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Monday, January 10, 2011

School bags - health issue




By Edward Arambewala







An epidemiological research was carried out in a representative district of Sri Lanka with the participation of 1,607 school children on Ergonomic factors in the educational environment and their influence on school-going early adolescents.




This was stated by Family Health Bureau Health Schoolbag project coordinator and Consultant community physician Dr Kapila Jayaratne when speaking to Daily News Health Watch.



Research findings



Many children experienced discomfort due to sub-standard seating arrangements in the classroom. A significant proportion had to turn their necks to see the blackboard. Seating locations were not changed for many children.


There is wide-spread incompatibilities of classroom furniture with anthropometric dimensions of children Majority of children perceived discomfort due to mismatched furniture There were gross deficiencies with regard to carrying school bags. Deficiencies were noted in weight, model, ergonomic features and the carrying behaviour.



Children experienced several negative effects, such as muscular-skeletal pain, attributable to mismatched ergonomic factors Research outcomes further revealed that a majority of children carried bags with unhealthy features and they were too heavy according to international standards. Text books and other writing books accounted for more than two thirds of the school bag weight. Bag behaviour was not healthy. Many children reported negative health consequences. It is evident that a 'big health issue' exists in Sri Lankan schools with regard to carriage of school bags. These findings necessitated formulation of feasible solutions with the involvement of major stakeholders.



We considered it important to translate research findings into action.

We adopted three strategies

  • Dissemination of research findings
  • Provision of feasible solutions
  • Advocacy

Research findings necessitated identification of priority areas and formulation of feasible solutions to improve the current status. Taking into account, several factors including feasibility of implementation and acceptability by the adolescents and their parents, it was considered that issues related to schoolbags should be a priority area for intervention.
Solutions were contemplated on - strategies for bag-weight reduction, introduction of a model healthy bag and bag behaviour changes.




The main conclusions were shared with Education Ministry and other stakeholders. Dissemination of research findings through multitude of mass media sensitized students, teachers, parents, general public and administrators of health and education sectors.
Research outcomes were even shared at international forums to obtain further inputs and update good practice evidence. Solutions were contemplated on; strategies for bag weight reduction, introduction of a model healthy bag and bag behaviour change.
When findings and recommended solutions were shared with the Education Ministry for education authorities themselves to find solutions to heavy schoolbag. Education Publication Department Commissioner W M N J Pushpakumara took the lead role. He initiated another research project to be undertaken to explore strategies to lighten the schoolbag. Text books were split in to several volumes. Only page-80 exercise books were recommended.



Introduction of the model school bag



The need for modelling a healthy schoolbag was imperative. Inputs were obtained from the International Ergonomic Association and from consultations with experts. Healthy bags designed ergonomically in other countries were also studied.
School Health Unit of FHB, for their role, initiated designing a model school bag. Dr Kapila Jayaratne, being a member of the Technical Committee of International Ergonomic Association on Ergonomics for Child Educational Environments (ECEE), consulted several international ergonomic experts on healthy features of a bag.
Several bag models were studied and a sample schoolbag with ergonomic features was manufactured to suit Sri Lankan contexts.




The model bag was evaluated by a team of experts including Paediatricians, Orthopaedic Surgeons, Community Physicians, Psycho-ergonomic consultants and Physiotherapists. It was field-tested at a Colombo suburb school and children, teachers and principals responded on local adaptability.



Our bag



A healthy schoolbag adapted for Sri Lankan children was modelled according to ergonomic standards. This sample bag was locally manufactured based on an ergonomically designed healthy bags approved by the Australian Chiropractic Association.



