Academic journal article International Journal of Child Health and Human Development

Evaluating the Cognitive Impacts of School Health in the Philippines

Academic journal article International Journal of Child Health and Human Development

Evaluating the Cognitive Impacts of School Health in the Philippines

Article excerpt

Introduction

School health and nutrition (SHN) programs are an increasing part of efforts to improve the educational outcomes of children around the world. Their success relies on a number of key factors. First, they can have a massive global impact on education outcomes because the diseases and nutritional conditions typically addressed are highly prevalent and have substantial impact on children's education. Second, SHN programs are highly cost-effective because simple treatments or nutritional supplements can be delivered inexpensively through the education system. Third, SHN programs promote equity because the educational outcomes of the poorest children benefit to the greatest extent and because programs delivered through schools are able to reach children in poor, marginalized communities wherever enrollment rates are high.

There is increasing evidence from efficacy trials of individual interventions that iron supplementation and deworming can both improve children's cognitive abilities and educational outcomes (1-3). However, there have been fewer programmatic evaluations of SHN interventions. The aim of this study was to evaluate a non-governmental SHN program in the Philippines for its effectiveness in improving children's cognitive outcomes. As part of this aim, the study also developed and evaluated simple, inexpensive tools for the monitoring of cognitive outcomes.

Anemia and parasitic worms are well- documented problems for children in developing countries, causing both physical and cognitive impairments. Anemia is the lack of hemoglobin, the oxygen-carrying protein in the blood; a deficiency in iron is the leading cause. More than half of all schoolchildren worldwide are affected by iron deficiency anemia (4). The World Health Organization (5) estimated that in 2002, 12.2 million disability-adjusted life years (DALYs) were lost worldwide due to iron deficiency anemia. Though it is a serious health issue in countries around the world, iron deficiency anemia is easily and inexpensively treated with oral iron supplement tablets. A randomized evaluation of a previous Save the Children school health project in the Philippines found that iron tablets distributed by teachers maintained treatment group children's blood hemoglobin levels, while control group children's hemoglobin levels fell and their anemia rates rose (6), possibly due to seasonal variations in income, food availability and disease transmission.

Efficacy trials suggest that iron treatment increases cognitive function in iron-deficient children (7-10). However, one study giving a short course of iron supplementation to iron-deficient children in Thailand failed to identify any educational improvements (8). Findings from these studies suggest that the educational benefits of iron supplementation depend on the period of supplementation and the educational and epidemiological context. Nevertheless, given the potential benefits, the low cost of iron supplementation-just $0.10 per child per year when delivered by teachers-makes it a cost-effective intervention (4).

Parasitic worm infections compound the risks of anemia. Two billion people worldwide carry soil- transmitted helminths or schistosomes, and at least half are children (11). Children with chronic worm infections may suffer higher rates of malnutrition due to reduced appetite, poor absorption of nutrients in the digestive system, and anemia caused by blood loss, conditions which can lead to stunting and low weight- for-age (12). Deworming drugs can be easily administered in schools by trained teachers. Depending on the prevalence of helminths in the area, deworming may take place once or twice annually. Costs for deworming drugs are low, ranging from $0.02 to $0.20 per dose (5,11).

Efficacy trials of the effect of deworming on cognitive abilities have produced mixed results. In general, deworming has been effective in improving cognitive abilities when targeted at the most disadvantaged children. …

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