An exploration of factors that influence the regular consumption of water by Irish primary school children

Addressing schoolteacher food and nutrition-related health and wellbeing: a scoping review of the food and nutrition constructs used across current research

BACKGROUND

Teachers form a large and essential workforce globally. Their wellbeing impacts personal health-related outcomes with flow on effects for the health, and wellbeing of their students. However, food and nutrition (FN) interventions that include teachers, typically neglect the impact of personal FN factors on a teachers' ability to achieve optimal nutrition-related health and wellbeing, and successfully fulfil their professional FN roles as health promoters, gate keepers, educators', and role models. The aim of this review was to scope FN constructs that have been studied internationally regarding teacher FN-related health and wellbeing.

METHODS

Six databases were searched, and papers extracted in June/July 2021. Eligibility criteria guided by the population, concept, context mnemonic included studies published after 2000, in English language, with an aspect of personal FN-related health and wellbeing, among in-service (practising) and pre-service (training), primary, and secondary teachers. Screening studies for inclusion was completed by two independent researchers with data extraction piloted with the same reviewers and completed by lead author, along with complete descriptive and thematic analysis.

RESULTS

Ten thousand six hundred seventy-seven unique articles were identified with 368 eligible for full text review and 105 included in final extraction and analysis. Sixty-nine descriptive studies were included, followed by 35 intervention studies, with the main data collection method used to assess both personal and professional FN constructs being questionnaires (n = 99 papers), with nutrition knowledge and dietary assessment among the most commonly assessed.

CONCLUSION

FN constructs are used within interventions and studies that include teachers, with diversity in constructs included and how these terms are defined. The evidence from this scoping review can be used to inform data collection and evaluation in future epidemiological and interventional research that addresses teacher FN-related health and wellbeing.

Schools preparedness for menstrual hygiene management: a descriptive cross-sectional study in the West Gonja Municipality, Savannah Region of Ghana

OBJECTIVE

This study aimed to investigate schools' preparedness for menstrual hygiene management in the West Gonja Municipality of Ghana.

DESIGN

This was a cross-sectional study with a mixed-methods approach.

SETTING

Junior high schools in the West Gonja Municipality.

PARTICIPANTS

Twenty-six schools were randomly selected, and 13 schoolgirls were purposively chosen for qualitative interviews.

ANALYSIS OF DATA

The quantitative and qualitative data were analysed using Microsoft Excel and thematic content analysis, respectively. The transcriptions were printed out and read repeatedly to identify similar wordings, phrases, concept and meanings.

OUTCOMES

Presence of menstrual hygiene facilities in basic schools.

RESULTS

Majority (69.2%) of the schools were poorly prepared towards menstrual hygiene management. Only 38.5% schools had water, most schools (61.5%) did not have waste bins, 30.8% of the schools had designated places for changing of menstrual materials. No school had menstrual hygiene materials available for emergency use. All participants acknowledged inadequate hygiene facilities in their schools. During menses, adolescent girls often absent themselves from school. Girls tend to be very inactive during their menstrual period for fear of embracement from their male counterparts. The following themes were obtained 'unavailability of hygiene material', 'involvement in class during menses' and 'absence from school'.

CONCLUSION

Schools in West Gonja Municipality have inadequate menstrual hygiene management facilities that could be a major setback to the health and educational attainment of young girls. The Ministry of Sanitation and Water Resources should expand menstrual hygiene and its management to reach the West Gonja Municipality as part of the National Sanitation and Hygiene Strategy.

Challenges of Access to WASH in Schools in Low- and Middle-Income Countries: Case Study from Rural Central Kazakhstan

