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 Health is a basic need of life; therefore health education programmed is necessary if people are to enjoy a worthwhile life style.  Since pupil are the immediate beneficiaries of school Health education programmes and need to live a productive life in school and after school years, there is need to evaluate health education outcomes to ascertain whether school health education programme achieved its set objectives.  The study evaluated health education outcomes in primary schools of Borno State.  To achieve this purpose a total of 1400 subjects were randomly selected from urban and rural primary schools of Biu and Monguno zone of Borno State.  A self developed and validated questionnaire was used to collect the required data.  The questionnaire contained 20 statements on health knowledge, 20 on health attitude, and 20 on health practice.   Descriptive statistical technique was used in this study. The major findings of this study showed that:

(1)             Health education programme of primary school pupil of Borno State was positive while their health attitude and practice were not positive.

(2)             Male pupil had better health knowledge than their female counterparts signifying the effects of gender on health knowledge. 

However, their health attitude and practice were not significantly affected by gender.

(3)             Pupil from urban primary schools had better health knowledge than those from rural primary  schools.

It was inferred from the findings of the study that health knowledge improves health attitude and practice in formal health education program.  Adequate health facilities and conducive teaching and learning environment promote health education outcome in primary  schools.  However, the acquired health knowledge according to the study was not applied to develop health attitude and practice of the pupil.  It was therefore necessary to make health education functional and compulsory at all levels of schools.  Emphasis of health education should not therefore be on examination results or grades but rather on improvement and promotion of health and wellbeing of the pupil.  There is the urgent need to improve school health services in order to create an enabling environment for good health practice and appraisal of health habits and skills.  There is also need to improve teaching and learning facilities, most especially in rural areas where such facilities are grossly inadequate.  The socio-cultural inhibitions and restriction generally found among girls that make access to information limited be identified and removed to make teaching and learning gender free.  



Background to study

Health education among children and young persons in particular has been given high priority in many industrialized countries, concentrating on health-related behaviours such as smoking and the consumption of alcohol. This concentration seems to be based on more general impressions that adolescence is important in determining the future health of the individual (Hurrelmann et al., 1995), on the impression that many adult habits are established during the years of growing up (Smith et al., 1992) and on the fact that it is better to try to prevent health-damaging behaviour at an early age than to be forced later to attempt to modify an already established habit (Alexander, 1994).

Schools are regarded as constituting a very important arena for health education among children and young persons. Apparently factual, objective and unquestionable potentials of schools are often put forward, such as the ability to reach young persons on a large scale (Hansen, 1992, 1993; Rudd and Chapman Walsh, 1993).

However, critical voices have also been raised against imposing too many duties on schools in respect of preventive and health education work (Hurrelmann et al., 1995). Criticism and questioning includes the classic problem concerning the relationship between schools' more traditional duties of providing knowledge and education on the one hand, and their responsibility for health and social training on the other. However, one main message from a review of 25 American reports is that education and health are mutually related (Lavin et al., 1992).

Nowadays, the area of health education in schools comprises a multiplicity of specific methods, models and directions. Attempts have been made to distinguish between different models (see, for example, Rundall and Bruvold, 1988). However, it is not easy to provide a picture of the combined efforts that have been made within the field of health education among children and young personsÐnot, in any case, if such an overall assessment is to be based on documented empirical material. This is because only a small part of all the work and projects that have been carried out in this area has been systematically evaluated (WHO, 1992; Durlak, 1995). While noting this, it is important to point out that research into prevention programmes in schools has expanded substantially since the 1960s (Durlak, 1995).

1.2    Statement of the Problem

Health education programmes is diverse in scope.  It encompasses all those activities and practices aimed at achieving a physical and social environment conducive to good health, prevention of diseases and minimize negative behaviours through appropriate practices; and also to make pupil active participants in their care as well as in their operation of the actions of the systems through evaluation.  The accomplishment of the set objectives of Health education programmes in primary schools will determine to a large extent desirable health knowledge, attitudes and practices of the pupil.  However, the planned school Health education programmes do not seem to produce the perceived desirable health education outcomes (Ajisafe, 1980).  The general wellbeing and lifestyle of pupil, particularly in Borno State, do not seem to reflect positive health outcome (Sanusi and Igbanugo, 2001).  Observable health behaviours seem to be generally poor.  It is these and similar reasons that prompted the investigator to evaluate health education outcomes in primary schools in Borno State.

 The specific focus of this study was on health knowledge, health attitude and health practices of pupil in the primary schools of Borno State.  This became necessary because of the fact that little has been reported on health education outcomes, particularly in primary schools in Nigeria in general and specifically in Borno State.  This research work attempts to answer the following research questions.

