School bags - health issue

By Edward Arambewala

Daily News online edition: http://www.dailynews.lk/2011/01/10/fea29.asp

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.

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.

Donald Court Visiting Fellowship for Dr. Kapila

Dr. Kapila Jayaratne, Senior Registrar in Community Medicine of Family Health Bureau, Ministry of Healthcare and Nutrition, has been awarded the prestigious Donald Court Visiting Fellowship by the Royal College of Paediatrics and Child Health (RCPCH), United Kingdom.
His extensive field work and research in the field of child health has been taken into consideration in selection for this fellowship which is awarded annually for the medical professionals worldwide involved in community child health.

Under this fellowship, Dr. Jayaratne is to undergo a three week training in childhood disability at Nottingham University Hospital.

In addition, he has been selected to present a scientific paper on 'Musculoskeletal Pain among school-going adolescents - a prevalence study in South Asia' based on his research on Sri Lankan schoolchildren at the Spring Meeting of the Royal College of Paediatrics and Child Health held from April 14 to 17 at the York University.

Daily News Healthwatch Friday, 11 April 2008 -http://www.dailynews.lk/2008/04/11/fea08.asp

Child Friendly Schoolbag introduced to Health Minister

Dr. Kapila Jayaratne of the Community Health Unit and Dr. Preethi Perera, Director, Family Health Bureau demonstrate the newly designed school backpacks to Minister of Health Nimal Siripala de Silva. The new backpack was designed as those currently used by children had come under severe criticism because of its weight and shape which experts say could affect them physically.


http://www.island.lk/2009/10/21/news.html

Ergonomic factors of educational environments

Ergonomics is the scientific study of the people and their work. It helps in improving human performance and finds solutions to health and safety problems. The school is the largest workplace of all. Children are the “workers” there. Matched ergonomic arrangement at the place of work is essential for better human performance.

Musculoskeletal pain, general tiredness, lateral deviation of the spine and poor educational performance have been identified as key negative effects due to mismatched ergonomics in the classroom.

Feasible solutions are available to mitigate ergonomic risks. Many developed countries have contemplated on both micro and macro ergonomic preventive strategies. The classical ergonomic approach is based on the study of human characteristics and environmental parameters. This knowledge needs to be applied in the analysis and redesign of total environment.

Study
A school-based cross-sectional study was conducted in a representative district (Gampaha) to analyse the ergonomic factors of school educational environments and negative health outcomes among school children with the objective of translating findings of research into action with key stakeholders.
A sample of 1607, school children of Grade 6,7 and 8 were selected from 55 schools using stratified multi-stage cluster sampling method.
The study included 52% male and 48% female students from urban (31.7%) and rural (68.3%) schools. They carried books in backpacks (79.6%), shoulder bags (17.9%) and suitcases (2.3%). Mean weight of schoolbag was 3.72 Kg. Mean schoolbag weight/body weight was 11.04% (SD=3.88).
A bag weighing >10% of bodyweight (international cut-off) was carried by 57.9% of children. They were seated with a mean angle of 30.71 degrees (SD=19.67) and 398.04cm (SD=132.09) mean distance to blackboard with 23.3% having to turn their necks >45 degrees to see the centre of the blackboard.
A standard chair with backrest without hand-rests was used by 95.6%.Regular use of backrest was reported by 12%. An individual desk had been provided to 78.3%. Desk surface was horizontal in 84.9%. A foot-rest was present in 82% desks.
Sitting area length of chairs did not match with buttock-popliteal length of child in 87.3%. A mismatch in seat height and popliteal height was observed in 79.8% while legroom height of desk did not comply with popliteal height in 76.3%.
A larger proportion (71.2%) of children reported musculoskeletal pain with 35.9% suffering from recurrent pain while 62.8% locating pain in more than two anatomical points. Presence of mismatched seat depth-buttock-popliteal length gave rise to 1.6 time risk of developing recurrent musculoskeletal pain.
Carriage of backpack over both shoulders protected them from such pain. Seventy two percent of children perceived discomfort due to carriage of schoolbag. No correlationship was found between bag weight and pain. Moderate to severe general tiredness was reported by 62%. Only 32 (2.35%) children found to have significant lateral deviation of the spine. Academic performance or school attendance were not significantly affected.

