PERCEIVED ROLE OF SCHOOL HEALTH SERVICES IN REDUCING

COMMUNICABLE DISEASE AMONG 100 LEVEL STUDENTS AT AHMADU BELLO

UNIVERSITY, ZARIA

By

USMAN ZAHARAU IZE

DEPARTMENT OF NURSING SCIENCES

FACULTY OF ALLIED HEALTH SCIENCES,
COLLEGE OF MEDICAL SCIENCES,
AHMADU BELLO UNIVERSITY, ZARIA.

MAY, 2025

i
 TITLE PAGE

PERCEIVED ROLE OF SCHOOL HEALTH SERVICES IN REDUCING

COMMUNICABLE DISEASE AMONG 100 LEVEL STUDENTS AT AHMADU BELLO
UNIVERSITY, ZARIA

By

USMAN ZAHARAU IZE

SUBMITTED TO
NURSING AND MIDWIFERY COUNCIL OF NIGERIA, IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE AWARD OF REGISTERED NURSING (RN)
CERTIFICATE

DEPARTMENT OF NURSING SCIENCES

FACULTY OF ALLIED HEALTH SCIENCES,
COLLEGE OF MEDICAL SCIENCES,
AHMADU BELLO UNIVERSITY, ZARIA.

MAY, 2025

i
 DECLARATION

I Usman Zaharau Ize declare that this project entitled “PERCEIVED SCHOOL HEALTH

SERVICES IN RELATION TO REDUCING COMMUNICABLE DISEASE AMONG

STUDENTS AT AHMADU BELLO UNIVERSITY, ZARIA” was carried out by me under the

supervision of Prof. A.B. Umar, to the best of my knowledge, it has not been Presented in any

form for any degree or certificate. All sources of information used are fully acknowledged

through references.

________________________ ________________________
Usman Zaharau Ize Date

ii
 CERTIFICATION

This is to certify that this project titled “PERCEIVED SCHOOL HEALTH SERVICES IN

RELATION TO REDUCING COMMUNICABLE DISEASE AMONG STUDENTS AT

AHMADU BELLO UNIVERSITY, ZARIA.” was carried out by Usman Zaharau Ize. Approved

by the undersigned in partial fulfillment of award of Registered Nurse.

_______________________ _____________________
Prof. A.B. Umar Date
(supervisor)

_______________________ _____________________
Dr. D.K. Sani Date
(Head of Department)

_______________________ _____________________
Name Date
External Examiner

iii
 DEDICATION

This study is dedicated to Almighty Allah for the strength, patience and knowledge to get

through with this project.

iv
 ACKNOWLEDGEMENT

All praises and gratitude to Allah for granting me the ability to finish this work successfully.

I wish to thank my supervisor Prof. A.B. Umar for her tireless efforts, corrections, observation

and advice he offered in the process of this project and his effort toward making this project a

successful one. I also wish to thank my parents Mr. and Mrs. Usman Audu for their sacrifices,

love, care and prayers may Allah SWA protect them against the evil, grant them good health,

wealth and peace in this world and reward them with Jannatul Firdaus in hereafter.

To my Siblings My siblings; Abdulhakim, Abdulzahir and Neemat, may Allah reward you

abundantly for your prayers.

Finally, to all my friends and family thank you for your support may Allah SWT reward you.

v
 ABSTRACT

School Health Services (SHS) play a vital role in promoting student well-being through health
education, disease prevention, and basic healthcare. In densely populated environments such as
universities, communicable diseases remain a major public health concern. This study assessed
the perceived role of SHS in reducing communicable diseases among 100-level students at
Ahmadu Bello University, Zaria. A cross-sectional descriptive survey design was employed,
using a self-structured questionnaire for data collection. A total of 180 respondents were selected
using stratified random sampling. Data were analyzed using means, frequencies, and
percentages. Findings revealed that most students had a positive perception of SHS, with over
85% agreeing that SHS help prevent disease spread and improve student health. However, gaps
remain in service utilization, with only 58.3% having used SHS and 52.8% citing lack of
awareness as a challenge. Other challenges included inadequate medical supplies, long waiting
times, and poor staff attitude. While basic preventive services like health education and hygiene
facilities were fairly known, awareness of immunization and isolation services was low. Overall,
students’ perceptions influenced their health-seeking behaviors, with positive experiences
encouraging utilization. The study highlights the need for improved staffing, medical resources,
and awareness campaigns to enhance the effectiveness of SHS in reducing communicable
diseases on campus.

Keywords: School Health Services, Communicable Diseases, Perception, Health-Seeking

Behavior

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 TABLE OF CONTENTS
TITLE PAGE................................................................................................................................i
DECLARATION.........................................................................................................................ii
CERTIFICATION......................................................................................................................iii
DEDICATION............................................................................................................................iv
ACKNOWLEDGEMENT...........................................................................................................v
ABSTRACT................................................................................................................................vi
TABLE OF CONTENTS...........................................................................................................vii
CHAPTER ONE..........................................................................................................................1
INTRODUCTION.......................................................................................................................1
1.1Background of the Study.........................................................................................................1
1.2 Statement of the Problem.......................................................................................................2
1.3 Aim of the Study....................................................................................................................3
1.4 Research Objectives...............................................................................................................4
1.5 Research Questions................................................................................................................4
1.6 Significance of the Study.......................................................................................................4
1.7 Scope of the Study.................................................................................................................5
1.8 Operational Definitions of Terms..........................................................................................6
CHAPTER TWO.........................................................................................................................7
LITERATURE REVIEW............................................................................................................7
2.1 Introduction............................................................................................................................7
2.2 Conceptual Review................................................................................................................7
2.2.1 Definition and Scope...........................................................................................................7
2.2.2. Principles of School Health................................................................................................7
2.2.3 Objectives of School Health Services.................................................................................9
2.2.4 Components of School Health Services............................................................................10
2.2.5 Requirements for the Provision of School Health Services..............................................11
2.2.6 Roles of School Health Services (SHS) in Preventing Communicable Diseases.............12
2.2.7 Challenges of School Health Services (SHS) in Preventing Communicable Diseases....14
2.2.8 Possible Solutions in Preventing Communicable Diseases..............................................15
2.2.9 Communicable diseases....................................................................................................16

