Abstract
Schools are the only institution regularly reaching the majority of school-age children and adolescents across the globe. Although at least 102 countries have school health services, there is no rigorous, evidence-based guidance on which school health services are effective and should be implemented in schools. To investigate the effectiveness of school health services for improving the health of school-age children and adolescents, a systematic review of systematic reviews (overview) was conducted. Five databases were searched through June 2018. Systematic reviews of intervention studies that evaluated school-based or school-linked health services delivered by a health provider were included. Review quality was assessed using a modified Ballard and Montgomery four-item checklist. 1654 references were screened and 20 systematic reviews containing 270 primary studies were assessed narratively. Interventions with evidence for effectiveness addressed autism, depression, anxiety, obesity, dental caries, visual acuity, asthma, and sleep. No review evaluated the effectiveness of a multi-component school health services intervention addressing multiple health areas. From the limited amount of information available in existing systematic reviews, the strongest evidence supports implementation of anxiety prevention programs, indicated asthma education, and vision screening with provision of free spectacles. Additional systematic reviews are needed that analyze the effectiveness of comprehensive school health services, and specific services for under-researched health areas relevant for this population.
Highlights
The World Health Organization (WHO) launched the Global School Health Initiative in 1995 with the goal to improve child, adolescent and community health through health promotion and programming in schools [1]
While various guidance documents have been published by United Nations (UN) organizations addressing a range of services from oral health to malaria [3,4,5,6,7], there is no internationally accepted guideline regarding school health services
It is difficult to formulate an overarching answer about the effectiveness of school health services for improving the health of schoolage children and adolescents due to the heterogeneity of systematic reviews (SRs) found and the evident gaps in the SR literature
Summary
The World Health Organization (WHO) launched the Global School Health Initiative in 1995 with the goal to improve child, adolescent and community health through health promotion and programming in schools [1]. This systematic review of systematic reviews, referred to as an overview, will inform the upcoming development of a WHO guideline that addresses the school health services component of health-promoting schools and feeds into the FRESH framework. This overview and the upcoming WHO guideline will address school health services delivered by health providers
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