Access
of drinking
Water in Schools
Aims of this
project are in line with government guidelines for the improvement
of the health of the nation e.g.The Aims are:
1.
Raise awareness of the benefits of water to health.
2. To encourage
children to drink less sweet drinks and more water and also to
educate children to change their behaviour towards making informed
healthier choices of drinks which would benefit their health,
well-being and their achievements at school.
3. To improve
water availability in schools in Manchester.
Rational
As a school nurse
and a GP practise nurse my colleagues and I experience on a
daily basis the effects of dehydration on children e.g.
constipation, bedwetting, urinary frequency, lethargy, poor
concentration, short attention span and
irritability resulting in bad behaviour.
With funding to
be used to develop a pilot project of water availability in a
number of schools across Manchester to monitor the method
of water availability that will
be more user-friendly and acceptable to the children and to
the schools, before promoting one method over another e.g.
a). Children
bringing into school every day plastic bottles of water. This
method is cost free and involves parental participation.
b). Provision of
drinking taps and cups. This method involves cost to school to
provide taps and cups and also the question of litter with plastic
cups. Parental involvement to discourage children from drinking
sweet drinks and bringing sweet drinks to school and to
encourage the drinking
of water at school.
c). Water cooler
system. Involves cost to school and also litter. Involves parents
as in b.
d). Water
fountains . Involves cost to school, litter, a question of how
much the children actually manage to drink from the fountains and
parental involvement as above.
A working party
representing education and health e.g. parents, dental health
promotion, school nurses, school doctors, school governor,
lecturer of post graduate student teachers, etc., is set up to
steer the project.
Research local evidence of the need for water in schools
1. A survey of
198/362 schools in Manchester showed that 62% of schools have no
accessible drinking water for children. For example the high sugar
content taken frequently in sweet drinks (which usually contains
other additives and preservatives) results in sugar build up in
the blood, essential fluids are drawn out of body cells to dilute
the sugar in the blood, this process increases urine production
and much needed fluid is excreted as urine. (Dr V. Meiarasu St
Mary's Hospital Manchester -now at Lister Hospital London-).
Sugar content
in commonly used drinks
Coke per can
= 7 tea spoon of sugar (£18 per school term)
Ribena per carton
= 6 tea spoon of sugar. Ribena Low sugar contain less.
Sunny Delight
= 10 teaspoon of sugar per 500 ml bottle.
Milk
= 0 teaspoon of sugar
(£3.00 per school term)
Water
= 0 teaspoon of sugar (free from your tap)
(Artificial
sweeteners cannot be beneficial to health)
Tooth decay is
strongly associated with sugary drinks
Dental decay and
gum disease in children, in the north west is twice the national
average. This high level of dental disease results in a great deal
of pain and suffering for children. Children with screw top
bottles and toddlers with feeding bottles can sip sugary drinks
all day. ( Chris Topping, Dental Health Promotion Manchester)
Parents/Carers
Information
Persuade children
to drink more water
Water may appeal
more to children if served with ice and in a fancy glass (with a
straw?)
Make cold
drinking water available and accessible to children at all times
at home and at school.
Encourage your
child's school to make drinking water accessible to your child
during the school day/send your child to school with cold water in
a plastic bottle.
Survey
Result
A telephone
survey in March 2000 by Radha Sethi showed
that 62 % of Manchester school do not have accessible drinking water for
children. In primary schools some children drink milk at break and
others take in sugary drinks. All children at primary school are
given a sugary drink with their lunch. The situation is worse in
secondary school where children do not get a drink of milk but
have vending machines selling sugary drinks all day. In the north
west and nationally children consume sugary drinks several times
per day and are rarely offered water as a drink.
Radha Sethi,
Practice Nurse, School Nurse, Health Promotion
Specialist
(Healthy School Awards Team Manchester). 0161-882-2314
TUBERCULOSIS
Recently there has been a lot of media attention on the recently
rapid spread of TB in the UK and how it is close to becoming an
epidemic. The reality is that TB has been with us for quite some
time and working with the Asian Community in Blackburn for the last
two years I have seen a steady stream of cases. It is quite a complex
disease, which is often not clearly understood.... so here is a
brief overview of the disease.
WHAT IS IT?
TB is a disease caused by an organism called mycobacterium tuberculosis.
It is spread from one person to another by close contact and usually
infects the lungs by one person coughing into another. Although
very rare it can also affect other parts of the body including the
stomach, kidneys and the skin. Once it enters the body it starts
to multiply and if it grows large enough, it will start to make
that person unwell. Sometimes however the body notices these TB
bugs and tries to fight it. Sometimes it successfully rids the body
of the bug. However sometimes the TB bug sneakily turns itself into
an inactive ball that can lie asleep in the body for years and then
suddenly become active again. This is what makes it so dangerous
because you can never tell it's totally gone.
WHO GETS THE DISEASE?
There is a group of people who are more likely to get
the disease, e.g. those with AIDS, drug abusers who neglect themselves,
the homeless and those with medical conditions where the immune
system does not work. However although these people are more likely,
ANYONE can get the disease and its important to look for the symptoms
in anyone, be they young, old, male, female, weak or strong.
WHAT ARE THE SYMPTOMS?
The main symptoms are:
- Fever
- Persistent Cough
- Weight Loss
- Night Sweats
- Feeling constantly Unwell
- Loss of Appetite
If you have a combination of a few
of the above symptoms it is always worthwhile getting yourself
checked by the Doctor.
WHAT ARE THE TESTS?
-The only clear test for TB is actually finding the cells in your
body.
- If there is likely chest TB then collecting sputum can sometimes
show the cells or grow the cells....but this is not always possible
and so other tests are available.
