Chapter 9

Significance of health checkups andtheir methods

Cambodia do not conduct health checkups. However, all schools in the country are called on to conduct
health checkups to ensure the sound growth and development of children (see the National School
Health Policy 2019 in chapter 1). Some countries include clinical medical tests such as electrocardiography,
radiography, and urinalysis in health checkups. This chapter will focus on easy and effective measurements
and tests that are feasible in Cambodia: height measurement, weight measurement, eye test, and hearing
test.

Learning objectives
You will be able to gain proper understanding and explain:- The significance of health checkups and learn to conduct health checkups correctly.
- Based on the results of health checkup, how to identify health issues of children, screen them, andconsider appropriate measures at school.
- The importance of creating a system for conducting high-quality and continuous health checkups
at schools.
In this chapter, you will learn about the significance of health checkups; specific procedures for measuring
and recording height, weight, eyesight, and hearing; how to utilize these data; and how to plan andColumn: Health checkup is “Screening.”

Screening means to group people into those who may have problems and those who do not throughtests. Health checkups are a form of screening, not a diagnosis of illness. If a child is suspected ofsome possible health problems in a health checkup, it is important to refer the child to the appropriate
health service.

2. Health checkup methods

prepare for health checkups at the school.
This section explains procedures for height measurement, weight measurement, eye test, and hearing

1. Significance of health checkups

test, and for evaluating the measurement/test results. Screening can be performed properly without
specialized equipment. Check the physical growth and health conditions of children with materials
available at your school.

There are two objectives for health checkups (health examinations and physical measurements):
The first is to check and evaluate whether children are growing steadily, and if abnormalities are
discovered, refer to health services. The second is to identify the health issues of children as a group, andlink to appropriate responses and health education at the school.
The primary goal of school health is for children to grow and develop soundly. As discussed in
Chapter 3, the growth and development of children is promoted or interfered with by various factors

1) Height measurement and weight measurement(1) Height measurement method
a. Items for use: Measuring tape, triangle ruler, adhesive tape (Figure 9.1)

(i.e., biological, behavioral, and physical/social environmental factors). Hence, it is important to regularly
check, evaluate, and screen whether children are growing and developing soundly. If children are left ina state where their growth/development is inhibited, it can cause a negative spiral that interferes withlearning and daily life and further inhibits growth/development. If the growth and development of achild is not smooth, it is vital to investigate the factors and make necessary improvements. Examples offactors that inhibit growth and development may include serious illnesses, nutritional conditions,unfavorable living environments, daily rhythm, and psychological stress.
Health checkups aim not only to evaluate the individual growth and development of children, but toidentify and improve collective health issues. For example, suppose a school has discovered that manyof its children have poor eyesight through a health checkup. To improve this, the school can propose toadjust the brightness of the classrooms, provide health education to the children regarding their postureand eye health, and take other measures on a schoolwide basis to improve the eyesight of the children.

Figure 9.1 Items for measuring height (triangle ruler, tape measure, and adhesive tape)

In this way, it is important to connect the health checkup to health education and school health activities.
Health checkup systems and programs vary from country to country. At present, most schools in
148

Chapter 9

Significance of health checkups and their methods

149

b. Set up the place for measuring height (Figure 9.2)(i)(v) Have them hang their arms down the side of the body.

Look for a level floor and wall. Even a pillar will work.

(vi) Have them look straight forward.

(ii) Hold the tape measure to the wall, making sure it is perpendicular to the floor.

(vii) Lower the triangle ruler(iii) Mark the floor where the child’s feet should be.

straight down along thetape measure, read, andnote it down the value atthe corner of the triangle
ruler (Figures 9.4 and 9.5).
d. Tips- Make sure that the postureof the child is correct
during measurement.
- Measurement may not be
accurate for children who
tie their hair near the topsof their heads. Ask them

Figure 9.2 Setting up the place for measuring heightfor consent to untie or

ruler

Figure 9.5 Scene ofmeasuring height

lower the knot.

c. Procedure(i)Figure 9.4 Lowering triangle

Call the names of the children one at a time.

(2) Weight measurement method(ii) Have them remove their shoes.
(iii) Have them stand upright with both heels touching the wall.

a. Items for use: Scale(iv) Make sure both heels, buttocks, and back are touching the wall.

b. Set up the place for weighing

Be sure that the back of the head touches the wall. (Figure 9.3)

Find a level floor.

(i)(ii) Position the scale.
c. Procedure (Figure 9.6)

Back of head(i)Call the names of the children one at atime.

(ii) Have them remove their shoes. Havethem take off their jackets and weigh
To measure accurately, open
toes 30-40° wide so that you
can stand stably and knees
stretch naturally.

without carrying anything unnecessary,

Backsuch as mobile phones or watches.
(iii) Have them stand gently on the middle

Buttocks

30 -40°Line connecting the infraorbital
margin with the superior marginof the external acoustic meatus.

of the scale.
(iv) Ensure that they do not move while on
the scale, and read and note down thenumber on the scale.

