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УДК 613.95:371.7:614.78/.79 https://doi.org/10.32402/dovkil2020.01.056
ВИВЧЕННЯ ФАКТОР1В ВПЛИВУ НА ЗДОРОВ Я С1ЛЬСЬКИХ ТА М1СЬКИХ УЧН1В У ЗАКЛАДАХ ОСВ1ТИ ЗА САНИТАРНО-ППСН1ЧНИМИ ПОКАЗНИКАМИ УМОВ ПРОВЕДЕННЯ ТА ОРГАН1ЗАЦ11 НАВЧАННЯ
Махнюк В.М., Гаркавий С.1., Назаренко В.1., Чорна В.В.
RESEARCH OF THE FACTORS INFLUENCING THE HEALTH OF RURAL AND URBAN SCHOOLCHILDREN STUDYING AT SECONDARY EDUCATIONAL INSTITUTIONS BY SANITARY-HYGIENIC INDICATORS
1MAKHNIUK V.M.,2HARKAVYI S.I., 3NAZARENKOV.I., 4CHORNA V.V.
1State Institution «O.M. Marzieiev Institute for Public Health, National Academy of Medical Sciences of Ukraine», Kyiv 2National O.O. Bohomolets Medical University, Kyiv, Ukraine 3State Institution «Yu.I. Kundiiev Institute for Occupational Medicine, National Academy of Medical Sciences of Ukraine», Kyiv 4National Pyrohov Memorial MedicalUniversity, Vinnytsia, Ukrainе
The state of children's health care at the secondary schools in Ukraine does not meet today's requirements [1]. The analysis of statistical data and the results of scientific research over the last decade indicates a significant increase in the incidence in the students, the frequent transition of acute diseases into
chronic forms [2-4]. The transition of secondary schools to a new content, structure and 12-years period of study is inseparable from the creation of the necessary conditions for students, as well as teachers, the improvement of the health care of the educational institutions. Reformation of education is a requirement of current glob-
ВИВЧЕННЯ ФАКТОР1В ВПЛИВУ НА ЗДОРОВ'Я СЛЬСЬКИХ ТА МЮЬКИХ УЧН1В У ЗАКЛАДАХ ОСВ1ТИ ЗА САНИТАРНО-ППеНЧНИМИ ПОКАЗНИКАМИ УМОВ ПРОВЕДЕННЯ ТА ОРГАН1ЗАЦ11 НАВЧАННЯ 1 Махнюк В.М., 2Гаркавий С. I., 3Назаренко В.1., 4Чорна В.В. 1ДУ «1нститут громадського здоров 'я ¡м. О. М. Марзеева НАМН Украши«», м. Ки)'в 2Нащональний медичний ун1верситет ¡м. О.О. Богомольця, м. Ки)'в 3ДУ «1нститут медицини пращ ¡м. Ю.1. Кундева НАМН Украши», м. Ки)'в 4В1нницький нащональний медичний ун1верситет ¡м. М. I. Пирогова, м. В1нниця Мета дослдження: встановлення залежност показниюв здоров'я учн1в в'щ сан1тарно-ппе-н1чних умов \ орган1заци навчання у м1ських та сльських ЗНЗ.
Методи досл'щження: сан1тарно-ппен1чне обстеження, епщемолопчний метод з засто-суванням сантарно-статистичного, матема-тичного \ соцолотного анал1зу. Результати. Як показали наш} досл1дження, матер1ально-техн1чна база мюьких \ сльських ЗНЗ протягом останн1х 20 роюв суттево не зм1ни-лася \ не вщпов1дае ппен1чним вимогам (з благоустрою - водопостачання, опалення, канал1зац1я; архтектурно-планувальних р1шень - набр прим1-щень, освтлення, вентиляц1я) у 72% випадюв. Особливо це стосуеться сльських ЗНЗ, в яких в'щсутн} спортивн1 зали у 36%, актов1 зали - у 67%, учбов1 комп'ютерн1 кабнети - у 69%. У зв'язку з орган1зац1ею клаав для шестир1чних дтей на баз\ ¡снуючих шкльних прим1щень показник фактично)' наповнюваност зНз пере-вищуе проектну у 26,7% мюьких ЗНЗ \ 4,5% сльських зНз, що призвело до двозм1нного режиму навчання. Нин1 лише п'ята частина учшв перших
кпаыв Украши (майже 22%) мае Heo6x^Hi умови для перебування i навчання, а решта першо-класниюв (майже 78%) навчаеться у ЗНЗ, як таких умов не мають. У зазначених ЗНЗ було детально вивчено i проанапiзовано данi стати-стично'1 звтност та медичноiдокументацн сто-совно 49193 учит.