- The tubercillin skin prick test can give a very good idea if
there is a chance of TB.
- A chest x-ray is excellent for looking for TB of the lung as
it shows a white shadow on the lung.
- Certain blood tests done by your doctor with your symptoms is
a good indicator as well.
HOW DO WE TREAT IT?
TB should be treated by doctors with a specialist interest in
the disease as it is important you get treated quickly and effectively.
The treatment is complicated and some of the bugs can be very
difficult to get rid of. Treatment usually requires taking up
to four different types of tablets which are changed regularly
for up to a period of twelve months. The reason the treatment
is so long is because the bugs can grow back even stronger and
even more difficult to kill if treatment is stopped too soon.
The worry is people stop taking their tablets regularly as soon
as they feel better and a bug will form which will start to kill
people like it used to years ago. Once treatment is started other
members of the family are checked and treated If necessary by
a specialist team. Anyone not affected may then be recommended
to have the TB vaccination which reduces the chance of TB in the
future.
WHAT OF THE FUTURE
Treatment for TB and new more accurate and quicker
tests are always being looked for and hopefully if we are more
aware of the disease we will be quick to catch it and treat it
to reduce the amount in the UK. From your point of view, always
remember the possibility of TB, be aware of it on your travels,
and if in doubt go and see your doctor.
Meningitis
and Meningococcal Septicaemia
There has been plenty of
press recently about the number of outbreaks of meningitis amongst
the Asian communities following the return from Hajj. In fact
we have been unfortunate enough to actually have some deaths as
a result of the disease. I therefore thought this would be a good
time to go through a few basic facts on the disease. Although
most people talk about meningitis, one of the main organisms that
causes meningitis can also affect the blood stream causing septicaemia
that can be as deadly so we will be talking about both.
What are they?
There is a lining of the brain which we all have known as the
meninges. If for any reason this lining becomes swollen or inflamed,
it is known as meningitis. It can be caused by a number of different
things such as bacteria, virus and even injuries to the head.
Septicaemia on the other hand is caused by the bacteria alone
which spread rapidly through the blood stream causing the circulation
system to break down and making the patient become rapidly unwell.
The main organism that is the most serious is a bacteria known
as Nisseria Meningitides and we will be concentrating on this
from now. There are actually thirteen different varieties of the
organism that are known to exist, but in England, the most important
are groups B and C. This does not mean however that the others
do not cause the disease and protection from all varieties can
be very difficult.
What are the signs and symptoms?
There are no symptoms or signs that are specific to meningococcal
disease and therefore it can be very difficult to diagnose. However
these diseases are life threatening and it is therefore very important
to look out for the following symptoms. Remember if you ever have
doubts, contact your doctor or nurse.
The signs and symptoms include:-
- Fever
- Stiff Neck/back pain
- Vomiting
- A very high pitched cry from the baby
- Headache
- Very sleepy baby that is difficult to wake
- Pale or blotchy skin
- Inability to tolerate bright lights
- Drowsiness or confusion
- Bruise like rash that does not disappear when you press on
it.
How is it
spread ?
This disease is spread by tiny droplets of water which hold
the disease being passed from on person to another. Therefore
even coughing or sneezing can be enough to spread the disease.
Close contact or even close proximity to carriers of the disease
makes it more likely to catch the disease. Another important note
is that not everyone who carry the bacteria actually get the disease.
These people may be perfectly well but may unknowingly pass the
disease to others.
Who is at risk?
Anyone can be affected by the disease the most common group to
get the disease are those less than one year old. Following this
come the group aged 1-5 years and then the group aged 15-19years.
Any place where there are very crowded conditions and people may
be a bit weaker than usual, for example when people were dehydrated
during Hajj, there is any increased chance of catching the organism
and becoming unwell with it. Another specific group is those with
specific medical conditions that lower the immune system, such
as having the spleen removed or those with leukaemia.
How is it treated?
Without going into detail, anyone who contracts the disease
needs immediate admission into hospital requiring antibiotics
through the veins along with a number of investigations and further
treatments. It usually requires reasonably long hospital stays
and on occasions may require transfer to specialist units. As
well as the patient, specialist units have been developed that
then try and find out where this disease may have originated from
and arrange for close friends and relatives to be treated with
antibiotics/vaccines.
Can it be prevented?
Newer methods and treatments are always being developed to improve
the care of these patients but unfortunately the current death
rate from meningococcal disease is around one in ten. Therefore
along with this great efforts are being made to develop vaccines
that prevent the disease occurring in the first place. In the
United Kingdom, a vaccine programme for group C meningitis has
been developed which has now been running for the past two years.
This has already shown a large reduction in the number of cases
in the first year alone and hopefully will continue to do so.
However the other common form of meningitis in the UK, group B,
still has no effective vaccine making it very important to be
aware of the disease and the signs and symptoms. For those travelling
to Saudi Arabia, recent TV reports have shown why it is so important
to follow the vaccination policy. There is a different vaccination
for Saudi which covers different groups. However the problem is
that millions of people from all over the world come and mix together
bringing with them different forms of the disease that are impossible
to cover with a vaccine. These vaccines are continuously upgraded
so that newer groups are covered as much as possible. Also remember
that children vaccinated at school are not adequately vaccinated
for Saudi Arabia and will still require a different Saudi Arabia
vaccine.
Conclusions
I accept this article is long and complicated but this disease
is important and as many people travel abroad it is becoming more
common. So all I ask you to take from this is, take the necessary
precautions, be aware of the disease and if in doubt contact a
health professional.
Dr. Zuber Bux
