COUNTRY REPORT: Executive Summary
In 2001, World Health Organization (WHO) in collaboration with United Nations' UNICEF, UNESCO, and UNAIDS; and with technical assistance from Centre for Disease Control and Prevention (CDC), initiated the development of the Global School-based Student Health Survey (GSHS).
To date 55 countries have completed a GSHS. This report describes results from the first GSHS conducted in Maldives by the Ministry of Education in collaboration with WHO, Ministry of Health and Family and technical assistance from CDC, during the period from August- September 2009.
The purpose of the GSHS is to provide data on health behaviours and protective factors among students to
• Help countries develop priorities, establish programs, and advocate for resources for school health and youth health programs and policies;
• Allow international agencies, countries, and others to make comparisons across countries regarding the prevalence of health behaviours and protective factors; and
• Establish trends in the prevalence of health behaviours and protective factors by country for use in evaluating school health and youth health promotion.
In 2009 Maldives GSHS employed a two-stage cluster sample design to produce a representative sample of students in grades 8 to 10. The first-stage sampling frame consisted of all schools containing any of the grades 8-10. Maldives was divided in to two sub groups representing Atolls (Rural) and Male’ (Urban). Schools were selected with probability proportional to school enrolment size. 39 schools were selected to participate in the Maldives GSHS. 14 schools from Male’ sample and 25 schools from Atoll schools were selected. The second stage of sampling consisted of randomly selecting intact classrooms (using a random start) from each school to participate. All classes in each selected schools were included in the sampling frame. All students in the sampled classrooms were eligible to participate in the GSHS.
The Maldives GSHS questionnaire contained 93 questions, 43 questions in core questionnaire module and 50 from core expanded questions, addressing all the GSHS core modules: Demographics, dietary behaviours, hygiene, violence and unintentional injury, mental health, tobacco use, alcohol and drug use, sexual behaviours, physical activity and protective factors. The 2009 Maldives GSHS questionnaire was developed by the input from the steering committee, school heads of selected schools and a religious leader. For the 2009 Maldives GSHS, 3,241 questionnaires were completed in 39 schools. The school response rate was 100%, the student response rate was 80%, and the overall response rate was 80%.
The survey results have identified the seriousness of health issues (suicidal thoughts, drugs, alcohol, tobacco, violence, dietary behaviour etc.) associated with our adolescent age school children. It is also evident that the problems are much greater among students in Atoll.
The 2009 Maldives GSHS indicated high percentage (19.9%) of students who seriously consider attempting suicide during the past 12 months in national sample. The Atoll survey showed students reported higher percentage than that of the National and the Male surveys, who considered attempting suicide.
The result also showed Maldives (5.4%) has high prevalence of lifetime drug use. Male students (7.5%) are significantly more likely than female students (3.2%) to report lifetime drug use. Life time drug uses in the Atoll (6.1%) are much more than Male’ (3.7%). Among students who ever had tried drugs, 67.7% were 13 years old or younger when they first tried drugs. In Maldives the prevalence of current alcohol use is 6.7%; male students (9.1%) are significantly more likely than female students (4.2%) to drink alcohol on one or more days during the past 30 days. The prevalence of current tobacco use in Maldives is 11.6%; Male students (17.7%) are significantly more likely than female students (5.5%) to smoke cigarettes. Among students who ever drank alcohol or smoked cigarette 71.5% of the students in Maldives national survey had their first drink of alcohol before the age of 14 years while 65% of students had their first tried of cigarette before the age of 14 years. In Maldives 57.5% of the students reported that people smoked in their presence one or more time during the past 7 days. Male students (61.1%) are significantly more likely than female students (54.1%) to report that people smoked in their presence on one or more days. Overall, 36.0% of students had a parent or guardian who uses any form of tobacco.
Results related to violence and unintended injuries showed that more than one-third of the students reported to experience bullies, physical fights, and serious injuries for one or more times in the past 12 months. Nationally, male students (47.6%) are significantly more likely than female students (29.2%) to have been physically attacked. In comparison, students (41.7%) from Atoll are significantly more likely than students (30.7%) from Male’ to be physically attacked. Overall in Maldives, 37.7% of students were bullied on one or more days during the past 30 days. Male students (41.2%) and female students (34.2%) are equally likely to be bullied on one or more days. The result of sexual abuse was astonishing. The national survey shows that it is not only female students (16.1%) who are victims but male students (17.8%) are equally affected to had ever been physically forced to have sexual intercourse when they did not want to.
