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Abstract Background: Public schools have considerable potential to reach a significant portion of a given population and can play a central role in improving health across the lifespan. However, little is known about the current health needs of children at schools in rural and limited-resource settings. We sought to assess the perceived health of children and the role of community health workers (CHWs) at public schools in rural Rwanda. Methods: We conducted a convergent mixed methods study among teachers and community members to assess the factors associated with the perceived health of students in rural areas of Musanze, Rwanda. Data collection instruments were adapted from the World Health Organization’s Health Promoting School (HPS) framework and the literature. Semi-structured interviews and focus group discussions were conducted to explore participants’ perceptions of children’s health. We performed a logistic regression analysis to examine the factors associated with perceived health. Thematic analysis was used to analyze the qualitative data. Results: A total of 479 individuals participated in this survey. Of these, 425 (89%) were community members, while 54 (11%) were employed as teachers at Nyabirehe or Rwinzovu public schools. Almost half of respondents 221 (46%) described the overall children’s health as poor. Many factors were associated with perceived children’s health, including having an established leadership team for school-based health promotion (OR = 1.97, 95%CI: 1.01,3,84), and being familiar with school-based health promotion (OR = 4.77, 95%CI: 2.27,10.0). The lack of access to primary care was associated with negative perceptions of children’s health (OR:0.54,95%CI:0.31,0.95). Qualitative results described the CHW as a bridge between communities, schools, and primary healthcare centers. Further, qualitative findings highlighted the structural barriers and needs to be addressed for effective implementation of school-based health promotion. Conclusion: This study’s findings revealed gaps in children’s health in rural areas of Musanze. The strong association between school-based CHWs and children's health reflects the vital role CHWs play in linking communities and primary healthcare facilities. This study provides evidence to inform the development of innovative strategies for effectively implementing school-driven interventions to strengthen health promotion in rural and low-resource settings.
Manzi et al. (Wed,) studied this question.