Figure 9.6 Scene of measuring weightd. TipsHeels- The method for turning on and using the scale differs for each scale. Check these methods
before starting. For analog scales, make sure that the needle is pointing to 0. For digital
instruments, check the batteries.

Figure 9.3 The correct posture when measuring height

150- Avoid weighing immediately after eating, as this can affect body weight considerably.
Chapter 9

Significance of health checkups and their methods151Column: What is standard deviation?

(3) Assessing height and weight
Reference values for comparing measurements are essential for checking the growth and development

The standard deviation is an indicator of how much the distribution of data varies from the overall

conditions of an individual, in order to determine if there is any illness or growth bias such as obesity or

mean. Assuming that there are data measuring the height of 100 children, it means that about 68%¹

thinness, and to know the position within the group. Physique indices are used for evaluating growth(68 children) of the height data are between +1SD and -1SD. About 96% of the data are included

based on height and weight. In addition to the body mass index (BMI) discussed in Chapter 6, they

between +2SD and -2SD. This means that children outside the range of + 2SD to -2SD are either

include the Rohrer index, Kaup index, the degree of obesity, and various other indices. BMI is used forvery short or very tall and may have health issues.

adults worldwide while the degree of obesity and Rohrer index are also widely used for childhood
assessment (Table 9.1).
However, note that BMI and Rohrer index must be used carefully. First, the formula for calculating
BMI is universal, but the criteria for judgment differ by country. For example, BMI ≥ 30 is obese

Table 9.1 Physique indices used for children

Physique index

Calculation method

Suited toAppropriate values

according to the WHO international standard² while ≥ 25 is obese in the Asia-Pacific region.³ Generally,

3 mo to <1 y :16 to <18

the Rohrer index can be used for children who are 125 cm or taller. However, considering that heightchanges are complicated during growth from elementary school age to puberty, the Rohrer index may
come out higher for children who are short.

1 y to <1 y 6 mo : 15.5 to <17.5
Kaup index

Weight (kg) / Height (m)²

3 mo to 5 y
1 y 6 mo to <3 y : 15 to <17

Furthermore, given individual differences in childhood growth and development, just measuring
how many centimeters a child has grown and how many kilograms the child has gained are not sufficient

3 y to ≤5 y : 14.5 to <16.5

for appropriate evaluation of growth. For example, a sudden increase in height tends to be welcomed inmost children but it may be a sign of precocious puberty (after an early growth spurt where there is atemporary sudden increase in height, growth stops with the body remaining extremely small) or abnormal

Rohrer index

Weight (kg) / Height (m)³× 10

Elementary school
children - Junior highschool students

115–145

Body massindex (BMI)

Weight (kg) / Height (m)²Senior high school
students and above

18–22

growth where the body stops growing completely after such sudden growth, both of which require
treatment.4 For this reason, it is important to not only evaluate the height and weight by simply comparing
the previous data, but also to continuously observe changes, so as to ensure the sound growth anddevelopment of the child without overlooking any abnormal changes.

mo=month, y=year

In the case of physique indices, the reference value differs depending on the age and is useful only
for evaluating growth at a single point in time. This means that the value is not an index of continuous
Table 9.2 Appropriate height and weight of children in Cambodian

growth. Consequently, the use of growth curves is recommended for continuously evaluating the growth5and development of children. A growth curve is a graph drawn by collecting measurements of height

Appropriate Value for Height (cm)Appropriate Value for Weight (kg)and weight of many children of various ages by gender, and connecting the average values of each age

Age (y)Boy

Girl

Age (y)Boy

Girlwith a curve. Growth curves of +2SD (SD: standard deviation), +1SD, -1SD, -2SD (or percentile) of the6

113–117

109–113

6

19–21

16–19

average values are also shown. By entering the measured data of the child in the standard growth curve,7

116–120

116–120

7

20–23

19–22

you can see how tall or short, how heavy or light the child is. Furthermore, by entering values over time,8

121–124

119–123

8

21–24

20–23

9

124–128

123–127

9

22–25

22–25

10

128–132

127–131

10

25–28

25–28

11

132–136

134–138

11

27–30

28–31

on the height and weight of children in the future, it will be possible to create growth curves for children

12

136–140

142–146

12

29–32

32–35

in Cambodia.