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2.2.10 Transmission, Risk Factors, and Preventive Measures...................................................16
2.3 Theoretical framework.........................................................................................................17
2.3.1 Introduction.......................................................................................................................17
2.3.2 Overview of Systematic Theory.......................................................................................17
2.3.3 Identification of Key Concepts.........................................................................................18
2.3.4 Feedback Loops in the System Theory.............................................................................19
2.3.5 Identifying Inputs, Processes, and Outputs in the School Health System........................20
2.3.5 Relevance of Systematic Theory to the Study..................................................................22
2.3.6 Justification of System Theory in the study......................................................................22
2.4 Empirical Review.................................................................................................................23
2.5 Summary of Literature.........................................................................................................25
CHAPTER THREE....................................................................................................................27
METHODOLOGY AND METHODS.......................................................................................27
3.1 Introduction..........................................................................................................................27
3.2 Research Design...................................................................................................................27
3.3 Area of study........................................................................................................................27
3.4 Population of the Study........................................................................................................28
3.5 Sample Size..........................................................................................................................28
3.6 Sampling Technique............................................................................................................29
3.7 Instrument of Data Collection..............................................................................................29
3.8 Validity.................................................................................................................................30
3.9 Reliability.............................................................................................................................30
3.10 Method of Data Collection.................................................................................................30
3.11 Method of Data Analysis...................................................................................................30
3.12 Ethical consideration..........................................................................................................30
CHAPTER FOUR......................................................................................................................31
DATA PRESENTATION AND ANALYSIS...........................................................................31
4.1 Introduction..........................................................................................................................31
4.7 Open-Ended Responses........................................................................................................36
4.2 Summary of Findings...........................................................................................................36
CHAPTER FIVE........................................................................................................................39

viii
DISCUSSIONOF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS..................39
5.1 Introduction..........................................................................................................................39
5.2 Discussion of Findings.........................................................................................................39
5.2.1 Socio-Demographic Data..................................................................................................39
5.2.2 Perception towards the Role of School Health Services...................................................40
5.2.3 Challenges in Utilizing School Health Services...............................................................41
5.2.4 Influence of Perception on Health-Seeking Behavior.......................................................41
5.2.5 Awareness of Preventive Services....................................................................................42
5.2 Conclusion...........................................................................................................................43
5.3 Recommendations................................................................................................................43
5.4 Limitations of the Study.......................................................................................................44
5.5 Suggestions for Further Research........................................................................................45
REFERENCES...........................................................................................................................46

ix
 CHAPTER ONE

INTRODUCTION

1.1Background of the Study

School health services is a coordinated system that ensures a continuum of care from school to

home to community health care provider and back (Small et al.,2018), it plays a crucial role in

promoting student well-being and preventing the spread of communicable diseases within

educational institutions. These services include health education, routine medical screenings,

immunization programs, and prompt treatment of minor illnesses. The provision of these services

is particularly important in university settings, where students from diverse backgrounds live and

interact closely, increasing the risk of infectious disease transmission (Allensworth. D et al.,

1997).

Communicable diseases such as tuberculosis, respiratory infections, hepatitis, and

gastrointestinal infections are common in school environments due to overcrowding, poor

hygiene practices, and inadequate health awareness (World Health Organization [WHO], 2021).

Regrettably, many Nigerian universities failed to quickly adjust and adapt to the new methods of

service delivery which heavily depends on modern technologies. All academic activities in

Nigerian public universities were completely shut down due to lack of modern instructional

technologies to facilitate learning (Omorobi, & Eton, 2020). The effectiveness of school health

services in mitigating these risks largely depends on students' perception, utilization, and

adherence to preventive measures.

Ahmadu Bello University (ABU) Zaria, has a large student population, making disease

transmission a major concern, school health services aim to address health challenges among

1
students. However, there is a need to assess how well these services are perceived by students,

particularly those in their first year (100 level), who may have limited knowledge of available

health services and may be more vulnerable to diseases due to environmental changes and

lifestyle adjustments. Understanding students' perceptions can provide valuable insights into the

effectiveness of these services and highlight areas for improvement.

Despite the existence of school health programs, there is limited research focusing on how

students, especially first-year students, perceive these services in relation to reducing

communicable diseases. Identifying students’ views and experiences will help in strengthening

health policies and improving healthcare delivery within university settings.

1.2 Statement of the Problem

School Health Services (SHS) are integral to promoting student well-being by offering

preventive, curative, and health-promoting interventions. At the university level, these services

are crucial in mitigating the spread of communicable diseases, especially among first-year

students who are acclimating to new environments and communal living arrangements. Despite

the availability of school health service at Ahmadu Bello University, the effectiveness of these

services in reducing communicable diseases, as perceived by the students, remains

underexplored.

First-year students are particularly susceptible to communicable diseases due to factors such as

shared accommodations, increased social interactions, and a possible lack of awareness

regarding infection prevention. Studies have shown that university students often exhibit

overconfidence in their health and may engage in ineffective personal hygiene practices,

2
increasing the risk of infections within the university community (Kim et al., 2021).