1.3     Research Questions

(i)                Are primary school pupil in Borno State knowledgeable about health matters? 

(ii)             Does health education programme of primary school pupil in Borno State influence their attitude towards health?

(iii)           Does their attitude towards health influence their health practices?

(iv)           Does health knowledge among primary school pupil in Borno

State influence their health practices?

1.4     Basic Assumptions

On the basis of research evidence and professional opinion, the following assumptions were made for the purpose of this study:

(i)                Ideal school education programme promotes and maintains desirable health knowledge, health attitude, and health practices of pupil.

(ii)             Desirable health benefits would only be realized when the school health education objectives are clearly defined and fully accomplished.

(iii)           When health education outcomes are fully, objectively and

systematically evaluated, it will be possible to ascertain the level of achievement in health promotion and lifestyle of pupil in primary  schools.

(iv)           Health education outcomes, which include health knowledge, attitude and practice, are objectively measurable.

1.5    Purpose of the Study

The specific purposes of this study are:

(i)                To assess pupil’ level of factual health knowledge.

(ii)             To assess pupil’ level of desirable health attitude.

(iii)           To assess pupil’ level of desirable health practice.

(iv)           To find out relationship between health knowledge, attitude and practices.

1.6     Question 1

                     Health knowledge, attitude and practices of primary school

pupil of Borno State are not positive.

1.7     Hypothesis 1

(i)                Health education programme, attitude and practices of primary school

pupil of Borno State are not related to each other.

(ii)             Health education programme, attitude and practices of primary school pupil of Borno State are not affected by their class level, gender and geographical location.

1.8 Significance of the Study

(i)                Most primary schools of Borno State offer comprehensive health education programme with well-defined objectives.  It is not clear whether the primary school pupil of Borno State really benefit

from this programme.  In other words, it is not well established whether the objectives of the programme, which include knowledge, attitude and practice, are achieved.  As this study was concerned with the evaluation of the outcomes of health education of primary schools in Borno State, it will show whether the pupil have expected health education programme, attitude and practices.

(ii)             The secondary outcomes of the primary school health education programme have been shown to be health education programme, attitude and practices.  It is not clear whether each of these outcomes has any influence on the other outcomes.  The results of the study will show whether these outcomes are related to each other.

(iii)           A number of demographic variables seem to affect the extent of benefits that the pupil of primary schools can derive from their health education programmes.  It is not well understood whether such beliefs that the pupil derive from health education programme depend on their grade, gender and geographical location they come from. The results of this study will show whether the magnitude of benefits that the pupil derive varies with their demographic variables.

(iv)           The study may bring to light issues concerning health education programme of primary schools as they affect knowledge, attitude and practices of the pupil.  These issues may be investigated in future.

1.9    Delimitations of the Study

The concern of this study was the evaluation of health education outcomes in primary schools of Borno State.  Therefore this study was delimited to the following: 

(i)                The health education outcomes included health education programme, attitude and practices.

(ii)             Two third of the primary schools of the two education zones of Borno State were used for the sample.  This is exactly 17 out of 26 primary schools in Biu and Monguno education zones of Borno State.

(iii)           This study was delimited to primary schools because of the assumption that pupil are exposed to health education at the junior level.  By the time they enter primary school, they must

have benefited from health education programme they underwent at the junior primary school level.  It is, therefore, appropriate to evaluate health education outcomes at primary school level.

1.10 Limitations of the Study

This study had the following limitations, which would be considered while interpreting the results:

1.                 The responses of the statement in the questionnaire could not be verified, but care was taken to ensure that the respondents understood every statement in its purported sense.

2.                 It was not possible to include all health education outcomes in the study especially health skills because of time constraints.

3.                 Borno State has co-educational schools, purely girls schools and purely boys schools. In comparing responses of boys and girls, it was not possible to separate girls of girls schools from girls of coeducational schools.

1.11 perational Definition of Terms

                   Technical terms used in this study are defined below in their

operational sense:

(i)                Health: State of wellness of pupil.

(ii)             School Health Education: Health education programmes carried out in a school setting for promoting and maintaining health of pupil.

(iii)           Health education programme:        The realization of           health          information,

particularly those passed in schools.

(iv)           Health Practices: These are practices that constitute healthful living. (v) Health Attitude: Feelings of pupil about good health.

(vi)           Health Education Outcomes:  In this research work they refer to health education programme, attitude, and practices of primary school pupil.

(vii)        Evaluation:  Determining the level to which health education outcomes are accomplished in primary  schools.

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