13

142–146

147–151

13

32–35

35–38

14

151–155

150–155

14

38–41

39–42

15

157–161

152–156

15

43–46

44–47

the growth pattern of the child can be obtained and the progress of growth can be confirmed.
Although there are no currently available growth curves for children in Cambodia, the Foundation
for International Development / Relief (FIDR)6 has proposed the appropriate height and weight ofchildren (Table 9.2). With the spread of health checkups across the country and the accumulation of data

Source: FIDR, 2017

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61532) Eye test9

Column: Situation of thinness and obesity in children in Cambodia

In Cambodia, height and weight are used to evaluate the nutritional status of children. Specifically,malnutrition (nutritional deficiency) or the state of lacking balanced nutrition for healthy growth
are classified into stunting, wasting, being underweight, and being overweight (Figure 9.7).
Stunting is assessed by “Height-for-age” and is an indicator of long-term chronic nutritional status.

(1) Eye test method
a. Items for use: Eye chart (see Exhibits for E chart), eye shield (Figure 9.8, if no eye shield, gently
cover one eye with your own hand or paper)

6,7

Wasting is assessed by “Weight-for-height” and is often used to evaluate short-term acute nutritional
status. Being underweight is assessed by “Weight-for-age,” and being overweight is assessed by“Weight-for-height,” as is done for wasting 8
According to the Cambodia Demographic and Health Survey 2014,8 the nutritional status ofCambodian children has been improving since 2000 with a downward trend in all stunted, wasted
and underweight children. However, results of every category differ by state significantly, suggesting
contributions of differences between urban and rural areas and between rich and poor. In this way,although the number of overweight children is surging in urban areas, the problem of stunting issignificant in Cambodia as a whole. Physiological tests are required for a detailed assessment of
nutritional status. However, given that height and weight can be easily measured without discomfort,
they can be considered an effective means for evaluating the growth and development status of

Figure 9.8 Eye shieldchildren.

b. Set up the place for performing the eye test
(1) Find a bright room that provides a distance of at least 3 m (turn on the light / open the window).
Normal height for age(2) Fix the eye chart on a wall or pillar with the big E at eye level. Mark the position 3 m from theeye chart to indicate clearly where to stand when taking the eye test.
(3) If the test is taken sitting down, prepare a chair that is 3 m from the eye chart.
c. Procedure (Figures 9.9, 9.10, and 9.11)(1) Before the test, explain to the children how to take the eye test in the classroom.
(2) Have several children line up at a time for the eye test to wait quietly for their turn.
(3) Call out their names one by one.
(4) Have those wearing eyeglasses to take the test with their eyeglasses on.
(5) Have the children stand or sit at a position 3 m from the eye chart (Figure 9.9).
(6) Have the children point their finger in the direction that E faces. Have them reply “can’t see” or“don’t know” if they cannot see (Figure 9.11).

NormalWasting
Low weight for height

Stunting
Low height for age

Figure 9.7 Different types of undernutrition

Underweight
Low weight for age(7) Testing the right eye. Tell the children to use an eye shield or something similar to gently hide
the left eye. (Figure 9.11)(8) Ask the direction of each large E (6/60). Record children who get all four directions (up,down, left and right) correct as Pass and all the other children as Fail. Those who fail in thelarge E test are not eligible for the test using the small Es.
(9) For children who passed the test using the large Es, ask which directions the five small Es facein row (6/12). Record children who could see 4 out of 5 as Pass, and 3 or less as Fail.
(10) Do the same for the left eye.

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Figure 9.9 Scene 1 of the Eye test

Figure 9.10 Scene 2 of the Eye test

Figure 9.12 Example of the Single eye test chart(2) Evaluation of eyesightRefractive errors and diseases of the eyes cause weakening of eyesight. The difficulty in viewing faraway
objects reduces concentration and limits activity. Some children may drop out of school because theycannot see the blackboard clearly and fail to keep up with their classes. In Cambodia, many children do
not wear eyeglasses. Some children themselves or people around them do not even know that they havepoor eyesight because they have never had their eyes tested before.
Eye tests are designed to check eyesight conditions. Examining children’s eyesight by eye tests andtaking the required action are important for promoting the growth and development of children. In the Echart method introduced in this chapter, it is desirable to be able to see both large Es (6/60) and small Es(6/12). If the children cannot see small Es, it means that their eyesight has deteriorated and a visit to
Figure 9.11 Scene of a student answering which way E is facing

basic eye care services available at 331 health centers (that is, 30% of the total health centers) inprovinces, or ophthalmological services available in 21 referral-based hospitals (that is, 23% of the totalreferral-based hospitals) for an eye test and visual correction if necessary is recommended. If children

d. Tips- The eye chart is a tool for measuring human eyesight that can be measured using numbers,letters, and symbols. Here, a method using the E chart is introduced.

cannot see a large E, they may have a very serious eyesight impairment and need to consult a medical
specialist. However, at present, only 40% of the people in Cambodia have access to eye care services in- If you do not have an eye shield, you can use your palm or paper.

