الفهرس 
Introductionيوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Respiratory infection (RI) is a significant global public health problem. It causes
considerable morbidity and mortality among all age groups especially in developing
countries. The fight against infectious respiratory diseases remains ongoing in Egypt and
around the world.
The use of precautionary measures is essential not only to a decrease in reported
SARS-CoV-2 cases but it contributed also to the reduction in the respiratory infectionrelated
hospital utilization particularly among the children and students attending
educational institutions. Moreover, it helped to reduce the prevalence of respiratory
illnesses including influenza and streptococcus pneumonia
Thus, the aim of the study was to assess respiratory infection prevention and
control practices adopted in governmental preparatory schools in Alexandria.
A descriptive design was adopted to carry out this study. It was conducted in
sixteen governmental preparatory schools representing the eight educational zones in
Alexandria governorate. from each zone two preparatory governmental schools ”one for
Boys and one for Girls” Multistage stratified sampling technique was used to select study
sample.
The sample size of the study comprised 496 persons (384 students and 112 school
personnel) was selected randomly. School personnel consist of 16 school administrators,
48 teachers, 16 school health nurses and 32 school workers. Three tools were utilized to
conduct the present study.
Tool I: Students structured interview schedule. It included the following parts :
Part I: Socio-demographic characteristics of the students and their families, part II:
Students’ health and educational profile, Part III: Students’ awareness about respiratory
infection prevention and control practices, part IV: Students’ reported practices about
respiratory infection prevention and control.
Tool II: School Personnel Structured Interview Schedule. It included the
following parts :
Part I: Socio-demographic data about school personnel, part II: Practices of school
personnel related to prevention and control of respiratory infection.
Tool III: School physical environment observation checklist. It included the
following parts :
Part I: General characteristics of the studied schools and part II: School physical
environment observation data .
Tools were tested for validity and reliability .
Approvals were obtained for conducting the study at the selected settings. A pilot
study was carried out on 40 students and 12 school personnel (two administrators,
two school nurse, five form teachers and three workers) not from the same schools
where the study had been carried out. Those students and school personnel were
excluded from the total study subjects.
Data were collected by the researcher during the school academic year (2020-
2021). The collected data was coded, entered, and analyzed using computer with
Statistical Package for Social Sciences version 25 .
The main findings obtained from the study were as follows :
Part I: Students’ and their families’ data
A. Students’ and their families’ socio-demographic data :
Students’ age ranged from twelve to sixteen years, with a mean of 13.76 ±0.72
years .
Half the sample (50.0%) was males and the other one were females.
Less than half (47.4%) of the students were rural residents.
Secondary or technical education had the highest percentage for both father
and mother (50.3% and 42.4% respectively), while more than one quarter
(22.6%) of fathers, compared to 1.8% of mothers were either illiterate or could
just read and write.
More than half (51.8%) of the families had a crowding index of two
persons/room.
B. Students’ health profile .
More than three quarters (77.6%) of the students suffering from health
problems such as anemia and bronchial asthma (39.3% and 38.6%
respectively).
Nearly equal percentages (31.0% and 29.4 %) of students who always or
sometimes respectively suffered from respiratory infections
Less than one third (29.9%) of them had exposed to Covid19. More than half
(51.3%) of those exposed to covid19 followed home isolation while the rest
(48.7%) didn’t follow.
C. Students’ scholastic profile.
More than half (52.1%) of students had an excellent level and one third
(34.6%) of them had a very good level compared to a minority (6.5% and
3.4%) of them had either good or poor level of achievement respectively.
More than two fifths (42.4%) of the students were absent from school three or
more days /week, more than one third (39.8%) were absent two days/week
while 17.7% were absent once/week. The highest percentage (96.1%) for their
absenteeism causes was fear of cross infection.
D. Students’ awareness regarding respiratory infection prevention and control
practices.
All the students (100.0%) stressed maintaining personal hygiene as hand
washing was the most preventive measures of respiratory infections. More than
two thirds (68.0%) of them reported that maintain social distance, use personal
protective equipment such as mask also intake of proper nutrition are preventive
measures of respiratory infection. While more than half (54.2%) of them added
administration of vaccination.