Safe water and sanitation, which give rise to appropriate hygiene, are fundamental determinants of individual and social health and well-being. Thereby, assessing and widening access to sustainable, durable water and sanitation infrastructure remains a global health issue. Rural areas are already at a disadvantage. Poor access to water, sanitation, and hygiene (WASH) can have a major negative effect on students in rural schools. Thus, the paper aims to assess the current condition and the challenge to access WASH in rural Kazakh schools. The study was conducted in three rural schools in Central Kazakhstan. Data were gathered through a survey among pupils, observations of the WASH infrastructure and maintenance, and a face-to-face interview with school administrators. The mean survey response rate was 65% across schools. Results indicated there was no alternative drinking-water source in schools, and 15% of students said they had access to water only occasionally. Half of the students reported that the water was unsafe to drink because of a poor odor, taste, or color. The toilet in school 3 was locked with a key, and a quarter of the students reported there was no access to a key. Moreover, not having gender-separated toilet facilities was a challenge because of the traditional gender norms. Despite the effective regulations and measures of handwashing taken during COVID-19, 27.7% of the students answered that soap was not offered daily in classrooms. Additionally, warm water was only provided in school 2. About 75% of students did not have access to drying materials continuously. The study shows that having the schools’ infrastructure is not enough when characteristics, such as availability, accessibility, maintenance, operation, quality of services, education, and practices, are ignored. Cooperation between local education authorities, school administration, and parents should be encouraged to the achievement of the sustainable development goals (SDGs) by 2030.

Is there a functional relationship between hydration and memory in children and adolescents? A meta-analysis

Objective: Hydration can favor cognitive functions during childhood and adolescence, helping with daily and school activities. This study aimed to identify possible interactions between hydration and memory in children and adolescents. Methods: This is a systematic review with meta-analysis. The bibliographic search was conducted in the MEDLINE/PubMed, SciELO, LILACS, Web of Science, Embase, and Cochrane Library databases, through a combination of the descriptors: “hydration” AND “memory”; “hydration” AND “memory” AND “child”; “hydration” AND “memory” AND “children”; “organism hydration status” AND “memory”; “organism hydration status” AND “memory” AND “child”. Results: The search resulted in 816 articles, of which ten were selected for qualitative synthesis and two for the meta-analysis. The results indicated that hydration could not enhance working, visual and visuomotor memories, or visual attention (Line Tracing Task, MD 0.67, 95% CI -0.87 to 2.22; Indirect Image Difference, MD 0.32, 95% CI -0.75 to 1.40; Letter Cancellation, MD 1.68, 95% CI -0.81 to 4.17). Conclusion: From the obtained results, hydration per se does not reinforce working, visual and visuomotor memories, or visual attention. However, there are still gaps regarding other types of memory and cognitive, motor, nutritional and environmental integration.

Teachers' Perceptions and Understanding of Children's Fluid Intake

No public health data exists on elementary teachers’ perceptions of both their own fluid intake and of their elementary school aged children’s fluid intake. A total of 271 (20 males, 251 females) teachers in developed areas of Australia, Belgium, England, Ireland, United Arab Emirates, and the United States of America completed an online questionnaire (Feb–Mar 2019) on: (i) their fluid intake, (ii) their perception and understanding of children’s fluid intake and (iii) barriers in the school day that they felt prevented school children consuming fluids. Overall, the data indicated that teachers consume considerably lower amounts than recommended themselves, but have a good awareness of children’s fluid intake and estimate children drink approximately half (1 litre (34% n = 93)) of what is recommended per day. The results were also similar to those reported by children previously. Yet, the data highlighted a lack of active encouragement of drinking water throughout the school day by teachers, with only 11% (n = 29) suggesting they actively encourage children to drink and 45% (n = 123) reporting no active encouragement at all. It is recommended as a public health measure that all school children consume an extra cup of water during lunch times in those schools where water intake was recognized as sub optimal. Furthermore, depending on weather conditions, a cup of water before, during and after Physical Education lessons should be encouraged by teachers. Water coolers or bottles may be used as a supplementary resource, provided that hygiene is maintained. From an educational perspective, more professional development needs to be provided to teachers on the importance of regular water consumption, and more time dedicated across the elementary curriculum to educational understanding of fluid consumption.

Water intake and urinary hydration biomarkers in children

BACKGROUND/OBJECTIVES

The aims of the study were as follows: (1) examine fluid intake and urinary hydration markers of children in Greece, (2) determine the calculated relative risk of hypohydration in children who did not meet the recommendations for daily water intake provided by the Institute of Medicine and the European Food Safety Authority compared with those who did and (3) analyze the efficacy of the recommendations as a method to achieve euhydration in children.

SUBJECTS/METHODS

One hundred and fifty Greek boys and girls (age 9-13) recorded their fluid intake for 2 consecutive days. A 24-h urine collection was obtained during the second day. Fluid intake records were analyzed for total water intake from fluids (TWI-F), and urine samples were analyzed for osmolality, color, specific gravity and volume. Urine osmolality ⩾800 mmol/kg H₂O was defined as hypohydration.