The results indicate that 22.7% of students usually ate fruit such as banana two or more times per day during the past 30 days. Male students (26.4%) are significantly more likely than female students (19.3%) to eat fruit. Vegetable consumption is still lower, 10.1% of students usually ate vegetable such as pumpkin three or more times per day during the past 30 days. Male students (12.6%) are significantly more likely than female students (7.7%) to eat vegetables. The consumption of fruit and vegetables in Male’ is much lower compared to Atoll with fruit intakes 24.7% and vegetables intake 11.2% in Atoll and in Male’ fruit intakes is 5.2% and vegetables intake 7.5%.The prevalence of hunger among students in Maldives is 6.9%; students (7.6%) from Atoll are slightly more likely than students (5.2%) from Male’ to go hungry most of the time or always.
In Maldives the percentage of students who did not clean or brush their teeth during the past 30 days was 8.0%. Male students (9.9%) are significantly more likely than female students (6.0%) not clean or brush their teeth. Likewise, the percentage of students who did not clean or brush their teeth was (9.3%) in Atoll, this is significantly more likely than Male’ (4.7%). The study showed that 8.3% of students never or rarely washed their hands before eating during the past 30 days. Male students (10.7%) are more likely than female students (5.7%) to never or rarely wash their hands before eating. In Maldives 5.9% of students never or rarely washed their hands after using the toilet or latrine. Among students who washed their hands at school during the past 30 days, 46.1% of students never or rarely used soap to wash their hands, (47.9%) are significantly more likely than female students (43.8%) to never or rarely use soap to wash their hands. Among students who washed their hands at school during the past 30 days, (41.8%) from Atoll are significantly more likely than (55.1%) from Male’, never or rarely used soap to wash their hands.
Satisfyingly 70.9% of students described the health of their teeth and gums as good and very good and 69.7% of students never or rarely had a toothache during the past 12 months. Students (82.8%) from Male’ is significantly more likely than students (64.0%) from Atoll to never or rarely have a toothache
The study showed that nationwide 70.7% had ever heard of HIV infections or the disease called AIDS. Students (66.6%) from Atoll are significantly less likely than students (80.1%) from Male’ to have ever heard of HIV infections or the disease called AIDS. Male students (67.2%) are significantly less likely than female students (74.3%) to have ever heard of HIV infections or the disease called AIDS. With regards to teaching HIV infections or AIDS in schools, close to one third of the students in all samples were taught in any of their classes during the school year about of HIV infections or AIDS.
Forlornly the result from the national survey revealed that only one fourth (25.5%) of students were physically active for a total of at least 60 minutes per day on five or more days during the past 7 days. Male students (29.3%) are significantly more likely than female students (21.9%) to be physically active. Overall, 41.6% of students spent three or more hours per day doing sitting activities during a typical or usually. Male students (43.5%) are significantly more likely than female students (39.7%) to spend three or more hours per day doing sitting activities. Likewise, students (39.6%) from Atoll are significantly less likely than students (46.2%) from Male’ to be engaged in sedentary behaviour.
In Maldives, high percentage 46.9% of students reported their parents or guardians really know what they were doing with their free time most of the time or always during the past 30 days. Male students (42.6%) are significantly less likely than female students (51.1%) to report their parents or guardians really know what they are doing with their free time most of the time or always. 28.5% of students reported their parents or guardians checked to see if their homework was done most of the time or always during the past 30 days. Nationally close to half (49.6%) of students reported that most of the students in their school were kind and helpful most of the time or always during the past 30 days. Male students (43.5%) are significantly less likely than female students (55.7%) to report that most of the students in their school are kind and helpful. Students (46.0%) from Atoll are significantly less likely than students (58.0%) from Male to report that most of the students in their school were kind and helpful. In Maldives more than a quarter (30.3%) of students missed classes or school without permission on one or more of the past 30 days. Male students (34.5%) are significantly more likely than female students (27.5%) to miss classes or school without permission. Students (32.1%) from Atoll are significantly more likely than students (26.4%) from Male’ to miss classes or school without permission.
In general it is recommended that the results should be disseminated to all stake holders and creates awareness among them in order to realize the seriousness of our students’ health problems and take proper action to minimize and also develop advocacy materials using this information in simple materials that target audience (school heads/senior management, teachers, public health workers and parents) would understand. Advocating “schools to implement concepts of health promoting school initiative” with the target to achieving the standards in health and family dimension of “Child Friendly Barabaru School Indicators” (CFBS). This dimension looks into the physical, social aspects of school children as well as the physical and social environment of the school which in turn have an impact on the students as a whole. At the same time Strengthen “skills based health education” in schools with a focus to develop communication, negotiation and interpersonal skills and competencies and health practices related to students health. Maldives should continue with the GSHS surveillance in order to track the trends in the prevalence of health risk behaviours and protective factors.
