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 Table of Contents  
Year : 2022  |  Volume : 12  |  Issue : 2  |  Page : 89-91

Does school based interventions effective in promoting adolescent health

Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Submission21-Feb-2022
Date of Decision06-Mar-2022
Date of Acceptance07-Mar-2022
Date of Web Publication26-Apr-2022

Correspondence Address:
Dr. Manish Taywade
Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmrp.cmrp_22_22

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How to cite this article:
Alekhya G, Taywade M, Sahoo BK. Does school based interventions effective in promoting adolescent health. Curr Med Res Pract 2022;12:89-91

How to cite this URL:
Alekhya G, Taywade M, Sahoo BK. Does school based interventions effective in promoting adolescent health. Curr Med Res Pract [serial online] 2022 [cited 2023 May 30];12:89-91. Available from: http://www.cmrpjournal.org/text.asp?2022/12/2/89/343934


Xu T, Tomokawa S, Gregorio Jr ER, Mannava P, Nagai M, Sobel H School-based interventions to promote adolescent health: A systematic review in low-and middle-income countries of WHO Western Pacific Region. PloS one. 2020 Mar 5;15(3): e0230046.

  Background Top

The World Health Organization (WHO) defines adolescents as those between 10 and 19 years of age.[1] At present, the total population of adolescents in the world is around 1.2 billion. While maternal and under-five mortality had decreased by around half, adolescent mortality still remains stagnant.[2] India has the largest adolescent population in the world, 253 million, and every fifth person is between 10 and 19 years of age.[3] Adolescence is characterised by rapid growth and development. It is an opportune time to build healthy habits and lifestyles. They have only limited knowledge of sexual and reproductive health and know little about the normal physiological process of puberty, sexual health, pregnancy or reproduction. It is a period of ongoing physical, emotional and social change and a period when they start exploring their sexuality and developing relationships with others.

Data have shown that preventable causes such as road injuries, human immunodeficiency virus/acquired immunodeficiency syndrome (AIDS), suicide, lower respiratory tract infection and interpersonal violence account for 1.3 million deaths among adolescents in the year 2012.[4] Therefore, limiting these preventable deaths were included as one of the goals under Sustainable Development Goals. Schools have become an essential place where adolescent health can be addressed since they spend a significant fraction of their time in the schools. Low and middle-income countries harbour about 90% of the adolescent population. Evidence-based interventions have been brought to the notice by countries who are the WHO Western Pacific Region members necessary for actions to be taken at their national-level policies. Today's generation of adolescents faces a different world from what their parents and grandparents had. New political, economic, educational, technological and religious realities shape the world in which adolescents today live. They change the way adolescents transition from childhood to adulthood. Understanding how to best support adolescents to have a healthy and smooth transition, we need to understand both how the transitions occur and how the external forces interact with the transitions. The Lancet Commission has recommended the development and practice of effective evidence-based policies and interventions to reduce the burden of adolescent mortality and morbidity worldwide.[5] There are various interventional studies done on assessing the effectiveness of health education pertaining to adolescent health. A systematic review in low and middle-income countries of the WHO Western Pacific Region Office (WPRO) assessed school-based interventions to promote adolescent health.

In the year 1995, the WHO has launched Global School Initiative for strengthening and mobilising school health programmes globally. This systematic review has considered the studies published between January 1995 and March 2019. The search strategy involved five electronic databases, namely CENTRAL, PubMed, Social Sciences Citation Index, Western Pacific Region Index Medicus and Education Resources Information Centre. Keywords searched were school base, adolescent, intervention study and name of WPRO LMI countries. The study objective was to find characteristics and identify the effectiveness of school-based intervention and facilitating factors for successful intervention to promote adolescent health in low- and middle-income countries of the WHO Western Pacific Region.

The study has searched for randomised controlled trials and non-randomised controlled trials among adolescents between 10 and 19 years of age done among WHO WPRO WPROLMIC targeting adolescent health behaviour, academic and school environment outcomes. The quality of included studies' risk of bias was done by using the tool adopted by Cochrane Handbook for Systematic Reviews. Data were presented in the form of mean and standard deviation with 95% confidence intervals. Results were reported as not significant if the P value was more than 0.05. Variables from each study included type and activities of intervention, targeted population, follow-up and outcome effects. The interventions which were effective and implementation approaches have been summarised for consideration in scale-up. There were only eight publications identified with 18,774 participants. Out of eight, three were cluster randomised controlled trials and five were nonrandomised controlled trials. As discussed above, the topics of intervention were AIDS, sexual and reproductive health, deworming, nutrition, obesity, tobacco use and suicide. The outcome measures were knowledge, attitudes and behaviours in most of the studies. Changes in school policy and physical environment were also some of the outcomes in a few studies. The restricted impact was found in studies demonstrating successful interventions such as improving knowledge, attitudes and behaviours. Interventions that were done by different studies varied from addressing a single action area (like developing personal skills) or were a combination of action areas in activities such as health promotion (e.g., policy development, creation of a supportive environment and development of personal skills). None of the studies addressed screening, counselling and developing safe and cultivated school environments.