RESULTS

Water intake from fluids was 1729 (1555-1905) and 1550 (1406-1686) ml/d for boys and girls, respectively. Prevalence of hypohydration was 33% (44% of boys, 23% of girls). Children who failed to meet TWI-F recommendations demonstrated a risk of hypohydration that was 1.99-2.12 times higher than those who met recommendations (P⩽0.01). Boys between 9 and 13 years displayed urine osmolality of 777 (725-830) mmol/kg, and urine specific gravity of 1.021 (1.019-1.022), which was higher than those in girls between 9-13 years (P⩽0.015), and >27% were classified as hypohydrated despite meeting water intake recommendations.

CONCLUSIONS

Failure to meet TWI-F guidelines increased calculated relative risk of hypohydration in children. Boys between 9 and 13 years are at greater hazard regardless of meeting guidelines and may require greater water intake to avoid elevated urine concentration and ensure adequate hydration.

"Bursting" to Go and Other Experiences

Children's use of the toilet at school, although rarely explored, is an important facet of school experience with consequences for physical and psychological health. A mixed methods study investigated views of 25 children (4-5 years) regarding potential stressors in the first school year, including views of toileting, in Dublin, Ireland. Despite very positive responses to school, most responses to toileting (15 of 25) were mixed or negative. Although some liked to go, or noted the toilets were clean, most indicated delayed toilet use ("bursting" to go) and ambivalent or negative experiences such as fear of not identifying the right toilet, fear of being alone, lack of privacy, and potential bullying. Many children did not expect to receive help from the teacher. As delaying toilet use can have lasting health consequences, teacher-nurse collaboration could be used to develop whole-school policies to support children's early adjustment in this sensitive area of functioning.

Hydration status moderates the effects of drinking water on children's cognitive performance

Changes in hydration status throughout the day may affect cognitive performance with implications for learning success in the classroom. Our study tested the hypothesis that the benefit of drinking water on working memory and attention depends upon children's hydration status and renal response to water intake. Fifty-two children aged 9-12 years old were tested under two experimental conditions. The treatment session (Water session) consisted of a standard breakfast with 200 ml water, a baseline test, consumption of 750 ml of water over a period of two hours and subsequently retested. No water was provided after breakfast during the control session. Changes in hydration were assessed via urine samples. Cognitive testing consisted of digit span, pair cancellation, and delayed match to sample tasks. Children who exhibited smaller decreases in urine osmolality following water intake performed significantly better on the water day compared to the control day on a digit-span task and pair-cancellation task. Children who exhibited larger decreases in urine osmolality following water intake performed better on the control day compared to the water day on the digit-span task and pair-cancellation task. These results suggest that focusing on adequate hydration over time may be key for cognitive enhancement.

Influence of school architecture and design on healthy eating: a review of the evidence

We examined evidence regarding the influence of school physical environment on healthy-eating outcomes. We applied a systems perspective to examine multiple disciplines' theoretical frameworks and used a mixed-methods systematic narrative review method, considering both qualitative and quantitative sources (published through March 2014) for inclusion. We developed a causal loop diagram from 102 sources identified. We found evidence of the influence of many aspects of a school's physical environment on healthy-eating outcomes. The causal loop diagram highlights multilevel and interrelated factors and elucidates the specific roles of design and architecture in encouraging healthy eating within schools. Our review highlighted the gaps in current evidence and identified areas of research needed to refine and expand school architecture and design strategies for addressing healthy eating.

Fluid intake survey among schoolchildren in Belgium

Background

In childhood, inadequate fluid intakes can lead on the short term, to reduced physical and cognitive performances. However, few data are available on the fluid intake among schoolchildren in Belgium. The main aim of this study is to evaluate total fluid intake provided by different types of beverages in a sample of Belgian schoolchildren, in order to assess the percentage of individuals complying with the European Food Safety Authority recommendations for total fluid intake. A secondary aim was to characterize the study population in terms of determinants of the total fluid intake requirements.

Methods

A child friendly “fluids and liquid food” diary was used to prospectively record the volume and frequency of beverage consumption over 7 days from 1045 schoolchildren. This diary also recorded the practice of physical activity. An adequate fluid intake was defined as an intake ≥ 75% of the age-specific adequate intake recommended by the EFSA.