10 out of the 25 provinces. Therefore, expanding eye care services and training ophthalmologists are- The description in this section is based on the Guidelines for Vision Testing in School

future issues to work on.10(Department of School Health, Ministry of Education, Youth and Sport, Cambodia 2016).9

Eye tests do not reveal the nature of refractive problems such as myopia or hyperopia or the presenceof illness. Detailed ophthalmology tests are required. For children with poor eyesight, it is necessary to

Column: Single eye chartadjust their learning environment, for example, by setting their seats in the front row of the classroom.
Please refer to Chapter 8 for details on eye structure, refractive errors, and diseases.

This chapter introduces how to test eyesight using an eye chart fixed on a wall or pillar. Sometimes,
a single eye chart is used according to age and the level of eyesight (Figure 9.12). Since only one
symbol is drawn on a single eye chart, children with low vision and/or who are young can answer
them without confusion. A single eye chart is also convenient in that it can be hand held and does
not require walls or pillars.
The teacher holds the eye chart and measures eyesight as he/she turns it around, but the basic
procedure is the same.

156

Chapter 9

Significance of health checkups and their methods

1573) Hearing tests11

Outer
ear

(1) Hearing test method

Middle
ear

Inner
ear

Auditory ossiclea. Item for use: Chair

Auditoryb. Set up the place for performing the hearing test
Find a quiet room because measurement cannot be performed correctly in a noisy place. Takemeasures such as closing windows and doors.
Position the chair.

Ear canalc. Procedure(i)

CochleaCall out the names of the children one by one in turn.

(ii) Have a child sit on the chair.

Basement
membrane(iii) Perform a voice test. Ask the child for their name and grade and check if there is any problem

Auditory tube

with answering. If the answer is good, record it as “Pass.” If there is any problem, record as

Eardrum“Fail.”(iv) Perform a hearing test (Figure 9.13). Tell theSound conduction systemchild to close their eyes and raise their handSound-sensing system

Figure 9.14 Structure of the earon the side where they hear the sound of
fingers rubbing together.
(v) Rub your fingers together about 5 cm away

outer and middle ears play the roles of transmitting sound while the inner ear plays the role of sensing

from the child’s ear. Repeat it on the left andand transmitting sound to the brain. Deafness can be divided into two types: conductive deafness caused

right sides twice each. Record as “Pass” ifby poor sound transmission due to disorders of the outer and middle ears, and sensory deafness caused

they can hear and “Fail” if they cannot.

by problems with the inner ear that make it difficult to sense sounds. Conductive deafness is caused byotitis media, otitis externa, and cerumen impaction. Sensitive deafness often develops naturally(congenital deafness). It also includes noise-induced deafness caused by exposure to factory mechanicalsounds or construction sounds at work and acoustic deafness caused by listening to loud sounds overheadphone, etc., for long hours.
WHO warns that 1.1 billion young people around the world are at risk of acoustic deafness caused
Figure 9.13 Scene of the hearing test

d. Tipsby listening to portable music players and smartphones.12 Deafness caused by ear disease may progress
slowly. In such cases, hearing is not lost overnight, and hence it is difficult for the person and others to
notice the condition. Deafness in a child can be suspected not only from the results of hearing tests but- Use the Voice test to check if children have any problems in daily conversation, and the hearing
test to check if they can hear weak sounds.
- Now smartphones have apps for simple hearing tests, which can be used to produce weaksounds in the hearing test.

(2) Evaluation of hearing

also from other symptoms: the child always listens with one ear, turns up the TV volume, sits near theTV, and does not notice people who are out of sight talking. If hearing is poor, the child must see anotolaryngologist or an audiological clinic for a detailed examination.

4) Recording
Keep records carefully and correctly as omissions or mistakes will disable correct evaluation and

Deafness is the condition of not being able to hear sounds or words clearly or at all. It is a serious

appropriate screening. To accurately record the measurement results, set up a stand for writing in thedisorder that interferes with daily life, language development, and knowledge acquisition. Hearing tests

recording sheets at each measurement location and deploy a recorder. Use standardized units, such as

are intended to check for the presence of deafness and its degree if any. It is extremely important toheight in cm (e.g., 156.5 cm) and weight in kg (e.g., 45.5 kg). Regarding height and weight measurements,

detect deafness and take early measures.

read to the first decimal place and record it. Be careful not to mistake the left and right sides for vision

The structure of the ear is divided into the outer ear, middle ear, and inner ear (Figure 9.14). The
158

and hearing results.
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Significance of health checkups and their methods

159

The record table (see Supplemental material 2) must have fields for filling out the child’s name,Step 2: Let’s measure children

gender, age, and date of measurement in addition to the field for entering the measurement results. To(i)facilitate data organization, it may be a good idea to include fields for the child’s date of birth, grade/(ii) Give prior instructions to children. In order to conduct health checkup smoothly, it is recommended

class, and school name. It would be ideal to prepare copies of the records for feedback to children andthat a prior lecture be given to the children on the purpose and method of health checkup and how

their families and for storage at the school. It is important to accumulate the results of health examinations

to answer the eye test. In particular, explain carefully to children who are taking the measurements/

not only for screening or cross-sectional evaluation but for longitudinal evaluation. For example, by

tests for the first time and younger children.

using recording sheets that can keep records for 6 years of elementary school, you can understand theDecide the roles (person measuring, person recording, and person giving instructions).