Additionally, barriers such as stigma, lack of confidentiality, and inadequate knowledge about

available health services can hinder students from seeking appropriate care.

Existing literature suggests that effective implementation of school health services can

significantly control and prevent the spread of communicable diseases. However, research

indicates that the practice of various components of SHS is often suboptimal, with private

schools performing slightly better than public ones (Oyinlade et al., 2014). Moreover, a study

assessing students' perceptions of healthcare services revealed predominantly negative views,

despite widespread usage, highlighting the need for improvements in service delivery (Edidiong.

O et al., 2024).

Understanding students' perspectives is crucial in identifying gaps in service delivery and

enhancing health interventions tailored to their needs. This study aims to assess the perceived

role of school health services in reducing communicable diseases among 100-level students at

Ahmadu Bello University. The findings will provide insights into the strengths and weaknesses

of the current system and contribute to policy recommendations for improving student health and

well-being.

1.3 Aim of the Study

This study specifically seeks to evaluate students’ awareness, utilization, and perception of the

effectiveness of school health service in preventing and controlling communicable diseases. The

findings will provide insights into the strengths and gaps in school health service delivery and

offer recommendations for improving student health services.

3
1.4 Research Objectives

i. To assess the level of perception towards the role of school health services in reducing

communicable diseases among 100-level students of A.B.U, Zaria

ii. To identify challenges faced by students in utilizing school health services.

iii. To explore how students' perceptions of the health services influence their health-

seeking behaviors

iv. To assess the availiabilty of communicable diseases preventive measures provision in

school health service

1.5 Research Questions

i. How do 100-level students at A.B.U, Zaria perceive the role of School Health Services in

reducing communicable diseases?

ii. What are the challenges faced by 100-level students in utilizing School Health Services at

A.B.U, Zaria?

iii. How does students' perception of School Health Services influence their health-seeking

behaviors?

iv. To what extent are preventive measures for communicable diseases available within the

School Health Services at A.B.U, Zaria?

1.6 Significance of the Study

This study is significant as it provides valuable insights into the perceived role of School Health

Services (SHS) in reducing communicable diseases among 100-level students at Ahmadu Bello

University (ABU), Zaria. By assessing students' perceptions, challenges, and the availability of

preventive measures, the study will help university health administrators improve service

4
delivery and enhance disease prevention strategies. It will also raise awareness among students

about available health services, encouraging better utilization for improved health outcomes.

Additionally, healthcare providers can use the findings to address students' concerns and improve

patient-centered care. Policymakers will benefit from data-driven recommendations to strengthen

school health policies and ensure adequate preventive measures. Furthermore, this research will

serve as a foundation for future studies on student health services and communicable disease

control in university settings.

1.7 Scope of the Study

This study focuses on the perceptions of SHS and the challenges faced in utilizing these services

among 100-level students at Ahmadu Bello University (ABU), Zaria. It will specifically assess

students', the influence of their perceptions on health-seeking behaviors, and the availability of

preventive measures for communicable diseases within SHS. The study will be limited to first-

year students, as they are more vulnerable to infections due to communal living and possible lack

of awareness about university health services. Data will be collected from students enrolled in

various faculties within ABU, using structured questionnaires and/or interviews. The study will

not include other university populations, such as staff or upper-level students, and will focus only

on communicable diseases rather than other health concerns.

5
1.8 Operational Definitions of Terms

 Communicable Diseases: Infectious diseases that can be transmitted from one person to

another, such as respiratory infections, gastrointestinal illnesses, and other contagious

conditions commonly found in university settings.

 Health-Seeking Behavior: The actions taken by students to maintain or improve their

health, including their willingness to visit school health facilities, adhere to preventive

measures, and seek medical attention when necessary.

 Perception: The awareness, beliefs, and attitudes of 100-level students regarding the

effectiveness and role of School Health Services in preventing and controlling communicable

diseases.

 Preventive Measures: Health interventions provided by School Health Services to reduce

the spread of communicable diseases, such as vaccination, hand hygiene programs, and

health education.

 School Health Services (SHS): The preventive, curative, and health-promoting services

provided within the university to ensure the well-being of students, including immunization,

health education, screening, and treatment of minor illnesses.

 Utilization of Health Services: The extent to which students access and use the available

school health services for disease prevention, treatment, and health promotion.

6
 CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter reviews the roles of school health services in reducing communicable diseases

among students at Ahmadu Bello University. It defines health services, discusses communicable

diseases, and provides a theoretical framework and it also reviews empirical studies on the

effectiveness of these services in preventing disease outbreaks. It addresses challenges such as

inadequate funding, lack of awareness, and poor implementation in Nigeria. The review serves as

a foundation for understanding the study's significance.

2.2 Conceptual Review

2.2.1 Definition and Scope

School health services refer to organized programs and interventions designed to promote and

protect the health of students within a school setting. These services aim to enhance students'

physical, mental, and social well-being, ensuring they are in optimal health to learn effectively.

School health services include preventive, curative, and promotive health measures provided

within educational institutions to safeguard students' health (WHO,2020).

2.2.2 Principles of School Health

 Health Promotion and Education: School health services should focus on health

promotion and the prevention of illness through educational programs. This includes

teaching students about healthy lifestyles, nutrition, exercise, hygiene, and mental health

awareness.

7
 Accessibility: Health services should be easily accessible to all students, regardless of

their socio-economic status or location. Schools should ensure that students can obtain

medical care when needed without significant barriers.

 Comprehensive Health Services: School health services should provide a broad range of

services, including preventive care, first aid, screening for health issues (e.g., vision,

hearing), mental health services, and referrals to healthcare providers when necessary.