The majority (87.0%) of the students mentioned the respiratory hygiene
practices were done through covering mouth/nose on cough with handkerchief ,
more than two thirds (64.3% and 64.1%) of them stated that discard
contaminated tissue paper in a closed container and cover mouth/nose on cough
with elbow respectively. Moreover, less than two thirds (59.4%) of them stated wearing face mask, and only 13.3% of them added never touch eye/nose with a
contaminated hand.
Slightly less than half (49.2%) of the students didn’t know the importance of
receiving vaccines in respiratory infections. More than two fifths (37.0%) of
them stated not important compared to only 19.5% of them knew that, it could
be strengthen the body immunity.
Less than two thirds (60.2%) of the students stated that the measures to enhance
immunity through nutrition are to eat variety of food elements in each meal,
more than half (56.5%) of them stressed taking breakfast compared to 16.7%
and 13.3% to have at least three meals per day and increase number of meals
per day respectively. A minority (5.5%) of them didn’t know.
More than half (69.8%) of the students had a fair level of awareness while the
rest (30.2%) of them had a poor one.
E. Students’ practices regarding respiratory infection prevention and control
practices.
More than one third (36.2%) of the students stated washing their hands once at
school while only 12.5% of them stated washing it twice. More than half
(51.3%) of them didn’t wash.
More than half (50.8%) of the students stated not carrying hand sanitizer in their
school bags while the rest (49.6%) of them carrying it. Less than one quarter
(23.4%) of those carrying stated using it usually, while 8.9% of them stated
using it always. Only 16.9% of them didn’t use it
The majority (86.1%) of the students mentioned not sharing personal equipment
with others while 39.6% of them sharing it.
More than half (56.3%) of the students claimed covering nose/mouth with
elbow or tissue paper, more than two fifths (43.5%) stated discarding
contaminated tissue paper in sanitary way, while 20.3% and 16.4% of them
wearing face mask and maintain social distancing respectively. A minority
(8.9%) of them mentioned avoid touching eye/nose. More than two fifths
(43.8%) of them stated coughing /sneezing in front of others.
More than half (52.1%) of the students acknowledged not wearing masks while
the rest (47.9%) of them stressed wearing it
Less than half (46.9% and 45.6%) of the students revealed maintain the social
distancing through; limiting use of public places/ transportation or staying
home as possible respectively, less than two fifths (38.3%) of them stated avoid
crowding places. Less than one third (31.0% and 26.6%) of them stated never
shaking hands/ hug/kiss others or keeping distance from others >1.5 meter
respectively also 21.1% of them stated keeping distance in class between desks.
All the students (100.0%) claimed that schools divided them into small groups
or checking their absenteeism. The majority (82.0%) of them stated wearing
face masks .While only 29.7% and 27.9% of them stated availability of
isolation room or checking their body temperature at entrance and exit
respectively as infection prevention control measures done at school.
More than two fifths (42.4%) of the students stated no health education given
about infection prevention and control. Less than one third (30.2%) of them
stated that they had applied the received health education messages given at school while more than a quarter (27.3%) of them stated that they didn’t apply.
The majority (86.5%) of the student’s practices level had a fair level while those who had a poor level were 13.5% of them.
Part II: School personnel data
A. Socio-demographic characteristics
The age of the school personnel ranged between thirty to fifty nine years
with a mean of 50.75 ±7.592 years .
Less than half (42.0%) the school personnel had a work experience less than
thirty years, while one fifth (20.5%) of them had less than thirty five years.
More than one quarter (27.7%) of them had less than twenty years.
More than half (51.8%) of them didn’t have any previous training about
communicable disease infection prevention and control, while the rest
(48.2%) of them had. Among those who nominated attending such courses
87.0% of them had only received one course while 13.0% of them received
two or more courses. More than two thirds (68.5%) of them had attended
those courses since more than 6 months.
B. School personnel’s awareness level regarding respiratory infections
The vast majority of workers (93.8%), more than three quarters of teachers
(79.2%), more than two fifths of nurses (43.8%) and less than one third of
administrators (31.3%) had a poor awareness level. Less than two thirds of
administrators (62.5%), less than one third of nurses (31.3%) while only
20.8% and 6.3% of teachers and workers respectively had a fair awareness
level in comparison to only 25.0 % and 6.32% of nurses and administrators
respectively who had a good awareness level of infection prevention and
control practices.
