Is the Health Security of Children Assured in Nigerian Schools? Assessment of Urban Schools' Responses to the Health Needs of Schoolchildren

ABSTRACT Background The World Health Organisation's (WHO) vision for Health Promoting Schools aims to create environments that are healthy and safe for both education and the wellbeing of schoolchildren. However, in Nigeria, the realisation of this vision is debatable, given the country's notably poor child health statistics. We undertook this research to assess the readiness of schools in responding to the health needs of schoolchildren in alignment with the WHO's vision of making schools health‐promoting. Methods A mixed‐method cross‐sectional study was conducted in two selected urban areas in Nigeria. The study compared a well‐off urban area (formal settlement) with an urban slum (informal settlement). Data were collected through interviewer‐administered questionnaires from 408 schoolchildren and 156 teachers across 20 schools. Furthermore, focus group discussions and in‐depth interviews involved caregivers, policymakers, teachers, and students. Qualitative data were analysed using thematic analysis, while quantitative data were examined using descriptive statistics and multilevel logistic regression. Results Consistent with the qualitative data, the quantitative aspect of the study found that 71.6% of schoolchildren and 69.9% of teachers reported a lack of qualified healthcare personnel in their schools. Additionally, 13.5% of schoolchildren and 22.4% of teachers said that ill students were usually referred or taken to health centres. A total of 43.9% of schoolchildren and 52.6% of teachers reported that first aid services were routine in their schools. Multivariate logistic regression revealed that, compared to students in formal settlements, those in informal settlements were five times more likely to be sent home when sick (OR 4.976, 95% CI 2.41–10.24, p < 0.001). The analysis also found that children in public schools were eight times more likely to be sent home when ill than those in private schools (OR 8.112, 95% CI 3.97–16.589, p < 0.001). Conclusion These findings from both qualitative and quantitative methods confirm the low prioritisation of health services in schools and contrast with the WHO's health‐promoting school vision and existing policies on school health and children's health rights in Nigeria. They highlight threats to schoolchildren's health security and call for urgent responses, including the revitalisation of school health frameworks and the enforcement of a combination of school‐based and school‐linked health services.