Referral Outcomes of Identified Health Problems and Difficulties Related to School Medical Inspections in Government Schools in an Education Zone in Sri Lanka

Abstract

Background and Introduction: School Medical Inspections (SMI) assess the health status of children, and provide opportunities for early detection, referral and prevention of disease conditions among school-aged children in Sri Lanka. There is paucity of data on the outcomes of referrals and difficulties encountered in relation to SMI. This study aimed to describe the outcomes of identified health problems in SMI and the difficulties encountered by public health staff in the conduct of SMI in an educational zone in the Kandy District, Sri Lanka. Methods: This study was comprised of a quantitative and a qualitative component. The quantitative component - a descriptive cross-sectional study was conducted with secondary data of 87 government schools in the Katugasthota educational zone in Kandy district, Sri Lanka. The study sample consisted of 2,876 children in whom health problems were identified and referrals were made. The qualitative component - key informant interviews (KIIs) were conducted among 5 Medical Officers of Health (MOH) and 10 Public Health Inspectors (PHIs) to identify the difficulties they encountered related to SMI. Results: The overall SMI coverage was 88.6%. Dental caries was the main health problem identified (22.9%, N=2,247). Other leading conditions included: skin diseases (1.1%, N=110); anemia (2.1%, N=202); visual defects (1.8%, N=182); and suspected heart disease (1.2%, N=120). Of the referrals, 92.1% (N=2,071) were for dental caries; 84.6% (N=154) were for visual defects; 90% (N=108) were for suspected heart diseases; 100% (N=110) were for skin diseases; 100% (N=202) were for anemia; and 66.6% (N=8) were for behavioral problems. Support from the schools to conduct the SMI was not satisfactory; parents faced many obstacles in obtaining services at the referral centers. Conclusions and Implications for Translation: There was a high coverage of SMI. Referral outcomes for dental caries, skin diseases and anemia were relatively high. Follow-up of area PHI in referral-outcome tracking and management should be strengthened. It is necessary to improve the priority services provided to referred school children in hospital settings.