C. School personnel’s practices of prevention and control of respiratory
infection
1. Administrators’ practices of prevention and control of respiratory infection
The majority (93.8%) of the administrators mentioned sharing in posters design
about preventive measures.
All the administrators (100.0%) stated that they ensure presence of hand washing
facilities and check a social distance measures (spaces between desks).
All the administrators stated avoiding overcrowding (divide students into small
groups, more school breaks), check body temperature through thermal scanner,
follow absenteeism and notify local health authority.
All the administrators (100.0%) claimed supervising regular cleaning of classes,
playground and school personnel rooms, maintaining good ventilation of school
facilities and ensuring presence of safe water supply.
All the administrators (100.0%) stressed notifying local health authority in case of
respiratory infection and ensuring immediate isolation of suspected / confirmed
cases.
More than three quarters of the administrators (81.3 % and 75.0%) stated
maintaining home isolation and seeking medical consultation respectively in case
of presence of suspected/confirmed Covid19 cases.
All the administrators (100.0%) stated ensuring early detection of cases and
applying school closure plan according to ministry of health and education.
More than two thirds (68.8%) of them had a good level while less than one third
(31.3%) of them had a fair level of practice.
2. Teachers’ practices of prevention and control of respiratory infection
Less than one quarter (16.7%) of the teachers mentioned that they participate in
monthly health awareness session with school health nurse. Around two fifths
(39.5%) of them reported that they didn’t participate in.
All the (100.0%) stated explaining the techniques of hand washing and more than
three quarters (79.2%) of them acknowledged encouraging students to wash hands
regularly.
The majority (87.5% and 79.2%) of teachers mentioned that they supervise students
to cover mouth/nose on cough with elbow and use face masks respectively.
The majority of teachers (89.6% and 85.4%) revealed supervising students to keep
distance at least 1 meter between desks at classroom and at the morning assembly
respectively.
More than two thirds (77.1% and 71.6%) of the teachers mentioned supervising and
instructing students not sharing school supplies or water bottles respectively.
The majority (85.4%) of the teachers mentioned that they supervise classes proper
ventilation and more than two thirds (68.8%) of them stated that they supervise
school cleanliness. Very few (2.1%) of them stated that they daily supervise
cleaning of toilets and usage of cleanliness supplies and disinfectants.
All the teachers (100.0%) stressed notifying parents of cases management (e.g.,
isolation) and the majority (93.8%) of stressed immediate referral of suspected
cases to school health clinic.
All the teachers (100.0%) stressed that they refer students with respiratory infection
to school health clinic, the majority (89.6% and 79.2%) of them mentioned that
they follow, report to school administrator with students’ daily absenteeism and
notify school health nurse/ physician and parents about student’s illness
respectively.
Two thirds (66.7%) of the teacher had a fair level and less than one third (31.3%) of
them had a poor level while 2.1% of them had a good level of practice.
3. Nurses’ practices of prevention and control of respiratory infection
More than two fifths (43.8%) of the nurses declared giving health education at the
school weekly and 12.6% of them declared giving daily. While 43.8% of them didn’t
give any education.
Less than two fifths (37.5%) of the nurses stated that they give session about
communicable diseases and its preventive measures. Only 15.6%, 12.5% and 6.3%
of them stated that they give sessions about personal hygiene, social distance,
vaccination and preventing bullying against infected students respectively.
More than two fifths (43.8%) of the nurses revealed that they demonstrate and re
demonstrate correct technique of hand washing. More than one third (37.5%) of them
stated that they encourage students to wash hands regularly. Only 18.8% of them
stated that they explain techniques of hand washing.
More than two fifths (43.8%) of the nurses acknowledged that they supervise
students to cover mouth/nose on cough with elbow. While 37.5% and 31.3% of them stated that they supervise students to discard contaminated tissue papers in a closed
container, avoid close contact such as hug, kiss and use face masks respectively.
