Evaluation of children’s health and the home and school environment

The SEARCH II project used the same protocol, questionnaires, measuring equipment and methods that were used for the first phase, with the ultimate goal of analysing the associations between the school environment and children’s health using a large, pooled database covering 10 countries and a variety of environmental factors. As the SEARCH I results per country have already been published in a small leaflet prepared for the Parma Ministerial Conference in March 2010, below we present the descriptive results related to health status and the home and school environment of children participating in the four new countries that joined the SEARCH II project.

Health status

A total of 2,797 children from the four EECCA countries participated in the SEARCH II project. Respiratory symptoms were the most common complaints: 32.5 percent of children reported suffering from this type of symptom, which is slightly more than the respective proportion in the six SEARCH I countries (28.0 percent). The two more serious respiratory symptoms (a cough for more than three months and cough with phlegm) were several times more frequent in Ukraine than in the other three EECCA countries (see link below).


Additional information

Table A7 Prevalence (%) of chronic cough symptoms in the four new SEARCH II countries

Symptoms

Belarus

(n=626)

Kazakhstan (n=615)

Tajikistan (n=869)

Ukraine (n=687)

Total (n=2,797)

Morning cough

17.12

18.32

23.87

16.30

19.45

Day/night cough

10.78

11.57

17.38

16.45

14.75

Cough >3 months

1.79

1.49

1.73

18.78

6.48

Cough with phlegm

4.18

5.79

4.93

16.89

8.41

Any chronic cough symptom

23.51

27.02

32.71

41.34

32.46



The data concerning the prevalence of asthmatic symptoms are very similar to those obtained during the SEARCH I study (see link below), although there is a big difference in the prevalence of doctor-diagnosed asthma (10.5 percent in SEARCH I, and only 2.35 percent in SEARCH II). However, this finding is in line with earlier studies carried out by von Mutius et al. in the 1990s. The difference might also be explained by the different medical and technical resources available.


Additional information

Table A8 Prevalence (%) of asthmatic symptoms in the four new SEARCH II countries

Asthma

(symptoms or disease*)

Belarus

(n=626)

Kazakhstan (n=615)

Tajikistan (n=869)

Ukraine (n=687)

Total (n=2,797)

Wheezing, last 12 months

8.17

2.82

3.62

5.97

5.08

Wheezing after exercise, last 12 months

6.62

5.32

6.44

4.22

5.64

Dry cough at night, last 12 months

14.95

5.96

10.37

8.30

9.92

Woken up by wheezing, last 12 months

2.25

1.49

3.08

0.29

1.83

Wheezing in the chest, ever

12.54

7.79

5.19

15.57

10.07

Doctor-diagnosed asthma*, ever

3.53

1.00

3.08

1.60

2.35

Asthma* treatment, last 12 months

2.26

5.52

13.19

3.20

6.06

Any asthmatic symptom

21.47

14.40

22.99

16.89

19.18



Doctor-diagnosed allergies were less frequent in the four new SEARCH II countries (15.1 percent) than in the other six countries (20.6 percent). However, there was significant heterogeneity among the four EECCA countries: in Tajikistan, the prevalence was as low as 8.0 percent, compared to 21.8 percent in Belarus. Food and drug allergies were the two leading types of allergy in all four countries, while in the SEARCH I countries allergies to house dust mites and pollen were the most frequent (about three times more frequent than in the SEARCH II countries).


Additional information

Table A9 Prevalence (%) of doctor-diagnosed allergies in the four new SEARCH II countries

Allergies

Belarus

(n=626)

Kazakhstan (n=615)

Tajikistan (n=869)

Ukraine (n=687)

Total (n=2,797)