To date 55 countries have completed a GSHS. This report describes results from the first GSHS conducted in Maldives by the Ministry of Education in collaboration with WHO, Ministry of Health and Family and technical assistance from CDC, during the period from August- September 2009.
The purpose of the GSHS is to provide data on health behaviours and protective factors among students to
• Help countries develop priorities, establish programs, and advocate for resources for school health and youth health programs and policies;
• Allow international agencies, countries, and others to make comparisons across countries regarding the prevalence of health behaviours and protective factors; and
• Establish trends in the prevalence of health behaviours and protective factors by country for use in evaluating school health and youth health promotion.
In 2009 Maldives GSHS employed a two-stage cluster sample design to produce a representative sample of students in grades 8 to 10. The first-stage sampling frame consisted of all schools containing any of the grades 8-10. Maldives was divided in to two sub groups representing Atolls (Rural) and Male’ (Urban). Schools were selected with probability proportional to school enrolment size. 39 schools were selected to participate in the Maldives GSHS. 14 schools from Male’ sample and 25 schools from Atoll schools were selected. The second stage of sampling consisted of randomly selecting intact classrooms (using a random start) from each school to participate. All classes in each selected schools were included in the sampling frame. All students in the sampled classrooms were eligible to participate in the GSHS.
The Maldives GSHS questionnaire contained 93 questions, 43 questions in core questionnaire module and 50 from core expanded questions, addressing all the GSHS core modules: Demographics, dietary behaviours, hygiene, violence and unintentional injury, mental health, tobacco use, alcohol and drug use, sexual behaviours, physical activity and protective factors. The 2009 Maldives GSHS questionnaire was developed by the input from the steering committee, school heads of selected schools and a religious leader. For the 2009 Maldives GSHS, 3,241 questionnaires were completed in 39 schools. The school response rate was 100%, the student response rate was 80%, and the overall response rate was 80%.
The survey results have identified the seriousness of health issues (suicidal thoughts, drugs, alcohol, tobacco, violence, dietary behaviour etc.) associated with our adolescent age school children. It is also evident that the problems are much greater among students in Atoll.
The 2009 Maldives GSHS indicated high percentage (19.9%) of students who seriously consider attempting suicide during the past 12 months in national sample. The Atoll survey showed students reported higher percentage than that of the National and the Male surveys, who considered attempting suicide.
The result also showed Maldives (5.4%) has high prevalence of lifetime drug use. Male students (7.5%) are significantly more likely than female students (3.2%) to report lifetime drug use. Life time drug uses in the Atoll (6.1%) are much more than Male’ (3.7%). Among students who ever had tried drugs, 67.7% were 13 years old or younger when they first tried drugs. In Maldives the prevalence of current alcohol use is 6.7%; male students (9.1%) are significantly more likely than female students (4.2%) to drink alcohol on one or more days during the past 30 days. The prevalence of current tobacco use in Maldives is 11.6%; Male students (17.7%) are significantly more likely than female students (5.5%) to smoke cigarettes. Among students who ever drank alcohol or smoked cigarette 71.5% of the students in Maldives national survey had their first drink of alcohol before the age of 14 years while 65% of students had their first tried of cigarette before the age of 14 years. In Maldives 57.5% of the students reported that people smoked in their presence one or more time during the past 7 days. Male students (61.1%) are significantly more likely than female students (54.1%) to report that people smoked in their presence on one or more days. Overall, 36.0% of students had a parent or guardian who uses any form of tobacco.
Results related to violence and unintended injuries showed that more than one-third of the students reported to experience bullies, physical fights, and serious injuries for one or more times in the past 12 months. Nationally, male students (47.6%) are significantly more likely than female students (29.2%) to have been physically attacked. In comparison, students (41.7%) from Atoll are significantly more likely than students (30.7%) from Male’ to be physically attacked. Overall in Maldives, 37.7% of students were bullied on one or more days during the past 30 days. Male students (41.2%) and female students (34.2%) are equally likely to be bullied on one or more days. The result of sexual abuse was astonishing. The national survey shows that it is not only female students (16.1%) who are victims but male students (17.8%) are equally affected to had ever been physically forced to have sexual intercourse when they did not want to.
The results indicate that 22.7% of students usually ate fruit such as banana two or more times per day during the past 30 days. Male students (26.4%) are significantly more likely than female students (19.3%) to eat fruit. Vegetable consumption is still lower, 10.1% of students usually ate vegetable such as pumpkin three or more times per day during the past 30 days. Male students (12.6%) are significantly more likely than female students (7.7%) to eat vegetables. The consumption of fruit and vegetables in Male’ is much lower compared to Atoll with fruit intakes 24.7% and vegetables intake 11.2% in Atoll and in Male’ fruit intakes is 5.2% and vegetables intake 7.5%.The prevalence of hunger among students in Maldives is 6.9%; students (7.6%) from Atoll are slightly more likely than students (5.2%) from Male’ to go hungry most of the time or always.
