Health status of children

Children’s health status was evaluated via health questionnaires completed by their parents. These questionnaires gathered information on the children’s past and present health status, perinatal conditions, parents’ respiratory health, smoking habits in the family, home environment and families’ socioeconomic status. The children's health questionnaire was one of five questionnaires used in the SEARCH initiative, along with school, classroom, comfort and energy questionnaires.

In addition, spirometry tests were used to monitor children’s lung function. Nearly half the parents of the participating children agreed to the spirometry test. Carrying out so many spirometry tests in different countries was extremely challenging, and many countries lacked skilled technicians at the start of the project. Before the field activities in the schools, local technical experts participated in an environment and health training, held at the REC in Hungary in May 2011, where they were introduced to the spirometry equipment. The majority of the tests were not done "professionally", although we consider that it was still worthwhile performing them. The majority of the acceptable tests, and almost all of the less acceptable tests (from a scientific point of view) were normal, or can be considered as normal, implying that the children’s respiratory health was globally good, mainly because they were young, non-smokers, and had been well cared for by their families.

The questionnaires completed by the parents provided information on respiratory and other symptoms (i.e. indications of health problems but not actual diseases) that could be related to the school (or home) environment. This information included, for example, whether a child usually had a cough in autumn/winter, had had asthmatic symptoms (wheezing) in the last 12 months, had any allergy, and had an allergy confirmed by a doctor.

Table 4 shows that more than a quarter of the participating children often had a cough, although only 5 percent of children had a chronic cough that lasted for more than three months (considered as a symptom of chronic bronchitis in adults). The table also shows a significant heterogeneity in prevalence among the countries.

TABLE 4 Prevalence (%) of children with a chronic cough, by country

Country

Regular
morning cough

Regular
day/night cough

Chronic cough
 >3 months

Regular cough
with phlegm

Any regular/
 chronic cough

Albania
(n=1,019)

18.7

20.8

7.7

41.6

53.6

Belarus
(n=625)

9.1

5.8

1.0

2.2

12.6

Bosnia and
Herzegovina
(n=865)

10.9

10.6

3.2

10.8

24.3

Hungary
(n=704)

8.4

6.5

3.3

3.6

13.4

Italy
(n=915)

13.2

11.8

3.5

8.5

22.8

Kazakhstan
(n=602)

17.3

10.6

1.3

5.5

25.4

Serbia
(n=735)

10.5

9.9

3.1

9.4

21.5

Slovakia
(n=825)

14.7

10.7

2.6

4.9

24.1

Tajikistan
(n=888)

22.1

15.5

1.6

4.4

29.6

Ukraine
(n=682)

16.3

16.6

18.6

16.7

41.1

Total 
(n=7,860)
average

14.4

12.3

4.6

11.8

27.9

Wheezing was reported by the parents of one in five children (Table 5). The prevalence of the most severe symptom — that of being woken up by wheezing — was only 3.9 percent, and was significantly lower in the four EECCA countries than in the other six countries.

TABLE 5 Prevalence (%) of children with asthmatic symptoms in the last 12 months, by country

Country

Wheezing after exercise
<12 months

Dry cough at night
<12 months

Woken up by wheezing
<12 months

Any wheezing
<12 months

Albania
(n=1,019)

6.5

14.2

7.4

22.8

Belarus
(n=625)

9.0

14.9

2.2

21.4

Bosnia and
Herzegovina
(n=865)

8.9

15.3

5.1

23.1

Hungary
(n=704)

8.2

10.9

2.0

16.9

Italy
(n=915)

11.5

13.9

3.6

23.4

Kazakhstan
(n=602)

6.3

5.8

1.5

14.0

Serbia
(n=735)

9.4

13.9

6.0

22.9

Slovakia
(n=825)

8.0

14.9

5.5

23.2

Tajikistan
(n=888)

6.8

9.4

2.8

20.5

Ukraine
(n=682)

8.2

8.2

0.2

16.6

Total
(n=7,860)
average

8.3

12.4

3.9

20.8

In general, a similar difference can be observed in the prevalence of doctor-diagnosed asthma (Table 6), although there is a relatively high proportion (4.06 percent, and 8.6 percent in Tajikistan) of missing answers.

TABLE 6 Prevalence (%) of children with asthma diagnosed by a doctor ever and treated for asthma in the last 12 months, by country

Country

Asthma diagnosed ever

Asthma treatment <12 months

Albania
(n=990)

11.8

5.7

Belarus
(n=622)

4.0

2.2

Bosnia and
Herzegovina
(n=796)

11.0

6.8

Hungary
(n=695)

7.1

3.7

Italy
(n=856)

12.2

7.9

Kazakhstan
(n=582)

5.8

5.2

Serbia
(n=719)

12.8

9.3

Slovakia
(n=797)

7.3

6.4

Tajikistan
(n=812)

10.9

9.7

Ukraine
(n=672)

4.0

3.1

Total
(n=7,541)
average

9.1

6.2

The prevalence of the various types of doctor-diagnosed allergy (Table 7) was also significantly lower in the four EECCA countries than in the other six countries, a finding that is in line with earlier studies carried out in Eastern and Western European countries (e.g. the significant difference found by von Mutius et al. in the 1990s between East and West Germany, which was confirmed in various subsequently published papers).