Research findings necessitated identification of priority areas and formulation of feasible solutions with the involvement of major stakeholders. Issues related to schoolbag were recognized as major concerns. Solutions were contemplated on: strategies for bag-weight reduction, introduction of a model healthy bag and bag behaviour change. Findings were disseminated through local mass media and at international forums to share and update good practice evidence.

Crucial role
Advocacy of policy makers, including Ministers of Health and Education, played a crucial role. Sharing of research outcome and recommendations with Ministry of Education (MoE) stimulated a secondary research by MoE exploring strategies to lighten the schoolbag.
Text books were split into several volumes. Only page-80 exercise books were recommended. A healthy schoolbag was modeled by the principal investigator according to ergonomic standards. Sri Lanka Standards Institution was consulted for physical quality assurance.Bag manufacturers were registered and were educated on healthy bag.

Children, Parents and teachers were made knowledgeable through mass media, leaflets and at exhibitions on healthy bag and bag behaviour.
A schoolbag regulatory committee was established to monitor implementation of national healthy schoolbag campaign.This pioneer public health sector research work led to a successful healthy schoolbag campaign at national level in Sri Lanka.

Read more: http://www.sundayobserver.lk/2010/06/27/spe05.asp

An outbreak of mumps in Dompe

Ceylon Medical Journal



An outbreak of mumps in Dompe
P Palihawadana, ILK Jayaratne, N Wijemunige
http://www.sljol.info/sljol/index.php/CMJ/article/view/1051

doi: 10.4038/cmj.v52i1.1051
Ceylon Medical Journal Vol.52(1) 35-36

Promoting Ergonomics for Children in Educational Environments (ECEE) in Industrially Developing Countries

Please visit: http://www.iea.cc/ECEE/index.html

The International Ergonomics Association (IEA) Ergonomics for Children in Educational Environments (ECEE) Technical Committee (TC) was organised by Cheryl Bennett following a successful symposium at the IEA 2000 Conference in San Diego. Anyone interested in joining the committee is urged to contact the Committee Chair, Karen Jacobs at kjacobs@bu.edu .

Mission
The purpose of the EECE TC is to provide a forum for the international exchange of scientific and technical ergonomics information related to children and educational environments.

The Committee promotes professional and public awareness of ergonomics related to children of all abilities in all aspects of their lives and the application of ergonomics in all educational environments.

Kapila Jayaratne was appointed as the co-chairperson of the International Ergonomics Association’s (IEA) Ergonomics for Children in Educational Environments (ECEE) Technical Committee (TC) in recognition of the work he is doing to advance the health and well being of children.


Read more:

National Healthy Schoolbag campaign in Sri Lanka -http://www.iea.cc/upload/IEA-IDC%20National%20Healthy%20Schoolbag%20campaign%20in%20Sri%20Lanka.pdf

Sri Lanka Medical Association (SLMA) oration 2010

Dr Kapila Jayaratne was awarded the opportunity to present the Sri Lanka Medical Association (SLMA) oration 2010 - Ergonomic Factors in the Educational Environment and their Influence on School-going Early Adolescents.

Dr Jayaratne is the first public health physician who has been honoured with this prestigious oration, the highest recognition for medical research, awarded by the Sri Lanka Medical Association.

The Sri Lanka Medical Association is the oldest professional medical association in Asia and Australasia, with a proud history dating from 1887. Being the national professional medical association in Sri Lanka, the SLMA brings together medical practitioners of all grades and all branches of medicine. The SLMA has expanded its territories to facilitate its members to present their research and to further their professional and academic development.

Read more:

www.slma.lk/static/viewnl.php?Details=8

www.slma.lk/static/viewnl.php?Details=2

Optimizing the roles of health workers to improve MDGs 4 and 5 discussion forum

http://my.ibpinitiative.org/DisplayKnowledge.aspx?c=7b47857a-349e-4eb2-bcba-fe6d95c04fbe&f=44a7373e-dcdc-46dd-b37c-8ea5ba3fb43b&i=32a29121-0f4f-4529-8bf8-0e3521f53eaf