  Commentary Top

Schools are the place where most adolescents spend a significant fraction of their lives. Only eight school-based health interventions were included in the review despite vast growing scientific literature on adolescent health in LMICs in WHO WPRO. The eight studies focussed on AIDS, sexual and reproductive health, nutrition, deworming, tobacco use, obesity and suicide. However, no study has focused on screening for health conditions and creating a healthy school environment. The adolescent phase is very important as they have unique health and development issues.[6],[7] Hence, there is a need for evidence-based school health programmes which align their health priorities.[8] In a study, it has shown that the important causes of mortality and health problems in adolescents were mental health disorders, injuries, violence and chronic conditions, which are usually neglected in school health services.[9] Therefore, school health programmes should focus on expanding beyond traditional health education for the health and social transition of adolescents. The services which can be included are screening for health and psychosocial conditions, creating safe and nurturing learning environments, providing counselling and treating for common morbidities and risk behaviours.[10] Efforts should be made for screening adolescents to identify risky behaviours, as they are prone to mental and physical health problems screening could be a critical tool for identifying barriers to a healthy transition to adulthood. The screening itself is not sufficient; it should be linked with follow-up services treatments of health problems.[11] Schools should take responsibility to provide a safe, nurturing and healthy space for adolescents. However, schools in many countries in the region lack basic things such as clean water, sufficient toilets and safe school grounds.[12] Finally, it should be a place where adolescents develop resilience and achieve mental, spiritual and emotional well-being and self-reliance through gaining life skills. Research from high-income countries presented four key components of effective school health services: wide engagement with the community, youth focus and participation, delivery of high-quality, comprehensive care and effective governance and administrative systems.[13]

Hence, there is an impending need for the implementation of school health programmes that include screening for health and psychosocial conditions, providing counselling services and creating safe and nurturing learning environments for adolescents' well-being apart from providing health education and health promotion.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Adolescent Health. Available from: https://www.who.int/southeastasia/health-topics/adolescent-health. [Last accessed on 2020 May 11].  Back to cited text no. 1
Adolescents Statistics UNICEF Data. Available from: https://data.unicef.org/topic/adolescents/overview/. [Last accessed on 2022 Feb 17].  Back to cited text no. 2
Adolescent Development and Participation | UNICEF India. Available from: https://www.unicef.org/india/what-we-do/adolescent-development-participation. [Last accessed on 2021 Jun 29].  Back to cited text no. 3
WHO. Health for the World's Adolescents Report; 2014. Available from: http://www.who.int/maternal_child_adolescent/topics/adolescence/second-decade/en/. [Last accessed on 2019 Feb 02].  Back to cited text no. 4
Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our future: A Lancet commission on adolescent health and wellbeing. Lancet 2016;387:2423-78.  Back to cited text no. 5
Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, et al. Adolescence: A foundation for future health. Lancet 2012;379:1630-40.  Back to cited text no. 6
Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, et al. Adolescence and the social determinants of health. Lancet 2012;379:1641-52.  Back to cited text no. 7
Salam RA, Das JK, Lassi ZS, Bhutta ZA. Adolescent health interventions: Conclusions, evidence gaps, and research priorities. J Adolesc Health 2016;59:S88-92.  Back to cited text no. 8
Baltag V, Pachyna A, Hall J. Global overview of school health services: Data from 102 countries. Health Behav Policy Rev 2015;2:268-83.  Back to cited text no. 9
Weiss HA, Ferrand RA. Improving adolescent health: An evidence-based call to action. Lancet 2019;393:1073-5.  Back to cited text no. 10
Lessler K. Health and educational screening of school-age children-definition and objectives. Am J Public Health 1972;62:191-8.  Back to cited text no. 11
UNICEF. Child Friendly School. Chapter 5: Schools as Protective Environments; 2009. Available from: http://www.unicef.org/education/files/CFSManual_Ch05_052009.pdf. [Last accessed on 2022 Feb 21].  Back to cited text no. 12
Winnard D, Denny S, Fleming T. Successful School Health Services for Adolescents: Best Practice Review 2018. Available from: http://www.schoolnurse.org.nz/Attachments/pdf_files/bestpractice/Best_Practice_Best_Practice_SBHC_Review.pdf. [Last accessed on 2019 Mar 22].  Back to cited text no. 13


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