Less than two fifths (37.5%) of the nurses declared that they supervise students to
avoid close contact such as hug, kiss. While 62.5% and 31.3% of them revealed that
it’s not her role except only in case of observation of faulty practice and not regular
respectively.
Less than one third (31.6% and 25.0%) of the nurses declared that they supervise
students not to share personal equipment as water bottle and school supplies
respectively. Less than two thirds (62.5%) of them stated that it’s not her role.
Less than one third (31.3%) of the nurses stated that they make observation of school
physical environment once daily and 12.5% of them mentioned twice weekly. While
37.5% and 25.0% of them stated not regularly or in case of reported problem
respectively.
The majority (87.5% and 81.3%) of the nurses stated that they wear personal
protective equipment and maintain principles of infection control measures at school
respectively.
Three quarters (75.0%) of the nurses stated that they check daily contacts of infected
students for longest incubation period and less than two thirds (62.5%) of them stated
that they give education about preventive measures.
The majority (81.3%) of the nurses mentioned that they document full details of
communicable diseases in special file.
All the nurses (100.0%) stressed notifying parents and maintaining documentation
.While less than two thirds (62.5%) of them added immediate referral and notify
administrator/ local health authority in case of respiratory infection.
The majority (93.8%) of the nurses had a fair level while 6.3% of them had a poor
one.
4. Workers’ practices of prevention and control of respiratory infection
Two fifths (40.6%) of the workers stated that they clean high touched surfaces
before starting and during the school day. However 40.6% of them reported
that cleaning done whenever it becomes unclean.
The majority (75.0%) of the workers mentioned that they didn’t make
documentation of cleaning and disinfection procedures. Only 25.0% of them
stated that they make it.
Less than two thirds (62.5%) of the workers reported that cleaning is to remove
wastes, decrease number of microorganisms and 18.8% of them stated that
disinfection is to kill all microorganisms. However 18.8% of them revealed
that there is no difference or they didn’t know.
More than one third (34.4%) of the workers mentioned that cleaning is for
removing microorganism from daily used surfaces and 15.6% of them stated
that disinfection is used for visible contaminated surfaces. However 65.5% of
them didn’t know the uses of them.
Minority (9.4 % and 6.3%) of the workers stated that they clean then disinfect
and disinfect then cleaning respectively. However 65.5% of them didn’t know
the sequence and 18.8% of them stated that there is no difference in sequence
respectively.
One third (33.3%) of the workers who preparing cleaning and disinfection
materials had trained before by school administrator or senior school worker.
The rest (66.7%) of them didn’t receive any training. previous training about
preparing cleaning and disinfection materials;
Less than one third (28.1% and 21.9%) of workers revealed that the stored
materials supervised by school administrator and senior worker respectively.
While half (50.0%) of them stated that they didn’t supervise it.
More than two fifths (43.8%) of the workers mentioned that all cleaning
materials and supplies are available. Less than one quarter (21.9% and 18.8%)
of them stated that they report to responsible person and buy new supplies on
their expenses respectively in case of unavailability of them.
The majority (81.2%) of workers mentioned that they didn’t use personal
protective equipment during work; while 18.8% of them stated using it.
Less than two fifths (37.5%) of the workers revealed that preventing waiting in
toilets and 18.8% of them stated maintaining distance between students > 1
meter. More than half (56.3%) of them stated that they didn’t do anything.
The total workers’ practices ’level reveals that; equal percentages (50.0%) of
the workers had a poor and a fair level.
D. School personal commitment to the Egyptian Ministry of Health infection
prevention and control guide plan for the educational institutions
Half of the workers (50.0%) had unsatisfactory commitment to infection
prevention and control guide plan compared to less than one third (31.3%) of
teachers and 6.3% of nurses. The majority of nurses (93.8%), two thirds
(66.7%) of teachers, half (50.0%) of the workers and less than one third
(31.3%) of administrators had a partially satisfactory commitment. However
more than two thirds (68.8%) of administrators and only 2.1% of teachers had
a satisfactory commitment.
E. Challenges facing respiratory infection prevention and control practices at
schools:
Less than half (48.2% and 47.3%) of the student’s related challenges were to lack
of awareness or non-compliance with preventive measures respectively followed by
28.6% were infrequent/irregular students’ attendance.