Week 1 Day 1
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Sri Lanka being a low income country is boasting of achievements on maternal and infant mortality rates in par with developed countries. Key factorsbehind this success story and novel strategies focused on further reductionof both mortalities need to be shared at international level.
The crux of this achievement is the public health service delivery systemwhich covers each and every household in the island. Public Health Midwives(PHMs), with basic training on filed health care, cater for 3000 - 5000population or nearly 800 - 1000 households in a designated healthadministrative locality. She is accountable for maternal and child healthcare of the each house hold under her purview. This domiciliary carenetwork has prompted tremendously health status of women and children inthis country. The spectrum of her service ranges from registration ofeligible couples, preconceptional counseling, antenatal care, intrapartumcare at field (if necessary), postpartum care, family planning promotion,neonatal care, promotion of exclusive breast feeding, immunization, earlychildhood care, growth monitoring, school health and adolescent reproductivehealth services in a life course approach.Linked with them are the supervisory staffs, Supervising PHM, Public HealthNursing Sister and Regional Health Care Manager. The supervision includesformal field visits to informal surprise checks. Review of service deliveryis done at local conferences (3-5 PHMs) and monthly conferences (all PHMsin a regional administrative area) where each PHM is supposed to presentprogress of her performances. The system is in-built with appraisals atvarious levels.

Publich Health Information system originates from the daily logs of the PHMdiary cascading in to a national level network which is continuouslymonitored at national level by the Family Health Bureau -the focal point formaternal and child health (MCH) in the country. The review system has beenexpanded from district level to national level with the participation of allthe stakeholders of MCH.

Sri Lanka introduced maternal death audits in 1982 and now it has beenupgraded to a National Maternal Mortality Surveillance System with a networkof maternal death information network and regular national level reviewsystem throughout the country. Sri Lanka has excelled in maternal mortalityreduction with the latest provisional MMR figure of 33.4 per 100000 livebirths for the year 2008. Learning from what went wrong at ground levelhelped fine tuning maternal care service delivery in the entire country.Capacity building of PHM, the grass root health care worker, is modelledbased on findings and recommendations of national maternal mortalityreviews. This is of importance with the increase of proportion of indirectmaternal deaths in Sri Lanka to develop skills of PHM on obstetric medicalconditions and what is expected from them. Early detection and approriatereferral is the theme as practiced universally. Novel strategies -eg. rapidcommunication with clinicians, targeted health education, high risk approachin family planning promotion- will undoubtedly help in further decline inmaternal mortality in Sri Lanka.

Sri Lanka hopes to reduce the catering population for each PHM with furtherexpanding scope of her domicillary care.

Kapila Jayaratne
Sri Lanka


Kapila Jayaratne, Sri Lanka has excelled in maternal mortality reduction of 33.4 per 100000 live births for the year 2008. Learning from what went wrong at ground level helped fine tuning maternal care service delivery in the entire country. Capacity building of PHM, the grass root health care worker, is modeled based on findings and recommendations of national maternal mortality reviews. This is of importance with the increase of proportion of indirect maternal deaths in Sri Lanka to develop skills of PHM on obstetric medical conditions and what is expected from them. Early detection and appropriate referral is the theme as practiced universally. Novel strategies -e.g. Rapid communication with clinicians, targeted health education, high risk approach in family planning promotion- will undoubtedly help in further decline in maternal mortality in Sri Lanka.

Femi Oladapo: Thanks to Kapila for sharing Sri Lanka's success story with the rest of the world. There is no doubt that building a formidable health team at the grassroots level based on evidence from situation analysis would go a long way in reducing the high rates of maternal and newborn mortality in many countries. It has to be acknowledged, though, that not many low income countries have the a strong public health service delivery system as described for Sri Lanka and the same initiative could have different outcomes in another setting. It would be nice if Kapila can provide the forum with more information about the training of these Public Health Midwives so that everyone can appreciate the degree of competence required to achieve a similar feat. Obviously, there is a wide range of services they can render particularly in the area of health promotion. The strength of this kind of health system probably still lies in a good referral system, appropriate supervision, monitoring and evaluation and incentivization of the workforce. The question we need to ask is this, is the success of this health policy intervention dependent on specialized workforce that can provide emergency obstetric care? Or how far could these PHM go to save the life of a woman when the need arises? For example do they perform manual removal of the placenta, give uterotonics or magnesium sulfate for pre-eclampsia?

A/HINI is back: Mothers to-be, take care

hhttp://sundaytimes.lk/101219/MediScene/mediscene_3.html



Sneezing, sniffling and coughing, the flu seems everywhere. As the second wave of A/H1N1 virus takes on the pattern of a seasonal flu, health officials while urging the public not to panic stressed that vulnerable groups should be extra-cautious.