 Confidentiality: Students' privacy should be respected. Health services should maintain

confidentiality to encourage students to seek help without fear of stigma or breach of

privacy.

 Collaboration and Coordination: School health services should work closely with school

counselors, community health organizations, and other stakeholders to ensure that

students' health needs are adequately met.

 Prevention and Early Intervention: Emphasis should be placed on preventing health

issues before they occur (e.g., vaccinations, health screenings) and providing early

interventions to address problems as soon as they are identified.

 Individualized Care: Health services should be tailored to meet the unique needs of

individual students. This may include managing chronic conditions, providing

accommodations for disabilities, and offering support for mental health issues.

 Health and Safety in the School Environment: Schools should provide a safe and healthy

environment that minimizes the risk of accidents, injuries, and exposure to harmful

substances. This also involves promoting a safe emotional environment, preventing

bullying, and supporting mental health.

8
  Student Involvement: Encouraging student participation in health-related activities and

decision-making helps promote ownership of their own health and well-being.

 Continuous Evaluation and Improvement: School health services should be regularly

evaluated for their effectiveness, and improvements should be made based on feedback

from students, parents, and healthcare providers.

2.2.3 Objectives of School Health Services

 Health Promotion and Awareness: Educating students, teachers, and parents about

hygiene, nutrition, and disease prevention to encourage healthy behaviors.

 Disease Prevention and Control: Implementing strategies to reduce the spread of

communicable and non-communicable diseases through immunization, screening, and

health education.

 Provision of Health Services: Offering basic medical care, first aid, and referrals to

ensure early detection and management of health issues.

 Nutritional Support: Promoting balanced diets through school meal programs and

nutrition education to prevent malnutrition and obesity.

 Mental Health and Emotional Well-being: Addressing psychological issues such as

stress, bullying, and substance abuse by providing counseling and support systems.

 Healthy School Environment: Ensuring safe water supply, proper sanitation, clean

classrooms, and a safe playground to minimize health risks.

 Physical Education and Fitness: Encouraging exercise and sports participation to promote

physical fitness and reduce sedentary lifestyles.

9
  Health Policy Implementation: Developing and enforcing policies that support health

initiatives, such as tobacco-free zones, healthy eating policies, and accident prevention

measures.

 Early Detection of Health Issues: Conducting periodic health screenings to identify

vision, hearing, and developmental problems early for timely intervention.

 Integration with Community Health Services: Collaborating with local health agencies

and professionals to enhance the effectiveness of school health programs.

2.2.4 Components of School Health Services

 Health Education: The program focuses on teaching students about personal hygiene,

nutrition, disease prevention, and promoting healthy behaviors like handwashing and

safe sexual practices.

 Disease Prevention and Control: The strategies include vaccination programs to

prevent vaccine-preventable diseases, regular screening for communicable diseases,

and infection control measures to reduce disease spread.

 Medical Care and First Aid: The organization provides basic medical care for minor

illnesses and injuries, refers students with serious health conditions to healthcare

facilities, and ensures emergency care for accidents and medical crises.

 Environmental Health and Sanitation: The focus is on ensuring clean water and

sanitation, maintaining hygienic school environments to prevent disease outbreaks,

and managing waste and vector control to reduce health hazards.

10
  Nutrition and School Feeding Programs: The focus is on ensuring students' nutritional

status, providing balanced meals in school feeding programs, and educating them on

proper diet and healthy eating habits.

 Mental Health and Psychosocial Support: The organization's main goals are to

address mental health concerns among students, provide peer support programs and

counseling services, and encourage positive mental health through extracurricular

activities.

 Health Screening and Medical Examinations: Regular health check-ups are conducted

for students, including vision, hearing, dental, and general health. Chronic illnesses

are identified and managed, and growth and development are monitored.

 Safe and Supportive School Environment: The focus is on preventing bullying,

substance abuse, and violence in schools, fostering a positive, inclusive environment,

and enforcing policies that promote student health and well-being.

2.2.5 Requirements for the Provision of School Health Services

 Government Policies and Regulations: The policy outlines the legal framework for

implementing school health services, including guidelines for immunization, screenings,

and emergency care.

 Adequate Funding and Resources: The budget allocates for health programs, equipment,

and staffs and it also ensures the availability of essential medicines and first aid supplies,

and provides safe and hygienic school facilities.

11
  Qualified Health Personnel: School nurses, physicians, and counselors are provided with

basic health education and first aid training, as well as access to specialists for necessary

referrals.

 Comprehensive Health Programs: The program includes preventive care, emergency

response systems, first aid services, and mental health support and counseling.

 Health Facilities and Infrastructure: A well-equipped school clinic or health room, clean

drinking water and sanitation facilities, and proper ventilation and lighting in classrooms

are essential for a safe learning environment.

 Collaboration with Healthcare Agencies: Partnerships with hospitals, NGOs, and public

health agencies, referral systems for specialized medical care, and community

involvement in school health initiatives are key strategies.

 Health Education and Promotion: The school curriculum is incorporating health topics,

promoting awareness on hygiene, nutrition, and substance abuse, and promoting physical

activities and wellness programs.

 Monitoring and Evaluation: The school health services are regularly assessed, health data

is collected for program improvement, and feedback mechanisms are implemented for

students, parents, and staff.

2.2.6 Roles of School Health Services (SHS) in Preventing Communicable Diseases

 Health Education and Awareness: The program educates students on personal hygiene,

handwashing, sanitation, disease transmission and prevention, and conducts vaccination,

safe water use, and proper food handling campaigns.

12
 Immunization Programs: The initiative involves ensuring students receive routine

vaccinations, organizing school-based vaccination drives, and educating parents about the

importance of immunization.