Кльюсть дтей з функ^ональними порушення-ми стану здоров 'я (II i III групи здоров 'я) зако-номiрно бльша в усх вкових групах обстеже-них учшв, що навчались у ЗНЗ з незадовльни-ми санiтарно-гiгiенiчними умовами i органiза-цею навчально-виховного процесу, порiвняно з аналопчними показниками в )'хшх однолтюв, як навчалися в оптимальних умовах. Доведено залежнсть показниюв здоров'я дтей в 'щ умов та органiзацii навчання у ЗНЗ - питома вага хворих учшв у 2-х, 5-х i 7-х класах ЗНЗ з задовльними умовами була меншою порiвняно з аналопчними класами, де ц1 умови незадо-в'льш (у 2-х класах - 13,3% проти 15,8% (p<0,05), у 5-х класах - 9,5% проти 10,2% (p<0,05), у 7-х класах - 8,9% проти 13,9% (p<0,001). Показники гостро)' захворюваност загалом у ЗНЗ з задовльними умовами в 1,3 рази меншi порiвняно з ЗНЗ з незадовльними умовами (p<0,001). В учшв мюьких та сльських ЗНЗ з незадовльними умовами навчання та у поеднаннi з двозмiнною органiзацiею навчання показники загальноi, первинноi, гостроi, iнфекцiйноi захворюваност та патологiчноi ураженост школярiв вищ1 в 1,2, 1,3, 1,5 та в 1,1 рази порiвняно з ЗНЗ, в яких е задовiльнi умови i органiзацiя навчання (p<0,05). Ключовi слова: MicbKi i сльсьК загально-освтн навчальн заклади, законодавча база, орган '1зац1я i умови навчання, рефор-мування осв'пи, школярi, функцюнальний стан, захворюванiсть.
© МахнюкВ.М., Гаркавий С.1., Назаренко В.1., Чорна В.В. СТАТТЯ, 2020.
№ 1 2020 Environment & Health 56
al trends, because only its implementation can bring about 20% of national income growth in the countries with advanced modern technologies. Nowadays, the practical task of the creation of the conditions necessary to ensure the harmonious development of a young person as a unique one and the highest value for society, the development of his talents, mental and physical abilities, formation of the citizens capable of conscious social choice, enrichment on this basis the intellectual, creative and cultural potential of the people faces the secondary educational institution (SEI) as the main link of public education [1, 5]. Thus, the above data indicate the relevance of the scientific elaborations in the solution of the problem of the protection and preservation of the health of the students of secondary educational institutions during 12 years which is many-sided and acute right now.
The objective of our research was to determine the dependence of the indicators of students' health on the sanitary-hygienic conditions and the organization of training in urban and rural SEI.
Materials and methods of research. The methods of sanitary-hygienic examination, epidemiological method with the application of sanitary-statistical, mathematical and sociological analysis were used in the work. Epidemiological and sanitary-statistical methods were used to analyze the incidence and health of the students. All SEI were examined according to the specially designed deep scheme that included 114 sanitary-hygienic indicators. According to these indicators, all 96 SEI were divided into 4 groups: urban SEI where optimum conditions for learning were created, i.e. satisfactory conditions; urban SEI without optimum conditions, i.e. with unsatisfactory conditions, respectively, rural
ririGHA flITEM TA niflfllTKIB =
SEI with satisfactory conditions and rural SEI with unsatisfactory conditions. The basic aspect of the problem, which was solved in the work, concerned the study of the conditions and organization of the training of the children and their health in rural and urban secondary educational institutions during the reformation of education in Ukraine.
Results and discussion. Education reformation in our country envisages the early start of systematic schooling for children from the age of 6 and the transition to a long 12-years period of secondary education. At the same time, there are controversies in the legislation of the country regarding the age «qualification» of the enrollment of the children into the SEI, i.e. according to the Law of Ukraine «On Education» the education of children begins «from the age of six or seven years», and the Law of Ukraine «On General Secondary Education» defines another norm : «...usually from 6 years».