TABLE 7 Prevalence (%) of children with doctor-diagnosed allergies, by country

Country

House
dust mite

Animal fur,
feathers

Pollen

Mould

Food

Drug

Any

Albania
(n=1,019)

13.2

4.9

5.9

5.1

5.3

5.0

19.4

Belarus
(n=625)

4.0

2.6

5.8

1.6

12.5

7.7

21.8

Bosnia and
Herzegovina
(n=865)

10.1

5.3

10.3

3.7

2.5

4.3

18.0

Hungary
(n=704)

9.5

9.7

12.2

7.2

8.8

10.8

23.70

Italy
(n=915)

8.9

4.4

8.9

3.2

4.9

3.4

17.5

Kazakhstan
(n=602)

1.0

1.2

3.2

0.2

6.2

6.2

15.5

Serbia
(n=735)

10.1

5.6

11.8

4.1

2.6

4.5

17.4

Slovakia
(n=825)

9.7

6.8

14.9

5.1

5.9

4.6

28.9

Tajikistan
(n=888)

2.6

2.3

2.1

1.8

4.3

3.0

6.60

Ukraine
(n=682)

3.2

3.1

4.7

1.5

7.5

10.3

15.4

Total
(n=7,860)
average

7.6

4.6

8.0

3.5

5.8

5.7

18.3

Other questions related to the children’s health concerned allergic symptoms other than those of the respiratory tract (skin rashes, eczema, allergic oedema, conjunctivitis) and some respiratory tract–related symptoms (runny or blocked nose, hay fever, earache, sinusitis and complications of these) experienced for at least two weeks in the last 12 months (Table 8). There was also a significant heterogeneity in the prevalence of these physical symptoms, although the difference between the SEARCH I and SEARCH II countries mentioned above was evident only in the case of some symptoms (e.g. allergic oedema, conjunctivitis or hay fever).

TABLE 8 Prevalence (%) of children with physical symptoms, by country

Country

Skin rash,
eczema

Allergic
oedema

Conjunc-
tivitis

Blocked/
runny nose

Hay fever

Earache

Sinusitis

Complications
(earache/
sinusitis)

Albania
(n=1,019)

6.6

6.0

10.5

45.9

7.8

22.6

3.4

24.5

Belarus
(n=625)

14.7

1.8

5.6

47.2

3.8

8.5

4.3

11.5

Bosnia and
Herzegovina
(n=865)

10.1

3.7

5.1

48.1

3.9

8.1

3.8

10.6

Hungary
(n=704)

15.6

2.3

8.2

34.8

6.1

6.7

4.0

9.9

Italy
(n=915)

9.7

3.7

6.9

27.8

3.2

10.7

7.0

15.5

Kazakhstan
(n=602)

6.0

1.3

2.7

35.7

2.2

6.6

2.3

8.6

Serbia
(n=735)

12.1

3.5

4.9

49.7

3.1

9.0

4.2

11.7

Slovakia
(n=825)

19.2

2.9

5.1

46.3

3.8

10.6

21.1

27.2

Tajikistan
(n=888)

2.1

1.9

1.5

23.1

0.8

9.8

3.2

11.8

Ukraine
(n=682)

11.4

2.6

3.7

63.1

2.8

5.6

13.3

15.7

Total
(n=7,860)
average

10.5

3.1

5.6

41.7

3.8

10.4

6.7

15.3

Mental health is an important aspect of human health, as influenced by various endogenous and environmental factors. The prevalence of certain psychological symptoms was therefore also evaluated in order to see if such symptoms might also reflect the impact of the school environment on health (Table 9). The high prevalence of symptoms of depression (the presence of a sleep disorder, fatigue or social withdrawal/reserve) deserves specific attention: one in every four children showed signs of such symptoms for at least two weeks during the last 12 months.

TABLE 9 Prevalence (%) of children with psychological symptoms, by country

Country

Sleep
disorder

Fatigue

Attention
deficit
disorder

Irritability

Anxiety

Social
withdrawal
(reserve)

Any of the 3
depression
symptoms*

Albania
(n=1,019)

9.0

21.8

2.1

19.0

6.3

9.1

29.7

Belarus
(n=625)

5.3

25.8

9.4

21.3

7.8

3.5

28.5

Bosnia and
Herzegovina
(n=865)

3.9

12.4

9.3

11.3

8.6

4.9

15.7

Hungary
(n=704)

4.1

13.2

9.8

15.8

6.8

6.4

18.6

Italy
(n=915)

6.7

26.9

14.9

18.1

18.0

7.7

30.7

Kazakhstan
(n=602)

4.8

24.6

15.3

17.4

8.5

2.7

26.1

Serbia
(n=735)

5.7

14.0

10.2

12.4

7.9

5.2

18.6

Slovakia
(n=825)

3.3

16.6

13.0

12.9

6.7

4.9

19.6

Tajikistan
(n=888)

5.9

11.0

8.7

10.8

9.4

4.3

15.7

Ukraine
(n=682)

8.2

32.7

21.7

30.5

23.9

23.5

46.5

Total
(n=7,860)
average

5.8

19.6

11.0

16.6

10.3

7.2

24.7

 
Ministero Dell'ambiente Italian Trust Fund