Children as messengers of health knowledge? Impact of health promotion and water infrastructure in schools on facial cleanliness and trachoma in the community

Background Health promotion is essential to the SAFE strategy for trachoma elimination. Schools are a valuable venue for health promotion. However, there is little literature about the impact of health education and water infrastructure in schools on facial cleanliness and trachoma in the community. Our study aimed to describe the current state of school health promotion in Kongwa, Tanzania, and to examine the transferability of health messages from schools to the community at large. Methodology/Findings A cross-sectional survey was carried out in all 92 villages in Kongwa district, which included 85 primary schools. Data were collected on health messages and water infrastructure in the schools. A random sample of 3084 children aged 0–5 were examined for facial cleanliness in all villages. In 50 villages, a random sample of 50 children aged 1–9 per village were examined for follicular trachoma (TF). Thirty-seven (44.6%) schools had educational materials on face-washing. Fifty (60.2%) schools had a washing station. The presence of a health teacher was correlated with having posters on face washing in classrooms. The presence of face-washing materials was correlated with the availability of washing stations. Neither teachers mentioning face-washing in health curricula nor educational materials in classrooms were associated with clean faces or trachoma in the community. Having a washing station in the school was associated with lower community rates of trachoma. Conclusions Primary school health messages and materials on trachoma were not associated with clean faces or lower rates of trachoma in the community. The target audience for primary school health promotion is likely the students themselves, without immediate rippling effects in the community. A long-term perspective should be considered during the implementation of health promotion in schools. The goal of school health promotion should be training the next generation of parents and community health leaders in combatting trachoma.
Author summary Trachoma is caused by repeated infection that is spread from person to person via contaminated ocular and nasal discharge. Education on healthy habits such as face washing is essential to the elimination of trachoma. Schools are one place for health promotion programs because so many children can be reached. In previous studies, students showed increased knowledge about trachoma and healthy behavior after engaging in health education programs. We examined if there was evidence that school-based messages were disseminated to the community at large via the primary school students. We found that school health messages did not impact clean faces in pre-school children or trachoma prevalence in the community in general. Having a washing station in the school was associated with lower community rates of trachoma. The data suggested that schoolchildren were not effective messengers of health knowledge and behavior. Primary school health promotion mainly targets students themselves and may not have rippling effects in the community. We should view school health curricula with a long-term perspective as they train the next generation of caregivers and heads of households to raise their own children with healthier habits.