But according to the scientific studies of the functional readiness of the first-graders, only 55-68% of six-years-old are ready for systematic training, 77-80% of such children are among seven-years-old children [3]. The implementation of such a categorical norm is not also substantiated by the absence of the regulated conditions for children of six years of age at many schools, since the main resource of school buildings was built in the mid-
dle of the last century and is not adapted for the children of six years of age and 12 class parallels. Our studies demonstrate that the material and technical basis of urban and rural SEI has not changed significantly over the last 20 years and does not meet the hygienic requirements (equipping with services and utilities -water supply, heating, sewerage; in architectural-and-plan-ning decisions - set of premises, lighting, ventilation) in 72% of cases. It is especially concerned with the rural SEI, where there are no gymnasiums in 36%; assembly halls in 67%; training computer rooms in 69%. Due to the organization of the grades for the children six years of age on the basis of existing school premises, the index of actual occupancy of the SEI exceeds the design level by 26.7% in urban SEI and by 4.5% in rural SEI, which has resulted in a two-session training regime. The reconstruction, construction, archi-tectural-and-planning decisions in order to create conditions for the children of six years of age, i.e. a set of premises, are not provided by any valid normative-and-legal act and existing domestic programs. Nowadays, only one-fifth of the first-grade students in Ukraine, i.e. about 22%, have necessary conditions for stay and study, and the rest, almost 78% of the first-year students study at SEIwhere there are no such conditions. There are no necessary medical premises (pediatrician, dentist, procedural and psy-
cho-physiological discharge rooms) in more than 80% of examined SEI. There are no school doctors or nurses in 25% urban and over 70% rural SEI.
In mentioned SEI, the data of statistical reporting and med-
ical records of 49,193 students, have been studied and analyzed in details: distribution of the students into physical training groups (main, preparatory, special) in general atschool and by grades; distribution of the students by health groups (I, II, III, IV) in general at school and by grades; indicators of general, primary, acute and infectious incidence; indicators of pathological lesion; the health index and the number of children who are sik often and for a long time during the year (table 1).
The proportion of the schoolchildren (in general at the examined schools) reffered to
Figure 1
Proportion of the students reffered to the III group according to state of health at urban SEI with different
conditions, %
SEI with satisfactory cond. SEE with urisatisfactory cond.
Figure 2
Proportion of the students reffered to the II group according to state of health at rural SEI with different conditions, %
40 30 20 10 0
II grade
V grade
VII grade
SEI with satisfactory cond. SEI with un satisfactory cord.
the preparatory and special physical education groups in urban SEI with unsatisfactory conditions was higher than in urban SEI with satisfactory conditions and made up, respectively, 19.7% and 4.7% vs. 11.0% and 4.0%. It was also proved that the proportion of the students reffered to the III health group in the 2-nd, 5th and 7-th grades at SEI with satisfactory conditions was lower in comparison with similar grades of the SEI with unsatisfactory conditions and made up 13.3% vs 15.8% (p<0.05) in 2-nd grades; 9.5% vs 10.2% (p<0.05) in 5-th grades; 8.9% vs 13.9% at p<0.001 in 7-th grades (figure 1). The indicators of acute incidence as a whole for the SEI with satisfactory conditions are 1.3 times as less than for the SEI with unsatisfactory conditions (p<0.001).
The proportion of the students (in general in the examined SEI) reffered to the preparatory and special physical training groups in rural SEI with unsatisfactory conditions was higher than in rural ones where they were satisfactory and made up 16.1% and 7.4% vs 11.7% and 4.7%. We also established that the proportion of the students classified as II and III health groups was lower in 2-nd, 5-th and 7-th grades of the SEI with satisfactory conditions in comparison with the similar grades of SEI with unsatisfactory conditions and made up 32.9% and 12.5% vs 42.2% and 14.5% in 2-nd grades; 33.4% and 16.2% vs 39.3% and 20.1% (p<0,05) in 5-th grades; 35.2% and 11.9% vs 37.1 % and 19.7% in 7-th grades. In comparison with the similar urban SEI, the proportion of the students was 2 and 1.5 times as high in the health group III in the 5-th and 7-th grades of rural SEI with unsatisfactory conditions
- (figures 2, 3).