Half (50.2%) of them related to time constraints which consider the most
prominent challenge followed by work load (39.3%), shortage of staff and poor
arrangement respectively (29.4% and 22.3%). However, a minority (10.7%) related
to lack of school personnel experience.
Around three quarters (75.9%) were due to lack of cleaning facilities/supplies
while less than half (45.5%) of them were due to lack of teaching facilities and
supportive services.
F. school health committee and its role in the prevention and control of
respiratory infection:
All the members (100.0%) have a role in making a plan for students’ medical
checkup and prepare health file for each student.
More than half (56.3%) of them maintain regular check of sick students,
prepare daily reports and communicate with local health authority also plan
scheduled assessment of school environment by teachers.
Less than two fifths (31.3%) of them maintain presence of sufficient medical
supplies.
Only 12.5% maintain regular assessment of school environmental sanitation.
Part III: School physical environment characteristics.
More than two thirds (68.8%) of the observed school environment had a poor
supportive level for prevention and control of respiratory infection while one third
(31.3%) of them had a satisfactory one.
Part IV: The results also revealed the following:
A.Relationship between the students’ level of awareness and their socio
demographic characteristics:
There was a significant difference between student’s place of residence as well as
absenteeism from school and their awareness level (X2 = 6.999, P= 0.030, X2 =
65.269, P=0.000).
B. Relationship between students’ level of awareness and health profile:
There was a significant difference between student’s family health history of
covid19 and their awareness level (X2= 7.884, P= 0.005).
C.Relationship between the students’ level of practice and their socio
demographic characteristics:
There was a significant difference was found between student’s place of
residence as well as academic achievement and their practice level (X2=
9.723, P= 0.008 and X2= 13.00, P= 0.000 respectively).
D.Relationship between the students’ level of practice and their health profile
and their level of awareness about prevention and control of respiratory
infections:
There was a significant relation was noted between family history of
Covid19 and students’ practice level (X2= 19.532, P= 0.001).
E. Relationship between the administrators’ level of practice, their socio
demographic characteristics and their level of awareness about prevention and
control of respiratory infections:
The better the level of administrators’ awareness the better level of their
practice with a significant relation where (X2= 8.078, P= 0.018).
F.Relationship between the teachers’ level of practice, their socio demographic
characteristics and their levels of awareness about prevention and control of
respiratory infections:
The only factor had a positive effect on teacher’s level of practice was their
previous training about prevention and control of respiratory infections (X2=
15.135, P= 0.001).
G. Relationship between the nurses’ level of practice, their socio
demographic characteristics and their levels of awareness about
prevention and control of respiratory infections:
No significant relation was ascertained between nurse’s age, level of
education, years of experience, previous training about infection control also
their awareness level on their practice’s level (X2= 0.640, P= 0.424, X2=
1.371, P= 0.504, X2= 0.640, P= 0.424, X2= 1.778, P= 0.182, X2= 1.371, P=
0.504 respectively).
H. Relationship between the workers’ level of practice, their socio
demographic characteristics and their levels of awareness about prevention
and control of respiratory infections:
No significant relation was ascertained between worker’s age, sex, level of
education, years of experience, previous training about infection control also
their awareness level on their practice’s level , while X2= 0.619, P= 0.734,
X2= 1.129, P= 0.288, X2= 2.343, P= 0.504, X2= 0.900, P= 0.825, X2=
0.533, P= 0.465, X2= 2.133, P= 0.144 respectively
I. Correlation between awareness and practices of students, administrators,
teachers, nurses and workers and school environment:
There was a significant positive correlation between student’s awareness
level and their own practice as well as with the nurse’s awareness and
practice level (r=0.815, P 0.012, r=0.553, P =0.026, r=0.787, P =0.047
respectively).
There was a significant positive correlation between student’s practice level
and the teachers’ awareness and practice level as well as with the nurse’s
awareness and practice level moreover workers’ practice level (r=0.512, P
=0.053, r=0.772, P =0.045, r=0.524, P =0.034, r=0.327, P =0.012, r=0.357, P
=0.045 respectively).