House-dust mites

4.03

1.21

3.47

3.20

3.08

Animal fur, feathers

2.58

1.42

3.09

3.06

2.61

Pollen

5.31

3.25

2.33

4.22

3.81

Mould

1.61

0.20

2.48

1.46

1.51

Food

12.52

8.32

5.77

8.01

8.61

Drugs

7.72

7.72

4.15

10.19

7.46

Any allergy

21.79

16.03

8.01

15.87

15.11



Risk factors in the home environment

In terms of home location, 32.2 percent of children lived near a busy road, although there was a high level of variability between Belarus (51.4 percent) and Ukraine (9.4 percent). Living near to an industrial facility was most frequent in Belarus (26.7 percent), and living near to a waste disposal site was most frequent in Ukraine (24.1 percent). There was also a high level of variability in the type of dwelling: around 62 percent of children lived in multi-storey apartment buildings, with extremes in Ukraine (96.4 percent) and Tajikistan (32.6 percent). The frequency of plastic flooring in the child’s room was highest in Kazakhstan (27.6 percent), while in the other three countries it was between 1.8 and 4.2 percent. In most children’s rooms the walls were papered. Walls painted with synthetic paints were less frequent (the highest proportion was 6.4 percent in Kazakhstan). Visible signs of dampness or mould in homes were reported with relatively low frequency (9.8 percent for the home as a whole, and 4.1 percent for the child’s room).


Additional information

Table A10 Prevalence (%) of some risk factors in the home environment in the four new SEARCH II countries

Risk factor

Belarus

(n=626)

Kazakhstan (n=615)

Tajikistan (n=869)

Ukraine (n=687)

Total (n=2,797)

Location of dwelling

In an area with clean air, far from busy roads

5.33

13.97

21.42

32.41

18.65

In an area with low traffic levels

43.30

54.17

42.17

58.18

49.13

Near to a busy road

51.37

31.86

36.41

9.41

32.22

Dwelling located within 500 m of

Industry

26.67

4.35

14.41

3.16

12.24

Power plant

5.83

1.91

7.04

0.90

4.06

Bus terminal

64.15

48.64

42.20

61.90

53.58

Waste disposal site

1.45

15.05

3.42

24.10

10.76

Type of dwelling

Detached house

9.15

35.52

41.47

1.51

22.64

Flat in a semi-detached house

7.04

15.12

24.03

1.66

12.53

Flat in an apartment building

33.98

48.27

18.86

68.73

41.48

Flat in a panel building

42.61

18.86

13.70

27.64

20.80

Flooring in child's room

Wood-strip flooring

25.16

38.37

57.80

27.46

38.69

Parquet

16.83

15.61

12.88

33.73

19.44

Wall-to-wall carpet

6.09

8.46

16.08

13.13

11.40

Plastic floor

1.76

27.64

4.02

2.24

8.35

Stone

0.00

0.49

0.35

0.45

0.33

Concrete

1.28

5.04

10.28

1.64

4.97

Wall covering in child's room

Wallpaper

98.72

83.39

78.89

95.83

88.60

Synthetic paint

1.12

6.38

5.45

3.72

4.23

Whitewash

0.16

9.24

15.01

0.74

6.81

Wood panelling

0.00

0.50

1.21

1.04

0.74

Panelling of synthetic material

0.16

0.17

0.85

0.30

0.41

Dampness or visible mould in child's room

No

95.79

97.15

94.36

96.64

95.89

Yes (from small spots up to palm size)

2.59

2.18

2.05

2.92

2.43

Yes (from palm size up to 1 m2)

0.65

0.34

1.67

0.29

0.78

Yes (over 1 m2)

0.97

0.34

1.92

0.15

0.90

Dampness or visible mould in any other room

No

88.44

92.44

89.61

90.48

90.21

Yes (from small spots up to palm size)

5.86

4.87

4.76

6.59

5.53

Yes (from palm size up to 1 m2)

3.75

2.35

2.02

2.20

2.55

Yes (over 1 m2)

1.95

0.34

3.61

0.73

1.70

Environmental tobacco smoke

Environmental tobacco smoke in the dwelling

16.13

20.99

7.31

14.29

13.92

As shown in Table A11, about half of the mothers in participating families had completed some form of higher education (college or university), with the exception of Tajikistan, where the proportion was 29.2 percent. Accordingly, a relatively small proportion of families (4.6 to 13.8 percent) received state benefit at least sometimes.