As it is demonstrated at the figures 2 and 3, the number of the children with functional disorders in health state (II and III
RESEARCH OF THE FACTORS INFLUENCING THE HEALTH OF RURAL AND URBAN SCHOOLCHILDREN STUDYING AT SECONDARY EDUCATIONAL INSTITUTIONS
BY SANITARY-HYGIENIC INDICATORS 1Makhniuk V.M., 2Harkavyi S.I., 3NazarenkoV.I., 4Chorna V.V.
1 State Institution «O.M. Marzieiev Institute for Public Health, National Academy of Medical Sciences of Ukraine», Kyiv 2National O.O. Bohomolets Medical University, Kyiv, Ukraine
3State Institution «Yu.I. Kundiiev Institute for Occupational Medicine, National Academy of Medical Sciences of Ukraine», Kyiv ^National Pyrohov Memorial Medical University, Vinnytsia, Ukraine
Objective: to determine the dependence of the indicators of students' health on the sanitary-hygienic conditions and the organization of training in urban and rural SEI. Methods: sanitary and hygienic examination; epidemiological method with the application of sanitary-statistical, mathematical and sociological analysis.
Results: Our studies demonstrate that the material and technical basis of urban and rural SEI has not changed significantly over the last 20 years and does not meet the hygienic requirements (equipping with services and utilities - water supply, heating, sewerage; in architectural-and-planning decisions - set of premises, lighting, ventilation) in 72% of cases. It is especially concerned with the rural SEI, where there are no gymnasiums in 36%; assembly halls in 67%; training computer rooms in 69%. Due to the organization of the grades for the children six years of age on the basis of existing school premises, the index of actual occupancy of the SEI exceeds the design level by 26.7% in urban SEI and by 4.5% in rural SEI, which has resulted in a two-session
training regime. Nowadays, only one-fifth of the first-grade students in Ukraine, i.e. about 22%, have necessary conditions for stay and study, and the rest, almost 78% of the first-year students study at SEI where there are no such conditions. In mentioned SEI, the data of statistical reporting and medical records of 49,193 students, have been studied and analyzed in details.
The number of the children with functional disorders in health state (II and III health groups) is naturally higher in all age groups of surveyed students who studied at SEI with unsatisfactory sanitary-hygienic conditions and the organization of educational process in comparison with the similar indicators in their peers who studied under optimum conditions.
Dependence of health indicators of the children on the conditions and organization of training at school has been substantiated. The proportion of sick students in 2-nd, 5-th and 7-th grades with satisfactory conditions was lower in comparison with the similar grades where these conditions were unsatisfactory (13.3% vs. 15.8% (p<0.05) in 2-nd grades; 9.5% vs. 10.2% (5<p) in 5-th grades; 8.9% vs 13.9% (p<0.001) in 7-th grades). In urban and rural students at SEI with unsatisfactory conditions for training and in a combination with a two-session training organization, the general, primary, acute, infectious and pathological lesion rates of the students are 1.2; 1.3; 1.5 and 1.1 times as high, respectively, in comparison with the SEI with satisfactory conditions and organization of training (p<0.05).
Keywords: urban and rural secondary educational institutions, legislative framework, organization and conditions for training, reformation of education, students, functional state; incidence.
health groups) is naturally higher in all age groups of surveyed students who studied at SEI with unsatisfactory sanitary-hygienic conditions and the organization of educational process in comparison with the similar indicators in their peers who studied under optimum conditions.
The data in table 2 show that at two-session training organization of education, the rates of general, primary, acute, infectious incidence and
pathological lesions of the students are 1.2; 1.3; 1.5 and 1.1 times as high at SEI with unsatisfactory conditions in comparison with the SEI where these conditions are satisfactory. It was reliably established that at the two-session organization of the educational process the number of the students reffered to II and III health groups in 2-nd grades was almost twice as low as the number of the students in the similar grades of
the SEI with unsatisfactory conditions (p<0.01 ). A similar situation is observed among the 7-th grade students: under unsatisfactory conditions and in combination with the two-session organization of the training process, the proportion of the students reffered to II and III health groups is 43.2% and 16.9%, while under satisfactory conditions, these percentages are 38.1% and 13.5%, respectively (p<0.01).