 Early Detection and Screening: Regular health check-ups and screenings for infectious

diseases, early identification of communicable symptoms, referral for treatment,

monitoring outbreaks, and taking preventive actions are crucial.

 Infection Control Measures: Implementing hygiene and sanitation policies, ensuring

proper waste disposal, and encouraging students to cover their mouths when coughing or

sneezing are crucial for maintaining cleanliness and preventive measures.

 Isolation and Referral Services: The program involves identifying and isolating students

with contagious illnesses, referring them to healthcare centers for treatment, and

implementing temporary exclusion policies to prevent disease spread.

 Safe School Environment: The focus is on maintaining a clean and well-ventilated

learning environment, controlling overcrowding to prevent disease transmission, and

providing access to clean drinking water and proper food safety practices.

 Collaboration with Health Authorities: Collaborating with public health agencies to

manage school outbreaks, reporting communicable diseases for timely intervention, and

collaborating with hospitals, NGOs, and community health workers for disease

prevention programs.

 Promotion of Healthy Lifestyle Practices: Promoting balanced nutrition, promoting

physical activities, and addressing risk factors like substance abuse can enhance

immunity against infections and improve overall health.

13
  Mental Health Support: The program aims to provide counseling to students experiencing

illness-related stress and educate them on the impact of communicable diseases on their

mental well-being.

 Emergency Preparedness and Response: The plan involves developing a strategy for

managing disease outbreaks in schools, training teachers and students on emergency

response, and establishing quarantine protocols for suspected cases.

2.2.7 Challenges of School Health Services (SHS) in Preventing Communicable Diseases

 Inadequate Funding: The school health programs are facing challenges due to insufficient

budget allocation, lack of financial resources for vaccines, medical supplies, and health

education materials.

 Shortage of Trained Health Personnel: The shortage of school nurses, doctors, and

counselors, coupled with inadequate training in health education and first aid, poses

significant challenges for students.

 Poor Infrastructure and Facilities: School clinics are often lacking, leading to poor

sanitation, lack of clean water, and overcrowded classrooms, which in turn increase

disease risks.

 Low Awareness and Compliance: Some individuals, including students, parents, and

staff, may not take health education seriously, leading to resistance to vaccination and

misconceptions about communicable diseases.

 Weak Policy Implementation: The lack of strict enforcement of school health regulations

and inconsistent policies across different schools and regions are significant issues.

14
  Limited Access to Healthcare Services: Rural schools often struggle with accessing

medical professionals and referral services, leading to treatment delays due to long

distances from healthcare centers.

 Poor Hygiene Practices: The issue is primarily due to inadequate handwashing facilities

and waste disposal systems, as well as non-adherence to hygiene guidelines among

students and staff.

 Stigma and Fear: Students often avoid reporting illnesses due to fear of isolation or

discrimination, which can lead to mental health challenges due to anxiety related to the

disease.

 Outbreak Management Challenges: The rapid identification and control of disease

outbreaks is hindered by a lack of emergency preparedness plans in numerous schools.

2.2.8 Possible Solutions in Preventing Communicable Diseases

 Increased government funding and policy enforcement.

 Training teachers and hiring more healthcare workers in schools.

 Improving school infrastructure, including clinics, sanitation, and clean water supply.

 Strengthening partnerships between schools and local health authorities.

 Conducting awareness campaigns to encourage hygiene, vaccinations, and disease

prevention.

15
2.2.9 Communicable diseases

Communicable diseases remain a major public health concern in university settings due to their

rapid transmission, (WHO, 2023). Communicable diseases, also known as infectious diseases,

are illnesses caused by microorganisms such as bacteria, viruses, fungi, or parasites that can

spread from one person to another. Transmission occurs through direct contact, airborne

droplets, contaminated surfaces, food, water, or vectors like insects. Common communicable

diseases affecting university students includes Influenza (Flu),Common Cold, Meningitis,

Tuberculosis ,Sexually Transmitted Infections ,Gastroenteritis (Food Poisoning), Hepatitis B and

C,COVID-19, Scabies and Fungal Infections and so on

2.2.10 Transmission, Risk Factors, and Preventive Measures

Communicable diseases can be transmitted through various methods, including airborne, direct

contact, fecal-oral, vector-borne, and blood borne routes. University students living in

dormitories are at higher risk of respiratory infections like influenza and tuberculosis (Centers

for Disease Control and Prevention [CDC], 2022) other increased risk factors such as poor

hygiene practices, unprotected sexual activity, stress, inadequate nutrition, and limited healthcare

access. Preventive measures such as proper hand hygiene and vaccination have been shown to

significantly reduce infection rates (Smith et al., 2021) others include vaccination, good hygiene,

safe sexual practices, proper nutrition and hydration, avoiding crowded and unventilated areas,

seeking medical attention early, and regular health screenings. By addressing these factors,

university students can reduce the risk of contracting communicable diseases and improve their

overall health.

16
2.3 Theoretical framework

2.3.1 Introduction

This study is based on Systematic Theory, which explains how interconnected components

within a system interact to achieve a common goal (Von Bertalanffy, 1968). The theory is

suitable for analyzing how school health services function to reduce communicable diseases

among university students.

2.3.2 Overview of Systematic Theory

Systematic Theory (also known as General Systems Theory) was developed by Ludwig von

Bertalanffy (1968) and is widely applied in health sciences and education. The theory proposes

that an organization (such as a school health service) operates as a system with various

interdependent components that work together to maintain balance and achieve objectives. The

key principles of systematic theory includes:

 Interdependence: Different units within the system (e.g., students, healthcare providers,

policies) interact to influence health outcomes.

 Holistic Approach: The system should be examined as a whole rather than as isolated

parts.