(iii) Precautions for measurement

trajectory of the growth situation and characteristics of each student. The analysis of the accumulated- Use signboards to indicate where the measurement is carried out. Also show notes on a poster.

data allows you to identify health issues in classes and schools. For details on using recording sheets,- During the eye test, make sure that the children waiting in the vicinity do not tell the answers to
the child being tested.

please refer to “4. Use of records” in this chapter.
Supplemental materials in the end part of this chapter show some examples of recording sheets. Edit
them to a format that is easy to use or create your own recording sheets according to the situation of each

- During the hearing test, make sure that the children waiting in the vicinity are not noisy.
- During the eye and hearing tests, if it is difficult to judge whether the child cannot see/hear ordoes not know how to answer, ask the child directly.

school.

- During the eye and hearing tests, do not laugh or get angry as it is not wrong to be unable tosee/hear.

3. Practice

4. Use of records

1) Flow of health checkups (Figure 9.15)
Preparations

Measurement/
Recording- Allocate roles- Prepare necessary equipment
and materials- Measure byappropriate method- Record accurately

Check- Check formeasurementomissions/recording
mistakes- Prior instructions to children- Check that everyone
has completed
measurement- Fill in required information on the- Check absentees- Set up a measurement location

recording sheet

Keeping records of each child over time enables tracking of growth longitudinally. The recording sheets
should include the height, weight, and other numerical data not only at a single measurement but overtime in a graph, and be bound into a healthcare notebook of the records for six years. By providing
sections for the children, families, and school to make comments, and having the children bring thehealthcare notebook home for families to write comments and then returning it to the school, the children
will be able to visually understand their growth, and both the school and family members can keep trackas well. Furthermore, by keeping records on eyesight and hearing, comparison of results can be madewith those of the last year, consequently the school can provide families with advice on points to note ineveryday life, and recommend medical consultation.

- Check clothing and belongingsat measurement

Records can not only be kept for saving individual growth but can also be used to statisticallyanalyze the health status of children throughout the school. By comparing the height, weight, and obesity

Figure 9.15 Flow of health checkups

of one’s school with national and regional values by age and sex, the health issues of one’s school can
be clarified and utilized for health education.
Figures 9.16 and 9.17 show the average and standard deviation for height and weight development

2) Let’s practice for measurement

among boys and girls through ages 6 to 12 years in Kandal Stueng County, Kandal Province, calculated
from data collected from nine schools that cooperated in the health checkup conducted by NGO Udon
House in 2019. For example, the left side of Figure 9.16 shows that between the +1SD and -1SD intervals,

Step 1: Let’s measure each other

there is approximately 68% of the boys in the sample for each age. In the same way, between +2SD and

Decide the roles (person measuring, person recording, and measured children) and measure alternately-2SD, approximately 96% of the boys in the sample are counted.

so that everyone has the chance to play all roles. After the measurement, discuss which part was difficult
and which should be improved.

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161

(cm)

Height-Boy(Average and standard deviation)

170.0

170.0

160.0

157.7
152.0

150.0
140.3

120.0

136.8
129.7

132.1

124.2

113.1

120.8

118.1
114.6

100.0 102.0
6

160.0

130.0

106.4

7

121.1

137.0

9

Age

128.0

10

11

12

+SD

+2SD

126.9

123.5
116.9
114.7

118.6

117.0

It is hence important to build a framework within the school. Ideally, teachers should be able to shareroles based on a common understanding, and the school should run the system for health checkups as awhole to ensure that checkups are conducted smoothly in a limited amount of time. It is also effective to

132.7

123.1

hold an internal training program for the significance and methods of health checkups or position healthcheckups as a school event.
It is necessary to draw up an implementation plan according to the size and situation of the school.
If the school has only a few teachers or many children, it is not necessary to take all the measurements

109.9

100.0 101.4
8

137.7

128.0

110.0

90.0

141.8

141.4

112.2

109.4

The understanding of managers and cooperation between teachers are indispensable for health checkups.

