Table C.1Findings from systematic overview of systematic reviews of comprehensive SHS

First author, year and referenceHealth area specifiedType(s) of interventionsFindingsMeta-analysis results
a. Findings from systematic reviews on asthma interventions
Geryk 2017 (5)AsthmaEducationImproved inhaler techniqueNA
Walter 2016 (6)AsthmaEducationImproved daytime and night-time symptoms; physical activity intolerance; emergency hospital visits; and missed school or work daysNA
b. Findings from systematic reviews on menstrual management interventions
Hennegan 2016 (7)MenstruationEducation, provision of sanitary productsSanitary pad provision: moderate yet statistically insignificant effect on school attendance; overall trends toward improvements in menstruation knowledge, management practices, psychosocial outcomes and school attendance

School attendance:

SMD = 0.49,

95% CI: −0.13, 1.11,

p = 0.12

c. Findings from systematic reviews on mental health interventions
Bastounis 2016 (8)Depression and anxietyEducation, prevention

Depression: non-significant, in favour of PRP programme;

Anxiety: non-significant, in favour of control

Depression:

MD = −0.23,

95% CI: −1.09, 0.62

Anxiety:

SMD = 0.13,

95% CI: 0.00, 0.26

Brendel 2014 (9)Well-beingCounsellingNo statistically significant changeNA
Gold 2006 (10)AutismTherapy (music)Small yet statistically significant effect sizes in favour of music therapy

Gestural communication:

SMD = 0.50,

95% CI: 0.22, 0.79*

Verbal communication:

SMD = 0.36,

95% CI: 0.15, 0.57*

Behavioural problems:

SMD = −0.24,

95% CI:−0.45, −0.03*

Higgins 2015 (11)AnxietyPreventionStatistically significant improvement in self-reported anxietyNA
Kavanagh 2009 (12,13)Depression and anxietyCounsellingStatistically significant reductions of depressive symptoms up to four weeks and three months follow-up

4 weeks: SMD = −0.16,

95% CI:−0.26, −0.05

Equivalent to reduction in 1.44 points on BDI*

3 months: SMD = −0.21, 95% CI: −0.35, −0.07; equivalent to reduction in 1.9 points on BDI*

McDonald 2018 (14)VariousTherapy (art)Improvements in outcomes on classroom behaviour, ODD and SADNA
Neil 2009 (15)AnxietyPreventionStatistically significant reductions in anxiety symptoms at post-test and/or follow-up in 21 out of 27 primary trialsNA
Sullivan 2016 (16)TraumaTherapyImprovements in trauma-related symptoms and impairment; negative effects for music therapyNA
Werner-Seidler 2017 (17)Depression and anxietyPrevention, therapySmall yet statistically significant effect sizes in favour of the intervention for both depression and anxiety

Depression:

Hedges g = 0.23,

95% CI: 0.19, 0.28*

Anxiety:

Hedges g = 0.20,

95% CI: 0.14, 0.25*

d. Findings from systematic reviews on obesity interventions
Schroeder 2016 (18)Obesity prevention and treatmentEducation, counselling, preventionSmall but statistically significant reductions in all three BMI outcomes

BMI, attenuated due to high heterogeneity:

SMD = −0.06,

95% CI: −0.17, −0.01*

BMIz score:

SMD = −0.10,

95% CI: −0.15, −0.05*

BMI percentile:

SMD = −0.41,

95% CI: −0.60, −0.21*

e. Findings from systematic reviews on oral health interventions
Arora 2017 (19)Oral health and dental care attendanceScreening, referralsInsufficient evidence for conclusions on oral health outcomes or dental attendanceNA
Cooper 2013 (20)CariesEducation, preventionInsufficient evidence for conclusions on caries increment or plaque accumulationNA
Marinho 2015 (21)CariesPreventionDecrease in caries increment

PF = 0.28,

95% CI: 0.19, 0.36,

p < 0.0001*

Stein 2017 (22)Caries and oral hygieneEducationDecrease in mean plaque levels; improved oral hygiene; no change in gingivitis

Mean plaque levels:

MD = −0.36,

95% CI: −0.59, −0.13,

p = 0.004*

Oral hygiene:

MD = −0.42,

95% CI: −0.69, −0.15,

p = 0.002*

Gingivitis:

MD = −0.07,

95% CI: −0.32, 0.19,

p = 0.61

f. Findings from systematic reviews on sexual and reproductive health interventions
Paul-Ebhohimhen 2008 (23)STIs and HIVEducationIncreased knowledge and attitudes; ineffective in changing risky behavioursNA
g. Findings from systematic reviews on sleep interventions
Chung 2017 (24)SleepEducationStatistically significant short-term benefits for all three outcomes

Weekday sleep time:

SMD = 0.23,

95% CI = [0.17, 0.29],

p = 0.0001*

Weekend sleep time:

SMD = 0.46,

95% CI = [0.04, 0.86],

p = 0.03*

Mood:

SMD = 0.81,

95% CI: 0.17, 1.47,

p = 0.01*

h. Findings from systematic reviews on vision interventions
Evans 2018 (25)Visual acuityEducation, screening, spectacles provisionStatistically significant increase in spectacles wear; no difference between provision of ready-made versus custom-made spectacles; no comparison of vision screening versus no vision screening

Free spectacles versus prescription:

RR = 1.6,

95% CI = [1.34, 1.90],

p < 0.00001*

Ready-made versus custom-made:

RR = 0.98,

95% CI = [0.91, 1.05],

p = 0.51

*

Statistically significant result.

BDI: Beck Depression Inventory. BMI: body mass index. CI: confidence interval. MD: mean difference. NA: no meta-analysis performed. ODD: oppositional defiant disorder. PF: prevented fraction. PRP: Penn Resiliency Program. RR: risk ratio. SAD: separation anxiety disorder. SMD: standardized mean difference. STI: sexually transmitted infection.

From: Web Annex C, Systematic overview of systematic reviews of comprehensive school health services: methodology and select findings

Cover of WHO guideline on school health services
WHO guideline on school health services [Internet].
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