 Feedback Mechanism: Continuous assessment and modification ensure effective service

delivery.

 Equilibrium: Proper functioning of all components leads to stability in disease

prevention.

17
2.3.3 Identification of Key Concepts

In the context of System Theory, school health services operate as an interconnected system

where different components work together to reduce communicable diseases among students

which includes:

i. Medical Personnel – Provide consultations, treatment, and referrals, managing acute and

chronic illnesses through routine check-ups.

ii. Health Education Programs – Raise awareness on disease prevention, hygiene, sexual

health, mental well-being, and substance abuse through workshops and peer education.

iii. Sanitation and Hygiene – Maintain clean facilities, handwashing stations, and safe

drinking water to prevent infections.

iv. Immunization Services – Administer vaccines against diseases like measles and polio in

collaboration with health agencies.

v. Disease Surveillance – Monitor illness patterns, conduct screenings, and report cases for

timely intervention.

vi. First Aid & Emergency Care – Provide immediate treatment for minor injuries and

medical emergencies.

vii. Nutritional Support – Ensure food safety, balanced diets, and nutrition education to

prevent malnutrition.

18
2.3.4 Feedback Loops in the System Theory

 Positive Feedback Loops (Reinforcing System Efficiency)

- Student Awareness → Increased Health-Seeking Behavior → Improved Health

Outcomes: When students perceive health services as effective, they are more likely to

seek medical help, this leads to early diagnosis and treatment, preventing disease

outbreaks.

- Effective Surveillance → Rapid Response → Disease Containment: If the school health

system detects an outbreak early, intervention measures (e.g., quarantine, vaccination

drives) are implemented quickly. The cycle reinforces the system’s effectiveness in

disease prevention.

 Negative Feedback Loops (System Weakness & Decline)

- Poor Student Perception of Services → Reduced Utilization → Increased Disease

Spread: If students perceive school health services as ineffective (e.g., long wait times,

inadequate care), they may avoid seeking medical help. Undiagnosed infections spread,

leading to higher disease prevalence.

- Inadequate Sanitation → Increased Infections → Higher Healthcare Burden: Poor

maintenance of hygiene facilities results in higher infection rates. Increased disease cases

overwhelm school healthcare providers, reducing service quality.

2.3.5 Identifying Inputs, Processes, and Outputs in the School Health System

 Inputs (Resources Required for the System to Function)

19
These are the foundational elements necessary to implement school health services effectively:

- Funding & Budget Allocation – Supports medical services, immunization programs,

sanitation, and health education.

- Health Policies & Regulations – Institutional and government guidelines that ensure

proper healthcare practices in schools.

- Medical Personnel & Staff – Doctors, nurses, health educators, and sanitation workers

who execute health programs.

- Infrastructure & Facilities – Functional health clinics, clean toilets, handwashing stations,

and waste disposal systems.

- Medical Supplies & Equipment – Vaccines, first aid kits, medications, and protective

gear.

- Community & Stakeholder Support – Collaboration with local health agencies, NGOs,

and public health authorities.

 Processes (Activities That Convert Inputs into Health Benefits)

These are the core functions carried out within the school health system to prevent and control

communicable diseases:

- Health Education & Awareness Campaigns – Teaching students about personal

hygiene, disease prevention, and proper nutrition.

- Medical Screening & Routine Check-Ups – Identifying and addressing potential

infections before they spread.

20
 - Immunization Programs – Administering vaccines to protect students from preventable

diseases.

- Sanitation & Hygiene Measures – Ensuring availability of clean water, proper waste

disposal, and hygienic facilities.

- Surveillance & Disease Monitoring – Tracking outbreaks and implementing timely

interventions.

- Emergency Response & Treatment Services – Providing first aid and medical care for

illnesses and injuries.

 Outputs (Results & Benefits of the System’s Functioning)

The expected outcomes when the school health system operates efficiently include:

- Reduction in Communicable Diseases – Lower infection rates due to preventive

measures and early detection.

- Improved Student Health & Well-Being – Fewer health-related absences and enhanced

academic performance.

- Increased Awareness & Behavioral Change – Students adopting better hygiene

practices and seeking healthcare services.

- Stronger Community Health Resilience – The school acting as a model for disease

prevention within the broader community.

21
2.3.5 Relevance of Systematic Theory to the Study

Systematic Theory is highly relevant to this study as it provides a structured approach to

understanding how various components of school health services work together to reduce

communicable diseases among students.

 It explains the interconnected relationship between health interventions and student

well-being, highlighting how medical care, health education, sanitation, and

immunization collectively contribute to disease prevention and overall academic

performance.

 It offers a comprehensive framework for assessing the effectiveness of school health

services by analyzing inputs (resources), processes (health interventions), and outputs

(student health outcomes), ensuring a holistic evaluation.

 It aids in identifying gaps and areas for improvement within existing health programs,

enabling stakeholders to refine policies, allocate resources effectively, and implement

targeted strategies to enhance disease prevention efforts in the university setting.

2.3.6 Justification of System Theory in the study

System Theory is the ideal framework for the study because school health services function as an

interdependent system where changes in one component affect the entire system.

 Interdependence of Components

- If sanitation is poor, the medical personnel will face a higher burden of infections.

- If students are not educated on hygiene, they may continue risky behaviors, reducing the

impact of health services.

22
  Feedback Loops for Continuous Improvement

- Positive feedback (e.g., effective health education leading to better student hygiene)

strengthens the system.

- Negative feedback (e.g., poor perception of health services discouraging utilization)

signals areas for improvement.

 Improving One Aspect Can Strengthen the Whole System

- Enhancing student awareness leads to increased health-seeking behavior and better

hygiene, reducing disease spread.