148.4

120.0

117.2

156.7

156.8

140.0

127.5
123.1

110.0

90.0

136.4

139.4

5. Implementation at schools
1) Importance of creating a school health organization

150.0

147.1

140.0
130.0

(cm)

Height-Girl(Average and standard deviation)

105.8

of all the children at once. The implementation plan should be reasonable and continuously implementable
at least once a year at the same time every year. Alternatively, by setting up a permanent health checkup

6

7

Average

8

9

Age

10

11

12

area in the Health Room, which is expected to become widespread in Cambodia, health checkup will
become more familiar to the children as a habit for them to check their own growth whenever they want.

-2SD

-SD

Health checkups serve an important health education opportunity for children to face and understandFigure 9.16 Average and standard deviation for height development among boys and girls

their bodies and should therefore be made good use of.

through ages 6 to 12 years -9 elementary schools in Kandal Stueng County, Kandal ProvinceColumn: Example of activities of Children’s Health Club (Figure 9.18)(kg)

Weight-Boy(Average and standard deviation)

60.0

(kg)

Weight-Girl(Average and standard deviation)

60.0
54.0

50.0

47.3

50.0

40.6
34.3

30.0
20.0

26.1

30.3

28.3

10.0
0.0

12.0

6

12.5

7

8
+2SD

24.9

13.6

9

Age

15.8

11
+SD

12

0.0

Average

Members have fun measuring the height and weight of friends and younger children, and test

22.9
18.2

16.7

10.0

10

Through repeated practice, they learn how to take measurements and perform tests correctly.

28.4

11.6

19.9

11.5

14.9
12.9

In neighboring Laos, there are elementary schools that actually operate children’s health clubs.
Children selected as members of the health club are taught by teachers about health checkups.

25.5

20.0
15.3

31.6

28.4

25.0

20.4

11.6

34.9

32.9

30.0

teachers, but also heighten the children’s interest in health, encouraging voluntary learning. For

the health of others and also make new discoveries.

36.5

32.0

27.9
23.0

19.1

40.0

how to conduct health checkups and doing it themselves, it will not only reduce the burden onclassmates and younger children how to take measurements provides the opportunity to think about

41.8

36.4

schools. One solution is to teach children to run the health checkup program together. By learning

example, having older children at the school organize a Children’s Health Club and teach their

48.4

44.7

40.0

Since there is a shortage of teachers in Cambodia, it is difficult to conduct health checkups in some

14.8

15.8

14.5

their eyesight and hearing. If a younger student of an ethnic minority who does not understand theLao language has difficulty taking the measurements and tests, an older student of the same ethnic
group will explain the tests thoroughly in the ethnic language, helping the younger student understand

6

7

8
-SD

9

Age

10

11

12

-2SD

Figure 9.17 Average and standard deviation for weight development among boys and girls

the procedure and take the health checkup smoothly.
For the Children’s Health Club to work, teachers must first understand the significance andmethods of health checkups. Teaching children and getting them involved in activities takes a lot oftime. But once these efforts take root, it will be a meaningful initiative that facilitates the managementof health checkups and deepens children’s learning.

through ages 6 to 12 years -10 elementary schools in Kandal Stueng County, Kandal Province162

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Significance of health checkups and their methods

163

Date/Implementation stage

Main details

ExampleImplementation
Preparation►Prepare required
items●Prepare the necessary items formeasurements and check if they
can be used without problems.
●Print the recording sheets.

►Provide priorinstructions●Check the purpose and methodof the health checkup, andpoints to note in measurements.
By practicing how to take theeye tests in advance, the test on
the day will proceed smoothly.
●Instruct children to fill in therequired information on therecording sheet. In the lower
grades, teachers can fill in themon their behalf beforehand.
●Check clothing and belongings
when taking the health checkup.

►Set up the place
to carry out
measurements/
tests●Use posters and signboards toindicate where the healthcheckup place is according to
the situation of the school.

Figure 9.18 Scene of a children’s health club (Laos)

2) Example of implementation (Plan – Implementation – Evaluation)
When you conduct health checkup in your school, you can refer to an example of the procedure forhealth checkup in school described in Table 9.3.
Table 9.3 The flow of from planning to evaluation of health check-up in school

Date/Implementation stage

Main details

Example●Consider the date and time andimplementation method.
Examples of methods include
measuring by grade or type over
several days, or measuring all
children over one day.
●Check the roles of teachers on
the day.
●Check the equipment and items
required on the day.
●It is advisable to set aside a day
to train teachers about healthcheckups, and/or a day to giveprior instructions to children,
apart from the day of themeasurement/test according to
the school situation.

●Date and time: HH:MM to
HH:MM on MMDD, HH:MM
to HH:MM on MMDD.
●Implementation method:
Perform all four measurements/
tests on all grades.
●Role: 6 persons carrying out
measurements, 6 to record
values, and two guides●One place each for measuring
weight, measuring height, andperforming hearing test
respectively. Two places for
performing eye tests as it takes
time.
●Give prior instructions tochildren on the day before.