It was established that without health care under conditions of the SEI, the rates of primary, acute incidence and the number of the children who were sick often and for a long time during the year were 1.8; 1.5 and 1.4 times as high among the students at SEIwith unsatisfactory conditions in ^m comparison with the similar
indicators among students of
Figure 3
Proportion of the students reffered to the group III according to state of health at rural SEI with different conditions, %
10 5 0
il grade
V grade
VII grade
SEI with satisfactory cond. SEI with unsatisfactory cond.
Table 1
Indicators of children's health at two-session regime
of training
Indicators SEI with satisfactory conditions SEI with unsatisfactory conditions
General incidence, %o,fl„A 723.7 881.1
Primary incidence, %o 375.876 483.7
Acute incidence, % 73.9 110.6*
Infectious incidence, % 33.1 42.2
Pathological lesion, % 25.5 28.5
Note: * - the difference is statistically significant (p<0.05) in comparison with the SEI with satisfactory conditions.
Table 2
Health indicators of the students studied under different conditions at the absence of health care at SEI
Indicators SEI with satisfactory conditions SEI with unsatisfactory conditions
Primary incidence, % 220.9±35.9 403.5±40.5*
Acute incidence, % 57.9±15.4 84.2±11.4
Pathological lesion, % 26.2±39 27.2±3.5*
Number of children that are sick often and for a long period of time, % 6.5±1.8 8.7±0.8
Note: * - the difference is statistically significant (p<0.05) in comparison with the SEI with satisfactory conditions.
the SEI with satisfactory conditions (table 3, figure 4). It was also detected that without medical care, the proportion of the students reffered to III health group and special group in physical training with an unsatisfactory conditions was 2.5 and 2 times as high than at SEI with satisfactory conditions and made up 7.2% and 5.3 and % vs. 2.8% and 3.8% (p<0.01).
The data from the figure 5 and table 4 indicate that at the absence of health care and nutrition at SEI, the rates of general, primary, acute, incidence and number of children who are sick often and for a long time during the year were 1.2; 1; 1.6, 1.6 and 1.7 times as high at SEI with unsatisfactory conditions in comparison with the similar indicators in the students who studied under satisfactory conditions. The rate of pathological lesion in children is also 1.3 times as high. The structure of the distribution of the students by health groups and physical training groups had its own specificity. The proportion of the students classified as health group III and the special group in physical training was 2.6 and 2.1 times as high, respectively, in the SEI with satisfactory conditions and was 7.7% and 5.3% vs. 2.9% and 2.5%. Similar data were also revealed by age structure: the proportion of the students reffered to the health group III who studied at SEI with unsatisfactory conditions was 13.8% in the 2-nd grade, which is 2.5 times as many than the indicator in the students with satisfactory conditions; 25.5% (4.5 times) in the 5-th grade; 16.6% (1.6 times) in the 7-th grade.
Thus, according to the results of our own research, data of the official statistics and mathematical processing, the impact of sanitary-hygienic conditions and organization of training on health indicators in the students at SEI has been proved:
□ iboth in rural and in urban SEI, the proportion of the students as a whole and by age structure who have chronic diseases and who study under unsatisfactory conditions is higher in comparison with urban and rural sEi where conditions for training are satisfactory from the hygienic point of view. The proportion of the students referred to health group III, i.e. sick, was 2 and 1.5 times as high in 5-th and 7-th grades of rural SEI with unsatisfactory conditions in comparison with the similar indicators in the students of urban SEI with unsatisfactory conditions;
□ in SEI, where there were no satisfactory conditions for study and in combination with a two-session working regime, the indicators of general, primary, acute, infectious incidence and pathological lesion of the students were 1.2; 1.3; 1.5 and 1.1 times as high in comparison with similar indicators of the students with satisfactory conditions, the proportion of the students in the 2-nd grades who were reffered to the II and III health groups according to their health state were twice as many in comparison with the similar indicators of the students under satisfactory conditions (at p<0, 01 );
□ at the absence of health care under conditions of SEI, the rates of primary, acute incidence and the number of children who were sick often and for a long time during the year were 1.8; 1.5 and 1.4 times as many at SEI with unsatisfactory conditions in comparison with the similar indicators in the students at SEI with satisfactory conditions. The proportion of the students reffered to III health group and a special group in physical training at SEI with satisfactory conditions was 2.5 and 2 times fewer, respectively, in comparison with the similar indicators of SEI students with unsatisfactory conditions (p<0.01);
□ at SEI, where there are
no satisfactory conditions for _
study and in the combination with the absence of health care and nutrition at SEI, the rates of general, primary,
acute incidence and the number of children, who are sick often and for a long time during the year, were 1.2; 1.6; 1.6 and 1.7 times as high, respectively, in comparison with the similar rates in the students who studied under satisfactory conditions. The pathological lesion rate of the schoolchildren is also 1.3 times as high. The proportion of the students reffered to the health group III by the health state and a special group in physical training was 2.6 and
2.1 times as high at SEI with unsatisfactory conditions than at SEI with satisfactory
Figure 4
The proportion of the students reffered to the special group in physical training and to group III according to the health state at SEI with different conditions and at the absence of medical care at school, %
T
T
-1r-
—t—
«
Special group III health group
■ SEI with satisfactory cond.