In Maldives the percentage of students who did not clean or brush their teeth during the past 30 days was 8.0%. Male students (9.9%) are significantly more likely than female students (6.0%) not clean or brush their teeth. Likewise, the percentage of students who did not clean or brush their teeth was (9.3%) in Atoll, this is significantly more likely than Male’ (4.7%). The study showed that 8.3% of students never or rarely washed their hands before eating during the past 30 days. Male students (10.7%) are more likely than female students (5.7%) to never or rarely wash their hands before eating. In Maldives 5.9% of students never or rarely washed their hands after using the toilet or latrine. Among students who washed their hands at school during the past 30 days, 46.1% of students never or rarely used soap to wash their hands, (47.9%) are significantly more likely than female students (43.8%) to never or rarely use soap to wash their hands. Among students who washed their hands at school during the past 30 days, (41.8%) from Atoll are significantly more likely than (55.1%) from Male’, never or rarely used soap to wash their hands.
Satisfyingly 70.9% of students described the health of their teeth and gums as good and very good and 69.7% of students never or rarely had a toothache during the past 12 months. Students (82.8%) from Male’ is significantly more likely than students (64.0%) from Atoll to never or rarely have a toothache
The study showed that nationwide 70.7% had ever heard of HIV infections or the disease called AIDS. Students (66.6%) from Atoll are significantly less likely than students (80.1%) from Male’ to have ever heard of HIV infections or the disease called AIDS. Male students (67.2%) are significantly less likely than female students (74.3%) to have ever heard of HIV infections or the disease called AIDS. With regards to teaching HIV infections or AIDS in schools, close to one third of the students in all samples were taught in any of their classes during the school year about of HIV infections or AIDS.
Forlornly the result from the national survey revealed that only one fourth (25.5%) of students were physically active for a total of at least 60 minutes per day on five or more days during the past 7 days. Male students (29.3%) are significantly more likely than female students (21.9%) to be physically active. Overall, 41.6% of students spent three or more hours per day doing sitting activities during a typical or usually. Male students (43.5%) are significantly more likely than female students (39.7%) to spend three or more hours per day doing sitting activities. Likewise, students (39.6%) from Atoll are significantly less likely than students (46.2%) from Male’ to be engaged in sedentary behaviour.
In Maldives, high percentage 46.9% of students reported their parents or guardians really know what they were doing with their free time most of the time or always during the past 30 days. Male students (42.6%) are significantly less likely than female students (51.1%) to report their parents or guardians really know what they are doing with their free time most of the time or always. 28.5% of students reported their parents or guardians checked to see if their homework was done most of the time or always during the past 30 days. Nationally close to half (49.6%) of students reported that most of the students in their school were kind and helpful most of the time or always during the past 30 days. Male students (43.5%) are significantly less likely than female students (55.7%) to report that most of the students in their school are kind and helpful. Students (46.0%) from Atoll are significantly less likely than students (58.0%) from Male to report that most of the students in their school were kind and helpful. In Maldives more than a quarter (30.3%) of students missed classes or school without permission on one or more of the past 30 days. Male students (34.5%) are significantly more likely than female students (27.5%) to miss classes or school without permission. Students (32.1%) from Atoll are significantly more likely than students (26.4%) from Male’ to miss classes or school without permission.
In general it is recommended that the results should be disseminated to all stake holders and creates awareness among them in order to realize the seriousness of our students’ health problems and take proper action to minimize and also develop advocacy materials using this information in simple materials that target audience (school heads/senior management, teachers, public health workers and parents) would understand. Advocating “schools to implement concepts of health promoting school initiative” with the target to achieving the standards in health and family dimension of “Child Friendly Barabaru School Indicators” (CFBS). This dimension looks into the physical, social aspects of school children as well as the physical and social environment of the school which in turn have an impact on the students as a whole. At the same time Strengthen “skills based health education” in schools with a focus to develop communication, negotiation and interpersonal skills and competencies and health practices related to students health. Maldives should continue with the GSHS surveillance in order to track the trends in the prevalence of health risk behaviours and protective factors.
I like the idea of single session, but some people seems trying to introduce some anti-religious activities along with single session type.
ReplyDeleteThis posting aims to inform educators and concerned readers about a Health Survey conducted in 2009. Could you be more specific in how your question relates to this Health Survey?
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