●Find a suitable place formeasurements. Pick a place
where the health checkup canproceed smoothly.

●Appropriate places wereselected assuming that themeasurements will be carriedout in the order of weight →height → eye test → hearing
test.

Plan
►Prepareimplementation
plan

More than 1
week before►Decide place for
performing
measurements/
tests

164

Measure/record
Day before–
day ofmeasurement/
test►Performmeasurements●Precautions on height●Measure according to anmeasurement: Have children
appropriate method.
adopt a hairstyle suitable for●Call children’s attention if
measurement.
necessary.
●Precautions on weight●Prevent confusion among thechildren by having them line up, measurement: Have children
take off their jacket and take out
calling their names first before
everything from their pocket.
measurement, and placing●Precautions on eye test: Make
guides.
sure that children waiting in thevicinity do not tell those who
are taking the test the answers.
●Precautions on hearing test:
Make sure that children waitingin the vicinity do not makenoise.

►Take records●Write the results in the correct
fields.
●Be careful not to make errors inwriting.

●Record weight in “kg” andheight in “cm.”

Check►Check●Check for omissions or errors inmeasurements entered.
●Check that everyone has beenmeasured/tested.
●Make arrangements forabsentees to take the healthcheckup on a later day.

Chapter 9

Significance of health checkups and their methods

165

Date/Implementation stage

Main details

Example►Perform
screening●Based on the results of healthcheckups, identify student withhealth problems.
●Continue to keep records andcreate graphs for futureevaluations.

●Height / Weight: Evaluate
physique and growth.
●Eye test: Check for refractive
problems and visual
impairment, and the degree ofinterference with daily life.
●Hearing test: Check for hearing
loss or impairment, and thedegree of disability in daily life.

►Follow-up●Support for students with
●Support at school: Improve
weakening eyesight: Set theirlearning environment, provide
seats in the front row in thefollow-up, provide healthclassroom. Check their posture
education, and report to parents.
during class. Check if they can●If necessary, advise parents tosee writing on the blackboard
consult a health center, or aclearly during class. Provide
clinic.
health education on the use ofsmartphones. If school support
is not enough, encourage
parents to make eyeglasses fortheir children or visit basic eye
care services at provincial
health centers or
ophthalmological services inreferral-based hospitals.

Evaluation

Next day andafterwards

Exercises for further thought and research[9-1] Use your height and weight to calculate your BMI.

References[9-2] Share what you found difficult or noticed when measuring children. Also, calculate the average

1height and weight from the measurement results and compare them with the appropriate values
indicated by FIDR (Table 9.2) and the average value of Kandal Stueng County (Figures 9.16 and9.17). Calculate the Rohrer index with the children.

[9-3] Make a preliminary guidance plan for children. How can you convey the purpose and significanceof health checkups, measurement methods, and precautions to children in an easy-to-understandKobayashi M. Physical growth and development. New School Health. eds. Tokuyama M, Takehana Y, Mimura Y, Hiroko K. pp.120–
134. Higashiyama Shobo, 2019.

2

WHO. Obesity: preventing and managing the global epidemic. 2000. https://www.who.int/nutrition/publications/obesity/WHO_
TRS_894/en/

3

WPRO. The Asia-Pacific perspective: redefining obesity and its treatment. 2000. https://apps.who.int/iris/handle/10665/206936

4

The Japanese Society for Pediatric Endocrinology. Precocious puberty. http://jspe.umin.jp/public/sishunnki.html

5Japanese Society of School Health. Utilization of growth curve. In Health examination manual for schoolchildren. Supervised by
School Health Education Division of Sports and Youth Bureau, MEXT. 2015 revised edition: 68-71. https://www.gakkohoken.jp/

manner?

book/ebook/ebook_H270030/index_h5.html#%E8%A1%A8%E7%B4%99
6

FIDR. Cambodian Food-based Dietary Guidelines Brochure. 2017.

7

Japan Association for International Health. Anomalotrophy (Malnutrition). In International Health Glossary. https://seesaawiki.jp/w/

8

Cambodia Demographic and Health Survey 2014. 16 Nutrition of Children and Women 16.1 NUTRITIONAL STATUS OF

9Department of School Health, Ministry of Education, Youth and Sports, Cambodia. Guideline for Vision Testing in Schools. 2016.