SEI with unsatisfactory cond.
Figure 5
Proportion of the students reffered to the health group III at SEI with different conditions at the absence of health care and nutrition, %
25 20 15 10 5 0
II grade
V grade
VII grade
SEI with satisfactory cond. SEI with unsatisfactory cond
ИЗУЧЕНИЕ ФАКТОРОВ ВЛИЯНИЯ НА ЗДОРОВЬЕ СЕЛЬСКИХ И ГОРОДСКИХ УЧАЩИХСЯ В УЧРЕЖДЕНИЯХ ОБРАЗОВАНИЯ ПО САНИТАРНО-ГИГИЕНИЧЕСКИМ ПОКАЗАТЕЛЯМ УСЛОВИЙ ПРОВЕДЕНИЯ И ОРГАНИЗАЦИИ ОБУЧЕНИЯ 1Махнюк В.М., 2Гаркавий С.И., 3Назаренко В.И., 4Чорная В.В. 1ДУ «Институт общественного здоровья им. А.Н. Марзеева НАМН Украины», г. Киев 2Национальний медицинский университет им. А.А. Богомольца, г. Киев, Украина зду «Институт медицины труда им. Ю.И. Кундиева НАМН Украины», г. Киев 4Винницкий национальный медицинский университет им. Н.И. Пирогова, г. Винница, Украина
Цель исследования: установление зависимости показателей здоровья учащихся от санитарно-гигиенических условий и организации обучения в городских и сельских ОУЗ.
Методы исследования: санитарно-гигиеническое обследование, эпидемиологический метод с применением санитарно-ста-тистического, математического и социологического анализов.
Результаты. Как показали наши исследования, материально-техническая база городских и сельских ОУЗ на протяжении последних 20 лет существенно не изменилась и не соответствует гигиеническим требованиям (по благоустройству - водоснабжение, отопление, канализация; по архитектурно-планировочным решениям - набор помещений, освещение, вентиляция) в 72% случаев. В первую очередь, это касается сельских ОУЗ, у которых отсутствуют спортивные залы - 36%, актовые залы - 67%, учебные компьютерные кабинеты - 69%. В связи с организацией классов для шестилетних детей на базе существующих школьных помещений показатель фактической наполняемости ОУЗ превышает проектную в 26,7% городских ОУЗ и в 4,5% сельских ОУЗ, что вынудило перейти на двухсменный режим обучения.
Ныне только пятая часть учащихся первых классов Украины (почти 22%) имеет необходимые условия для пребывания и
обучения, а остальные первоклассники (почти 78%) учатся в заведениях, не имеющих надлежащих условий. В указанных ОУЗ были детально изучены и проанализированы данные статистической отчетности и медицинской документации по 49193 учащихся. Количество детей с функциональными нарушениями состояния здоровья (II и III группы здоровья) закономерно больше во всех возрастных группах обследованных учащихся, которые учились в заведениях с неудовлетворительными санитарно-гигиеническими условиями и организацией учебно-воспитательного процесса по сравнению с аналогичными показателями у их сверстников, имеющих оптимальные условия.