- Investing in sanitation and health facilities improves student participation and service

effectiveness.

2.4 Empirical Review

The school health service plays a vital role in promoting student well-being and preventing

communicable diseases. University students, particularly freshmen are vulnerable due to

increased exposure, communal living, and lifestyle changes. This section reviews previous

studies on school health services, common communicable diseases among students, behavioral

factors influencing healthcare use, and barriers to accessing health services. Several studies have

explored students' perceptions of school health services and their role in preventing

communicable diseases. Basch (2011) conducted a study on student perceptions of healthcare

services and found that awareness and utilization of school health programs significantly

influence the reduction of disease outbreaks. Similarly, a study by Odebiyi et al. (2019) at Afe

Babalola University, Nigeria, revealed that students who had positive perceptions of health

23
services were more likely to participate in preventive health measures such as vaccination and

routine check-ups. In another study, Jourdan et al. (2008) highlighted that comprehensive school

health programs improved student health outcomes and contributed to the early detection and

prevention of communicable diseases.

Several barriers hinder students' access to healthcare services. A study by Wellfleet (2023)

identified six key challenges affecting student healthcare utilization, including financial

constraints, lack of awareness, stigma, and long waiting times. A similar study by Amoran et al.

(2014) found that inadequate funding and insufficient medical personnel in university health

services in Nigeria contributed to low utilization rates. Additionally, research conducted by the

World Health Organization (2021) emphasized the role of limited resources and students’

reluctance to seek medical help due to social stigma in reducing the effectiveness of school

health programs.

Student perception significantly influences their willingness to seek healthcare services.

Research by Adebayo et al. (2017) found that students with a negative perception of health

services, due to previous experiences of inadequate treatment, were less likely to visit school

health centers. A study by Ajayi et al. (2020) further supported this finding, revealing that trust

in healthcare providers and service efficiency positively correlated with students’ health-seeking

behaviors. Additionally, research by Aluko et al. (2016) showed that when students were actively

engaged in health education programs, their likelihood of utilizing school healthcare services

increased.

The provision of preventive measures in school health services varies across institutions. The

Centers for Disease Control and Prevention (CDC, 2021) conducted a study that found that

24
schools with well-equipped sanitation and hygiene facilities had lower infection rates among

students. Similarly, a study by the Minnesota Department of Health (2023) emphasized the role

of infection prevention measures, such as vaccination campaigns and proper waste disposal, in

reducing disease spread. Furthermore, research by the American Academy of Pediatrics (2022)

reported that schools that actively implemented communicable disease control programs

experienced fewer outbreaks compared to those with limited health services.

2.5 Summary of Literature

School health services are crucial in promoting student well-being and preventing the spread of

communicable diseases, particularly among first-year university students. Studies have shown

that well-structured school health services significantly contribute to reducing infection rates

among students. Preventive measures such as vaccinations, routine medical checkups, health

education, and hygiene promotion have been linked to lower infection rates. However,

respiratory infections, sexually transmitted infections (STIs), and gastrointestinal diseases are

among the most prevalent communicable diseases affecting university students. Factors such as

poor hygiene, contaminated food, and risky sexual behaviors contribute to the high incidence of

these infections.

Students' awareness of disease prevention and attitudes toward healthcare services play a crucial

role in determining their health-seeking behaviors. Researchers have applied behavioral theories

to understand why some students utilize school health services while others do not. The Health

Belief Model suggests that students' perceived susceptibility to infections influences their

likelihood of seeking healthcare services. The Theory of Planned Behavior highlights the role of

peer influence, personal attitudes, and perceived control over health choices in determining

25
whether students seek medical care. Social pressure and accessibility to healthcare facilities also

impact their decisions.

Despite the availability of school health services, students often face several barriers that limit

their access to healthcare. Lack of awareness, fear of stigma, long waiting times, a shortage of

healthcare professionals, and cultural and religious beliefs can discourage students from seeking

medical attention. Addressing these barriers requires targeted interventions such as improving

health service awareness, ensuring confidentiality in healthcare delivery, and expanding medical

staff and facilities within the university.

There is limited research specifically focused on first-year university students and their unique

health challenges. This study aims to bridge these research gaps by assessing students'

perceptions of school health services in preventing communicable diseases at Ahmadu Bello

University. By applying behavioral theories, the findings will guide university policies to

enhance student health services and promote disease prevention strategies. Addressing research

gaps and implementing policy recommendations will enhance the role of school health services

in ensuring better health outcomes for students.

26
 CHAPTER THREE

METHODOLOGY AND METHODS

3.1 Introduction

This chapter presents the research methodology adopted for the study. It discusses the research

design, population, sample, data collection methods, instruments used, data analysis techniques,

ethical considerations, and limitations of the study to gain insights into students' views on

healthcare services.

3.2 Research Design

This study uses a descriptive cross-sectional research design to assess students' perceptions of the

effectiveness of health services at Ahmadu Bello University Zaria. The design allows for a

snapshot of current perceptions and aims to establish associations between perceived quality and

effectiveness.

3.3 Area of study

This study was conducted at Ahmadu Bello University (A.B.U), Zaria, located in Zaria, Kaduna

State, Nigeria. A.B.U is one of the largest and most reputable universities in Sub-Saharan Africa,

with a diverse population of students from various cultural and socio-economic backgrounds.

The university has a comprehensive school health service unit within its medical and health

services department, which plays a significant role in promoting student health and preventing

communicable diseases. The focus will specifically be on 100-level undergraduate students, who

are in their first year of university and are often more vulnerable to communicable diseases due

to changes in environment, lifestyle, and exposure to new communities.