Once the sample bag was evaluated by experts and children, recommendations were sent to the Education Ministry. Sri Lanka Standards Institute was consulted for physical quality assurance.
Registration of bag manufacturers
Bag manufacturers were registered by the Education Ministry and they were educated on the healthy bag concept.
A successful awareness program for bag manufacturers on healthy schoolbag was held. More than 400 manufacturers from all over Sri Lanka on participated at this meeting. Dr. Kapila Jayaratne, described the research background: focusing on burden of the problem, why the ergonomic features are essential to safeguard health of children and what is expected from local manufacturers. Sri Lanka Standards Institute Chamari Geeganage explained physical quality aspects and the process of developing standards on schoolbag. Mr. Tissa Vitana of Ministry of Education elaborated on registration procedure, evaluation of bags by the National Advisory Committee on Schoolbag, the process of awarding logo of the 'healthy schoolbag' and post-market surveillance system for quality assurance.



The project was pioneered under the supervisory guidance of Prof Dulitha Fernando.


Tuesday, January 4, 2011

Children’s Environmental Health Units

The World Health Organization has released its latest publication on Children’s Environmental Health Units.

www.who.int/entity/ceh/publications/childrensunit.pdf


Health care providers are well placed to detect, treat, and prevent environmentally-related diseases and health conditions. Few mechanisms and structures are in place to enhance the recognition of environmental influences on human health, serve as repositories and sources of information for those concerned about children’s health and the environment, and promote action towards healthier and safer environments for children of today and adults of the future.

For health professionals to effectively protect children from environmental threats, specialized training is useful. Evidence shows that health providers are generally not provided the training that they need to address the complex environmental health issues with respect to air, water, soil, and products (Pope & Rall, 1995) Diarrhoeal diseases often recur frequently when underlying causes such as contaminated water are not taken into account by the health provider, understood by the community or adequately addressed by governments. The complexity of children’s environmental health (CEH) issues is compounded by the combination of legacy environmental issues, such as water quality and sanitation service delivery, with modern challenges such as transboundary contamination by persistent toxic substances, ozone depletion and hence ultraviolet and ionising radiation, global climate change, and exposure to endocrine-disrupting chemicals). For children in developing countries, the presence of all such risks represent a ‘triple burden of disease’ – a high level of communicable diseases, the increasingly severe burden of non-communicable diseases, and emerging risks from new diseases and additional stressors from the social and physical environment.

Definition of a Children’s Environmental Health Unit
A Children’s Environmental Health Unit (CEHU) is a centre that advances the ongoing training of health care providers, the ongoing education of the public and other sectors concerned about CEH on the protection of children from environmental threats, the management of children with known or suspected exposure to environmental stressors, and the diagnosis, management, and treatment of children with illnesses that are derived from environmental stressors.


Children’s Environmental Health Units educate health care professionals and others about preventing environmental exposures and about diagnosing and treating environmentally-related diseases. Their policy advice to government officials can strengthen governmental responses to environmental health problems. By maintaining databases and collaborating with partners in the health community, they can contribute to the knowledge base on children’s environmental health issues.


The development of this document was funded by the U.S. Environmental Protection Agency under assistance agreement CR 831028 to the World Health Organization.
This publication was coordinated at WHO by Jenny Pronczuk de Garbino, Marie-Noel Bruné, and Ruth Etzel with the assistance of Tania Gavidia from the WHO Collaborating Centre in Perth, Australia.

The following people contributed to this publication:

Martha Berger
Irena Buka
Enrique Cifuentes
Lilian Corra
Fernando Díaz Barriga
Luis Roberto Escoto
Adriana Grebnicoff
Michael Hatcher
Raul Harari
Kapila Jayaratne
Amalia Laborde
Philip Landrigan
Sang-il Lee
Siobhan McNally
Helia Molina
Juan Antonio Ortega-García
Enrique Paris
Jerry Paulson
Leslie Rubin

Standards for schoolbags

Sri Lanka Standards Institute is in the process of developing standards for schoolbags. A working group comprised of healthcare professionals, ergonomists, university academics, representatives from Ministry of Trademm textile engineers and selected bag manufacturers is involved in the process.


Dr. Kapila Jayaratne serves as the chairman of the working group on developing standards for schoolbags.

Once the specifications and standards are finalized, they would be accepted as the legal standards.