There was a statistically positive moderate correlation was noticed between
administrator’s practice level and teachers as well as workers’ practice level
(r=0.626, P =0.009, r=0.518, P =0.040 respectively).
There was a statistically a positive weak correlation was noticed between
teacher’s awareness level and their practice level (r=0.286, P =0.049). As
well as a positive moderate correlation was found between teacher’s practice
and workers’ practice level (r=0.629, P =0.006). Moreover the same
moderate correlation was found between nurses’ practice and workers’
practice level (r=0.573, P =0.020). In addition there is a strong positive
relation found between workers’ awareness and their own practice level
(r=0.853, P =0.034).
Based on the current findings the following recommendations were suggested :
Ministry of Education .
o Ensure that every school has a written policy/guideline about promoting the
preventive measures and enhancing the compliance with infection
prevention and control practices. Moreover, this policy/guideline should be
routinely communicated to all school staff.
o Establish and enforce the role of infection prevention and control health
committee at schools where all school personnel should be involved in
promoting and maintaining the regular assessment of school environmental
sanitation.
o Maximize in-person learning with symptom awareness and home isolation
control measures by integrating the respiratory infections and its preventive
practices into the school curriculum.
o Provide graduate convenient numbers of competent well prepared teachers
and nurses to provide healthy educational messages at school.
o Ensure that every school has well prepared isolation room or designated
space to isolate students or staff who become ill (symptomatic students or
school staff of COVID-19) during the school day until the isolated persons
are transferred to the concerned medical authority
Recommendations directed to Ministry of Health and Population (MOHP) in
collaboration with School Health Insurance:
o Encourage and facilitate provision of COVID-19 vaccination for all eligible
students and staff, including booster vaccine doses when recommended
o Holding periodic training programs for school nurses about IPAC practices
and encouraging the adoption of public health measures that should be
emphasized in health promotion programs.
o Establish a health education unit to raise students’ and their parents
awareness in every health insurance school clinic (in each educational
zone) with a qualified and trained health care personnel available all time
Recommendation directed to Ministry of Communications and Information
Technology (MCIT)):
o Raise public awareness with respect to the importance of applying
respiratory infection preventive and control practices as a routine and as a
part of human healthy life style this could be done through developing well
designed messages disseminated through schools, youth clubs, religious
places and media
o Depiction of positive role models and famous figures in applying preventive
and infection control practices among students.
o Enhance the use of new technologies like internet, social working sites and
cellular phones (what’s up, Skype, Facebook) in disseminating the
preventive practices messages to students and their families Recommendations directed to School Health Committee: (Members in the
health committee including; school administrator, nurse, health coordinators social
worker, and environmental supervisor and science teachers).
o Ensure continuous scheduled supervision for all school setting especially at
certain times and places for adherence to IPAC practices through using a
risk-based approach to investigate the challenges related to the existing
health hazards or the non-compliance with IPAC practices.
o Promote morning messaging through announcements and broadcasts under
supervision of school health nurse to raise students’ awareness about the
respiratory hygiene and social distancing measures, respiratory infection’s
vaccination and its importance and also the nutritional measures to
enhancing their immunity.
o The school health committee should provide training and monitoring for the
school workers with respect to their changing role in dealing with
respiratory infection especially during the pandemic of covid19 at the
school settings.
o Display a creatively designed and planned information board located
prominently in the school high traffic area to grasp attention and generate
interest in IPAC.
o Continue advising parents to report cases of COVID-19 to the school and
maintain accurate absentee data.
o Facilitate the collaboration between school nurses with other schools
personnel in developing a comprehensive care plan for students to maintain
the preventive practices.
o Emphasize the availability of adequate water, sanitation and hygiene
(WASH) facilities and ensure the availability of cleaning supplies and
materials. Also maintain proper classroom arrangements that facilitate
spacing between seated individuals in classrooms and during other
activities, if possible to prevent the gatherings and cross infections
o Supervise all staff workers following the isolation guidelines for COVID-19
to prevent the occurrence of outbreak. Moreover, inform cleaning staff
about appropriate surface disinfection methods and the use of adequate
personal protective equipment.