Доказана зависимость показателей здоровья детей от условий и организации обучения в ОУЗ: удельный вес больных учеников во 2-х, 5-х и 7-х классах учебных заведений с удовлетворительными условиями была меньше по сравнению с аналогичными классами, где эти условия неудовлетворительные (во 2-х классах -13,3% против 15,8% (p<0,05), в 5-х классах - 9,5% против 10,2% (p<0,05), в 7-х классах - 8,9% против 13,9% (p<0,001). Показатели острой заболеваемости в целом по ОУЗ с удовлетворительными условиями в 1,3 раза меньше по сравнению с ОУЗ с неудовлетворительными условиями (p<0,001). У учащихся городских и сельских учебных заведений с неудовлетворительными условиями обучения и в сочетании с двухсменной организацией обучения показатели общей, первичной, острой, инфекционной заболеваемости и патологической пораженности школьников выше в 1,2, 1, 3, 1,5 и в 1,1 раза по сравнению с ОУЗ, имеющими удовлетворительные условия и организацию обучения (p<0,05).
Ключевые слова: городские и сельские общеобразовательные учебные заведения, законодательная база, организация и условия обучения, реформирования образования, школьники, функциональное состояние, заболеваемость.
conditions. The proportion of the students reffered to group III by the health state in the 2-nd, 5-th and 7-th grades at SEI with unsatisfactory conditions was 2.5; 4.5 and 1.6 times as high than at
SEI with satisfactory conditions.
Conclusions
1. The transition of secondary school to a new content, structure and 12-years term of education is taking place at the
outdated material and technical base of urban and rural SEI which has not changed significantly over last 20 years and does not meet the hygienic requirements (in equipping of services and utilities - water
supply, heating, sewage; in architectural and planning decisions - set of premises, lighting, ventilation, school furniture) in 72% of cases. It is especially concerned with the rural SEI where there are no gymnasiums (in 36%); assembly halls (in 67%); training computer rooms (in 69%).
2. Due to the organization of the grades for the children of six years of age on the basis of existing school premises, the indicator of actual occupancy of the SEI exceeds the design level in 26.7% of urban SEI and in 4.5% of rural SEI, which has resulted in a two-session training regime.
3. There is no adequate material and technical basis for canteens and food blocks: 30.5% of school canteens operate under adapted conditions; 25% of food blocks are not provided with cold running water and 20% are not provided with appropriate refrigeration and technological equipment. Nutrition of the students is organized in 83.6% of secondary educational institiu-tions and in one-third of them only at the expense of buffet products.
4. There are no necessary medical premises (pediatrician; dentist; procedural and psycho-physiological discharge rooms) in 81% of surveyed SEI, 25% urban and over 70% rural SEI are not provided with the school doctors or nurses. There is no consistency and hereditary in the performance deep medical examinations and corresponding complex
preventive-sanitary measures under conditions of school in 79% of SEI.
5. Dependence of health indicators of the children on the conditions and organization of training at school has been substantiated. The proportion of sick students in 2nd, 5-th and 7-th grades with satisfactory conditions was lower in comparison with the similar grades where these conditions were unsatisfactory (13.3% vs. 15.8% (p<0.05) in 2-nd grades; 9.5% vs. 10.2% (5<p) in 5-th grades; 8.9% vs 13.9% (p<0.001) in 7-th grades). In urban and rural students at SEI with unsatisfactory conditions for training and in a combination with a two-session training organization, the general, primary, acute, infectious and pathological lesion rates of the students are 1.2; 1.3; 1.5 and 1.1 times as high, respectively, in comparison with the SEI with satisfactory conditions and organization of training (p<0.05).
As a result of the study of the hygienic provision of optimum conditions and organization of the training of the children at the modern urban and rural secondary educational institutions, the patterns of the impact of conditions and organization of training on the indicators of functional state and incidence in the students have been revealed. A negative correlation between unsatisfactory conditions in combination with the absence of health care and nutrition at the secondary educational institutions
Table 3
Students' health indicators at the absence of health care and nutrition at SEI
Indicators SEI with satisfactory conditions SEI with unsatisfactory conditions
General incidence, %o 360.2±10.6 439.0±17.0
Primary incidence, % 164.1 ±36.8 269.0±42.0
Acute incidence, % 49.2±12.4 71.6±9.2
Pathological lesion, % 9.1±1 11.7±3.6
Number of children that are sick often and for a long time, % 7.5±2.3 12.6±0.0
and the health indicators of the students has been established, which requires organizational, sanitary-hygienic measures aimed at the optimization of the conditions and organization of training and prevention of «school» diseases.
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Надйшло до редакцп 16.11.2019
