacity to choose the priority activities implemented in each content group.
CONCLUSIONS
1. The prevalence of myopia, spinal deformity, and dental caries among primary students in 6 provinces in 2012:
The prevalence of myopia among primary school students was 5.8%, with a clear upward trend by grade from 2.9% in grade 1, increased 8.3% in grade 5, differ markedly in regions, high percentage of 10.5% was in Hai Phong, 6.5% in Ho Chi Minh city, low percentage of 0.9% was in Kon Tum, 1.1% in Hoa Binh.
The prevalence of spinal deformity among students was not high at 3.6%, the percentage difference by gender (men and women 3.0% and 4.1% respectively), increased by grade, different by regions, a high proportion in rural, mountainous areas (Hoa Binh 7.9%, Kon Tum 7.1%), low percentage in the urban (Ho Chi Minh 2.0%, Haiphong 1.3%).
The prevalence of dental caries among primary school students was quite high at 73.4%, different by gender, women higher than men, tended to decrease with age, no significant differences of region (66, 0% - 86.6%).
2. Some factors related to myopia, spinal deformity and dental caries in students:
The research results have showed that the lack of knowledge, practical skills in the prevention of myopia, spinal deformity, and dental caries among primary students themselves, parents of students and teachers was one of the factors causing difficulties in school health care, contributing to increasing incidence of the diseases among students. The percentage of students with knowledge, practice graded Pass in the prevention of myopia, and spinal deformity was from 46.9% to 62.4% Knowledge and practice graded Pass in the prevention of dental caries was from 65.0% to 79.3%. There were still around 6.3% to 41.4% of teachers, parents graded Fail on KAP of prevention of myopia, spinal deformity, and cavities. 52.9% of parents did not prompt their children to sit correct posture. Lack of knowledge, wrong practice of students, parents increased the risk of myopia, spinal deformity, and caries among students 1.4 - 2.1 times with statistical significance.
School-based health care activities of surveyed schools were poor due to the lack of qualification and professional skills of school health staffs (50% of staff are part-time, 75% of health care staff did not fully understand school healthcare duties; infrastructure