jaih/d/%B1%C9%CD%DC%BC%BA%C4%B4%A1%CA%B1%C9%CD%DC%C9%D4%CE%C9%A1%CB
CHILDREN. p.173-178. https://dhsprogram.com/pubs/pdf/FR312/FR312.pdf
10 Sogbesan E, Yutho U. Cambodia’s national Eye Care Programme and VISION 2020: The Right to Sight. Community Eye Health13(36):57-59. 2000. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705982/
11 USAID, Cambodia–All Children Learning. Hearing and Vision Disability Screening Report. 2019. https://ierc-publicfiles.
s3.amazonaws.com/public/resources/Cambodia%20Screening%20Report_Approved.pdf
12 WHO. 1.1 billion people at risk of hearing loss. 2015. https://www.who.int/mediacentre/news/releases/2015/ear-care/en/

166

Chapter 9

Significance of health checkups and their methods

167Supplemental materials (Suppl.)
Health Checkup Recording Sheet (For individual data)

Name

Sex

Sample…No problem

Date of BirthMale

12/25/2009

Academic Year

2015-20162016-20172017-20182018-20192019-2020

2020-2021

Grade and Class

Grade 1A

Grade 2A

Grade 3A

Grade 4A

Grade 5A

Grade 6A

Month

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Age

6

7

7

8

8

9

9

10

10

11

11

Height

115.0

118.5

121.5

124.0

127.5

130.0

133.5

136.0

140.0

143.0

145.5

Weight

20.0

22.0

23.5

26.5

28.0

29.0

32.5

33.5

35.0

36.5

37.5

R



















L























R























L























GlassesGlassesGlasses

Small E Small E

Apr

Nov

Apr

Eyes

Ears

Suppl 9.1 E chart

Other

Health Checkup Recording Sheet (For class)Academic Year:
Grade and Class:

Health Checkup Recording Sheet (For individual data)

…No problem

No .

Name

Sex

Age

Date of BirthEx

SampleF1112/24/2009

Height (cm)Weight (kg)

Eye(R)

Eye(L)

Ear(R)

Ear(L)

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Apr

140.5

145

35.0

37.5







Small E

QS test…No problem

Other

Name

Sex

Date of Birth1
2

Academic Year

3
4

Grade and Class

5
6
7

Month

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Apr

Nov

Apr

8
9

Age

10
11

Height12
13

Weight

14
15

R

16

Eyes

17

L

18
19

R

20

Ears

21

L

22
23
24

Other

25

Suppl 9.2 Recoding sheet for class168

Suppl 9.3 Recording sheet for individual data
Chapter 9

Significance of health checkups and their methods

169

13

14

Date of Today:
Name:

Age:

Date of Birth:

Grade and Class:
CM

Male

FemaleWeight:KG

12Height:

Sex:

11

Eyes:

10

Ears:

Large E

<Right>NormalImpaired		<Left>

NormalImpaired

Small E

<Right>NormalImpaired		<Left>

NormalImpaired

Voice T

<Right>NormalImpaired		<Left>

NormalImpairedHearing T<Right>NormalImpaired		<Left>

NormalImpaired

9

Cutting off

7

8Date of Today:
Name:

Age:

Date of Birth:

Grade and Class:
CM

Male

FemaleWeight:KG

6Height:

Sex:

5

Eyes:

50
49
48
47
46
45
44
43
42
41
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14

Ears:

Large E

<Right>NormalImpaired		<Left>

NormalImpaired

Small E

<Right>NormalImpaired		<Left>

NormalImpaired

Voice T

<Right>NormalImpaired		<Left>

NormalImpairedHearing T<Right>NormalImpaired		<Left>

NormalImpaired

Weight (kg)Cutting off

12

13

14

Date of Today:
Name:

Age:

Date of Birth:

Grade and Class:

Height:

11

Eyes:

10

Ears:

CM

Sex:

Male

FemaleWeight:KG

Large E

<Right>NormalImpaired		<Left>

NormalImpaired

Small E

<Right>NormalImpaired		<Left>

NormalImpaired

Voice T

<Right>NormalImpaired		<Left>

NormalImpairedHearing T<Right>NormalImpaired		<Left>

NormalImpaired

9

Cutting off

6

7

8

Date of Today:
Name:

Age:

Date of Birth:

Grade and Class:

Height:

5

Eyes:

160
159
158
157
156
155
154
153
152
151
150
149
148
147
146
145
144
143
142
141
140
139
138
137
136
135
134
133
132
131
130
129
128
127
126
125
124
123
122
121
120
119
118
117
116
115
114
113
112
111
110
110
109
108
107
106
105
104
103
102
101
100

Ears:
Height (cm)Suppl 9.4 Recoding sheet for graphing

170

CM

Sex:

Male

FemaleWeight:KG

Large E

<Right>NormalImpaired		<Left>

NormalImpaired

Small E

<Right>NormalImpaired		<Left>

NormalImpaired

Voice T

<Right>NormalImpaired		<Left>

NormalImpairedHearing T<Right>NormalImpaired		<Left>

NormalImpaired

Suppl 9.5 Recoding sheet: brief version
Chapter 9

Significance of health checkups and their methods

171