Table A11 Distribution of socioeconomic status of participating families in the four new SEARCH II countries
 

Belarus

(n=626)

Kazakhstan (n=615)

Tajikistan (n=869)

Ukraine (n=687)

Total (n=2,797)

Maternal education

<8 classes

0.00

0.83

2.48

0.15

0.96

8 classes

0.49

2.67

9.69

2.21

4.15

Vocational school

27.57

24.50

10.93

3.24

15.80

Secondary school

14.36

19.17

47.70

30.38

29.41

College or university

57.59

52.83

29.19

64.01

49.67

State benefits

Yes, regularly

2.61

3.81

1.21

7.81

3.75

Yes, sometimes

3.75

1.33

3.39

6.04

3.68

No

93.65

94.86

95.39

86.16

92.58



Classroom environment

Around a third of classrooms were facing the street (more than half in Tajikistan). There was no plastic flooring in Kazakhstan, while in the other three countries plastic flooring was used in more than half the classrooms. Water-resistant paints were used most frequently in Belarus (37.7 percent). More than half the classrooms had been painted within one year, with extremes of 6.4 percent (Ukraine) and 83 percent (Tajikistan). Overcrowding (floor space of less than 2 m2/child) was least frequent in Belarus (8 percent), while in the other three countries about half the children were in crowded classrooms.


Additional information

Table A12 Classroom characteristics in the four new SEARCH II countries (%)

Variables

Belarus

(n=626)

Kazakhstan (n=615)

Tajikistan (n=869)

Ukraine (n=687)

Total (n=2,797)

Classroom orientation

Facing the street

19.01

17.40

52.36

38.72

33.86

Facing the schoolyard or green space

3.51

52.52

33.37

61.28

37.75

Other

77.48

30.08

14.27

0.00

28.39

Classroom flooring

Wood

34.03

12.85

54.66

46.43

38.83

Plastic

65.97

0.00

52.01

53.57

44.08

Stone

0.00

0.00

2.65

0.00

0.82

Classroom wall covering

Whitewash

0.00

13.33

71.23

0.00

25.06

Water-soluble paint

49.68

66.83

37.17

10.63

39.97

Water-resistant paint

37.70

3.41

21.17

12.52

18.84

Wallpaper

60.38

18.86

5.52

83.41

39.86

Wood panelling

0.00

0.98

2.99

9.17

3.40

Classroom last painted

Within 1 year

38.34

79.19

82.97

6.40

53.34

1 to 2 years ago

24.12

14.47

14.04

25.04

19.09

3 or more years ago

37.54

6.34

2.99

14.04

27.57

Occupation density

<2 m2 /person

8.05

55.93

49.48

44.54

40.61



In most countries, classrooms were cleaned after school hours, and sometimes between classes. With the exception of Ukraine, more than half the classrooms were cleaned twice a day (see link below). Mops were used most frequently for cleaning in every country. Bleach was used only in Kazakhstan with a high frequency (89.9 percent). The frequency of windows being opened during cleaning varied between 11.3 percent in Belarus and 100 percent in Ukraine. In most cases, classroom furniture was made of medium-density fibreboard (MDF). With some exceptions in Kazakhstan, most classrooms were equipped with a blackboard.


Additional information

Table A13 Classroom environment in the four new SEARCH II countries (%)

Variables

Belarus

(n=626)

Kazakhstan (n=615)

Tajikistan (n=869)

Ukraine (n=687)

Total (n=2,797)