Explaining that the World Health Organization (WHO) has now declared that H1N1 is in the ‘post-pandemic period’ or last phase, the Family Health Bureau, however, advised expectant mothers to take care as pregnancy is a recognized co-morbidity for this virus.


The Maternal and Child Morbidity and Mortality Surveillance Unit of the bureau is making all efforts to prevent maternal deaths due to H1N1, said Consultant Community Physician Dr. Kapila Jayaratne.H1N1 if contracted during pregnancy is considered “a high risk condition”, he says adding that there could be complications especially in pregnant women with co-morbidities such as diabetes, heart disease and bronchial asthma.


It is also associated with an increased risk of adverse pregnancy outcomes including spontaneous abortion, preterm birth and foetal distress, according to him. It is important not only for pregnant women but also those in the reproductive age group to be aware of the symptoms of this virus infection, MediScene understands. They are fever along with a cough, sore throat, rhinorrhoea, headache, muscle pain and malaise.


Advising pregnant women to avoid unnecessary travel, crowded public places and public transport as much as possible, Dr. Jayaratne says that pregnant women and new mothers should avoid providing care for persons with influenza-like illnesses except for their own newborns.Any pregnant mother with acute febrile respiratory illness (fever > 38oC) with symptoms ranging from cough, sore throat, shortness of breath to pneumonia, should consult a qualified physician (either in the government or private sector).


These mothers should be admitted to a hospital if they present with features of complicated influenza or progressive disease manifestations of cardio-respiratory distress (e.g. shortness of breath either during physical activity or while resting dyspnoea, tachypnea, hypoxia, low blood pressure); radiological signs of lower respiratory tract disease (e.g. pneumonia); central nervous system involvement (e.g. altered mental status, unconsciousness, drowsiness, recurring or persistent convulsions (seizures), confusion, severe weakness or paralysis); severe dehydration; persistent high fever and other symptoms beyond 3 days.


Most pregnant women can be managed if Oseltamivir is started early. It is a must to start Oseltamivir when H1N1 is suspected without waiting for laboratory confirmation, he said, adding that Chemoprohylaxis is NOT recommended in pregnancy. The patient should also be provided the necessary supportive therapy (adequate nutrition and oral fluids) and medication (antipyretics, antibiotics where indicated, rehydration etc). Non-Steroidal Anti Inflammatory Drugs (NSAIDs) should be avoided.

Recently we had a successful workshop on "Healthy Schoolbag - Role of Healthcare Workers" organized by Piliyandala Clinical Society. Doctors from both clinical and public health sectors, Assistant Medical Officers, General Practitioners and several categories of field health care workers participated at this workshop to update their knowledge on newly introduced ergonomically designed healthy schoolbag.

The participants were explained the concept of ergonomics, its applications on school children, ergonomics of schoolbag, newly designed national healthy schoolbag and role of primary care health care workers.It is fundamental to disseminate information on latest developments in the healthcare field to major stake holders in the periphery. The above categories in the first contact level will have frequent encounters of ultimate beneficiaries of National Healthy Schoolbag Campaign -children and their parents.

Child Health Partnerships: a review of program characteristics, outcomes and their relationship

Kapila Jayaratne1,2* , Margaret Kelaher1* and David Dunt1*

1 Centre for Health Policy, Programs and Economics, School of Population Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Victoria 3010, Australia
2 Child Health Unit, Family Health Bureau, Ministry of Healthcare and Nutrition, 231 De Saram Place, Colombo 10, Sri Lanka

Abstract

Background
Novel approaches are increasingly employed to address the social determinants of health of children world-wide. Such approaches have included complex social programs involving multiple stakeholders from different sectors jointly working together (hereafter Child Health Partnerships). Previous reviews have questioned whether these programs have led to significant improvements in child health and related outcomes. We aim to provide definitive answers to this question as well as identifying the characteristics of successful partnerships.

Methods
A comprehensive literature search identified 11 major Child Health Partnerships in four comparable developed countries. A critical review is focused on various aspects of these including their target groups, program mechanics and outcomes.

Results and Conclusions
There was evidence of success in several major areas from the formation of effective joint operations of partners in different partnership models to improvement in both child wellbeing and parenting. There is emerging evidence that Child Health Partnerships are cost-effective. Population characteristics and local contexts need to be taken into account in the introduction and implementation of these programs.

For FullText, please visit:

http://www.biomedcentral.com/1472-6963/10/172

Further instructions on Healthy Schoolbag

Healthy schoolbag promoted in the community.