Results

The median (P25-P75) of habitual daily fluid intake was 864 (608–1104) ml/day, with 355 (194–579) coming from drinking water. This habitual daily fluid intake varied significantly among the three investigated EFSA groups (girls and boys aged from 8 years, girls from 9 to 13 and boys from 9 to 13), except for the drinking water (P = 0.906). The highest medians of fruit juice, sugar-sweetened beverages and milk and derivatives were found among boys of 9–13. Only 9.5% of the children had an adequate fluid intake, with a value of 19.2% among the 8 years old girls and boys, 7.0% among girls of 9–13 and 8.4% among boys of 9–13. In the whole sample, 27.7% of the children declared to drink less than 3-4x/day, 56% drunk water less than 2x/day and 7.7% drunk no water at all. Every day, 27.1% and 34.1% of the children drank respectively one fruit juice and one sugar-sweetened beverage.

Conclusion

Belgian schoolchildren have an inadequate total fluid intake. Given the potential health consequences, interventions involving parents and school environment to promote water consumption seem pertinent.

Encouraging consumption of water in school and child care settings: access, challenges, and strategies for improvement

Children and adolescents are not consuming enough water, instead opting for sugar-sweetened beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars), 100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight status, reduced dental caries, and improved cognition among children and adolescents. Because children spend most of their day at school and in child care, ensuring that safe, potable drinking water is available in these settings is a fundamental public health measure. We sought to identify challenges that limit access to drinking water; opportunities, including promising practices, to increase drinking water availability and consumption; and future research, policy efforts, and funding needed in this area.

Dehydration affects brain structure and function in healthy adolescents

It was recently observed that dehydration causes shrinkage of brain tissue and an associated increase in ventricular volume. Negative effects of dehydration on cognitive performance have been shown in some but not all studies, and it has also been reported that an increased perceived effort may be required following dehydration. However, the effects of dehydration on brain function are unknown. We investigated this question using functional magnetic resonance imaging (fMRI) in 10 healthy adolescents (mean age = 16.8, five females). Each subject completed a thermal exercise protocol and nonthermal exercise control condition in a cross-over repeated measures design. Subjects lost more weight via perspiration in the thermal exercise versus the control condition (P < 0.0001), and lateral ventricle enlargement correlated with the reduction in body mass (r = 0.77, P = 0.01). Dehydration following the thermal exercise protocol led to a significantly stronger increase in fronto-parietal blood-oxygen-level-dependent (BOLD) response during an executive function task (Tower of London) than the control condition, whereas cerebral perfusion during rest was not affected. The increase in BOLD response after dehydration was not paralleled by a change in cognitive performance, suggesting an inefficient use of brain metabolic activity following dehydration. This pattern indicates that participants exerted a higher level of neuronal activity in order to achieve the same performance level. Given the limited availability of brain metabolic resources, these findings suggest that prolonged states of reduced water intake may adversely impact executive functions such as planning and visuo-spatial processing.

Voluntary dehydration among elementary school children residing in a hot arid environment

BACKGROUND

Voluntary dehydration is a condition where humans do not drink appropriately in the presence of an adequate fluid supply. This may adversely affect their physical and intellectual performance. The present study aimed to describe the prevalence of voluntary dehydration among elementary school children of different ethnicities and countries of birth.

METHODS

Four hundred and twenty-nine elementary school children, aged 8-10 years, from four subpopulations (Israeli-born Jewish and Bedouin-Arab children, and immigrant children who recently arrived to Israel from Eastern Europe and from Ethiopia) were studied. The level of dehydration was determined by noontime urine osmolality, from samples taken over 1 week in mid-summer. Urine osmolality <500 mOsmol kg(-1) H(2)O was considered to be an appropriate level of hydration.

RESULTS

Mean urine osmolality was 862 +/- 211 mOsmol kg(-1) H(2)O. Osmolality above 800 mOsmol kg(-1) H(2)O was detected in 67.5% of the urine samples; among these, 25% were above 1000 mOsmol kg(-1) H(2)O. The most dehydrated group was that of Israeli-born Jewish children, whereas the Bedouin-Arab children were the least dehydrated.

CONCLUSIONS

A high proportion of children who reside in a hot and arid environment were found to be in a state of moderate to severe dehydration. Bedouin ethnicity was associated with better hydration, whereas Israeli-born Jews were most severely dehydrated. Educational intervention programmes promoting water intake should start in early childhood and continue throughout life.