Classroom cleaned during the day

Before school time

0.00

0.00

15.07

0.00

4.68

After school time

100.00

91.97

94.02

92.87

94.57

Between classes

70.13

68.62

14.50

13.83

38.68

Frequency of cleaning

Twice a day

70.13

60.33

45.91

20.82

48.34

Once a day

29.87

39.67

54.09

79.18

51.66

Mode of cleaning

Vacuum cleaner

11.34

0.00

0.00

2.62

3.18

Broom

48.40

0.00

13.81

100.00

39.69

Mop

93.61

83.41

100.00

97.38

94.28

Mop with bleach

6.07

89.92

7.36

10.48

25.99

Frequency of opening windows during the heating season

Every break between classes

46.49

34.47

27.73

18.34

31.10

2 to 3 times a day

36.42

20.98

35.67

68.12

40.58

Once a day

17.09

23.09

20.37

13.54

18.56

Once a week

0.00

13.82

14.04

0.00

7.40

Windows opened during cleaning

11.34

34.47

82.28

100.00

60.24

Furnishing material

MDF panel

100.00

97.40

65.71

87.19

85.63

Veneer

100.00

4.88

10.36

15.43

30.46

Laminated with no covering

0.00

0.00

15.19

8.88

6.90

Wood with no covering

0.00

12.20

6.56

9.90

7.15

Type of board

Blackboard

100.00

96.91

100.00

100.00

99.32

Whiteboard

0.00

3.09

0.00

0.00

0.68



School environment

Most of the schools were originally built as schools, and most were constructed from brick and concrete. In Kazakhstan and Tajikistan, 7 to 8 percent of children attended schools made from adobe. Renovations carried out over the past five years concerned classrooms (65.7 percent), windows (44 percent) and lighting (46.2 percent). Heavy traffic in the vicinity of the school was reported in almost 60 percent of schools in Kazakhstan and 0 percent in Belarus. Almost all schools had a schoolyard, and most children made use of it during the breaks or after school hours. The presence of green spaces around the school was not so uniform: only 28.7 percent of schools in Ukraine compared to 100 percent in Tajikistan. In some schools, teachers were permitted to smoke in designated places, although in most schools the teachers were not allowed to smoke. There was not much variability in terms of the type of heating used in the investigated schools. In Kazakhstan, 64 percent of the children attended schools with artificial ventilation, while in the other three countries the figure was around 10 percent. In Tajikistan, 36 percent of the children attended schools in the vicinity of an industrial facility or waste disposal site, while these environmental risk factors were only minimal in the other three countries.


Additional information

Table A14 School environment in the four new SEARCH II countries (%)

Variables

Belarus

(n=626)

Kazakhstan (n=615)

Tajikistan (n=869)

Ukraine (n=687)

Total (n=2,797)

School building originally built as a school

100.00

88.29

79.29

100.00

90.99

School reconstructions undertaken

21.25

40.33

Not known

Not known

30.70

School features renovated in the last five years

Electric cables

21.25

10.73

26.58

9.61

17.73

Lighting

50.48

32.52

26.58

79.48

46.23

Water system

43.45

33.82

16.34

48.18

34.07

Classrooms

66.29

49.92

49.48

100.00

65.75

Windows

21.25

78.86

38.78

40.17

44.01

Main building material

Brick

82.27

55.61

91.48

82.10

79.23

Concrete

58.15

63.25

30.96

100.00

61.10

Wood

0.00

0.00

17.61

38.28

14.87

Adobe

0.00

7.48

8.40

0.00

4.25

Traffic density within 100 m

Light

60.86

32.78

29.23

41.92

40.40

Medium

17.41

7.55

31.76

37.55

25.10

Heavy

0.00

59.67

26.12

10.92

22.97

Very heavy

21.73

0.00

12.89

9.61

11.52

Schoolyard

School has a yard

100.00

100.00

100.00

89.08

97.32

Activities in the schoolyard

Sports

100.00

89.27

100.00

90.39

95.28

Playing

100.00

67.32

87.11

20.38

69.25

Resting

87.54

66.67

76.29

18.92

62.60

For other purposes

12.46

0.00

0.00

0.00

2.79

When children use the schoolyard

In the breaks

62.94

88.13

100.00

69.72

81.66

In the long morning break

20.77

0.00

80.78

0.00

29.75

After school time

100.00

100.00

89.18

90.39

94.28

Very seldom

0.00

0.00

0.00

9.61

2.36

Green space

Green space around the school

60.22

92.52

100.00

28.68

71.93

Teachers smoke in the school building

Only in designated places

0.00

0.00

8.40

11.64

5.47

Not at all

100.00

100.00

91.60

88.36

94.53

Heating system

Central heating

100.00

89.92

100.00

100.00

97.78

Electric heating

0.00

10.08

87.80

9.61

31.86

Gas heating

100.00

100.00

100.00

100.00

100.00

Artificial ventilation

In the whole building

9.74

63.58

12.20

9.61

22.31

In some parts of the building

90.26

21.95

57.88

80.79

62.85

No

0.00

14.47

29.92

9.61

14.84

School located within 500 m of:

Industry

11.98

7.48

23.71

0.00

11.69

Power plant

0.00

7.80

0.00

0.00

1.72

Waste disposal site

0.00

0.00

12.89

0.00

4.00



Final remarks

It should be stressed that the investigated schools should not be regarded as representative of the countries and that the results therefore by no means reflect the situation in the individual countries. The results merely illustrate the variability of our sample survey, which helps us to study the impact of various risk factors found in the school environment on children’s health.

 
Ministero Dell'ambiente Italian Trust Fund