27
3.4 Population of the Study

The population of this study comprises 100-level undergraduate students of Ahmadu Bello

University (A.B.U), Zaria) for the 2024/2025 academic session. It is estimated to be over 5,000

based on the average annual admission rate of the university. These students are drawn from

various faculties and departments and represent a diverse demographic. They are selected for this

study because they are new to the university system and may be at higher risk of exposure to

communicable diseases. Their perceptions provide valuable insight into the effectiveness of

school health services in promoting health and preventing disease outbreaks. (Management

Information System Unit ABU, 2024/2025 academic session).

3.5 Sample Size

The sample size of this research is calculated by using Taro Yamane (Yamane, 1973) formula

with 90% confidence level. The calculation of the Yamane is presented as follows;

N
n= 2
1+ N (e )

Where

n = sample size required,

N=total population of study

e=the acceptable sample error

With 90% confidence level i.e. e=0.1

5000 5000
n= 2 , n= , n≈197(rounded)
1+5000 (0.07 ) 1+24.5

To improve the accuracy of results and account for possible non-responses, the sample size was

increased to 200 students.

28
3.6 Sampling Technique

A stratified random sampling technique was employed to select participants for this study.

The 100-level students of Ahmadu Bello University (A.B.U), Zaria, were stratified based on

their respective faculties to ensure proportional representation across different academic

disciplines. A random selection of students was made using the proportionate allocation

method, which allowed for fairness and equal chances of participation among students in each

faculty. This method was chosen to minimize bias and ensure that the sample accurately reflects

the diversity of the target population.

A total of 200 students were selected to participate in the study. The sample size was determined

using Yamane’s formula, applying a 7% margin of error due to time and logistical constraints.

The stratified random sampling technique ensures that the findings can be generalized to the

larger population of 100-level students within a reasonable level of confidence.

3.7 Instrument of Data Collection

Using a stratified random sampling method, data was collected using structured

questionnaires with closed-ended questions. The questionnaire was divided into four

sections:

- Section A: Consist of questions on demographic characteristics of the respondent

Section B: Entails questions about the Awareness of School Health Services

- Section C: Entails questions about Perception of School Health Services in

Preventing Communicable Diseases

- Section D: Consist of questions on Behavioral Impact

29
3.8 Validity

The supervisor was given a draft copy of the questionnaire to review and make changes to in

order to assess the validity of the instrument in order to guarantee precise and comprehensive

measurement from the instrument.

3.9 Reliability

Reliability of data collection instruments is crucial for consistent results. Internal consistency is

assessed using Cronbach's alpha, while test-retest reliability is determined through a pilot study,

comparing the same questionnaire to different groups over time. (Tavakol & Dennick, 2011).

3.10 Method of Data Collection

Data was gathered using a structured, closed-ended questionnaire; prior to data collection, the

respondent's consent was obtained.

3.11 Method of Data Analysis

To be able to effectively summarize and present the data, descriptive statistical measures like

frequency distribution tables and percentage were used. This made it easier to spot trends and

patterns in the way that students perceived the school health services.

3.12 Ethical consideration

The research ensured confidentiality and privacy when distributing the questionnaire and

gathering data from the respondent. They were not penalized for filling out the questionnaire

incorrectly, nor were they told to write their name on it.

30
 CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

4.1 Introduction

This chapter describes the presentation and analysis of findings. It is guided by the research

objectives and questions formulated in Chapter One. The data collected through the use of

questionnaires have been organized and presented using descriptive statistical tools such as

frequencies, percentages, tables, charts, and graphs where necessary. A total of 200 structured

self-administered questionnaires were issued out of which 180 were returned and analyzed.

Table 4.1 Socio-Demographic Characteristics of Respondents

Variable Frequency Percentage (%)

Age in years
16–18 60 33.3
19–21 75 41.7
22–24 30 16.7
>25 15 8.3
Total 180 100.0
Gender
Male 85 47.2
Female 95 52.8
Total 180 100.0
Heard of SHS
Yes 150 83.3
No 30 16.7
Total 180 100.0
Used SHS
Yes 105 58.3
No 75 41.7
Total 180 100.0

Table 4.1 shows that majority of respondents were between 19 and 21 years old (41.7%), and
8.3% were aged 25 and above. More than half (58.3%) had utilized school health services, while
83.3% were aware of them."

Table 4.2 Perception towards the Role of School Health Services among 100 level students
in Ahmadu Bello University.
31
Statements Agree (SA+A) Disagree (SD+D)

F % F % Mean
SHS are important 155 86.1 25 13.9 3.22
in preventing
communicable
diseases
The school health 155 86.1 25 13.9 3.22
unit plays a vital role
in improving student
health
SHS contribute to 154 85.6 26 14.4 3.21
reducing the spread
of infections
The school creates 110 61.1 70 38.9 2.72
enough awareness
about disease
prevention
Confidence in SHS 110 61.1 70 38.9 2.72
to manage health
concerns
Aggregate mean 3.02

Table 4.2 shows that most respondents had a positive perception of SHS. About 86.1% agreed

that SHS help prevent communicable diseases and improve student health, while 85.6% believed

SHS reduce the spread of infections. However, only 61.1% felt the school created enough

awareness or had confidence in the SHS. The mean scores for these items were lower, suggesting

moderate agreement. With an aggregate mean of 3.02, the overall perception was positive,

though awareness and trust in SHS can still be improved. This supports findings from other

studies showing that awareness doesn’t always equal full satisfaction.

Table 4.3 Responses to Challenges in Utilizing School Health Services 100 level students in
Ahmadu Bello University.

32
 Challenge Frequency Percentage (%)

Lack of awareness about SHS 95 52.8

Inadequate medical personnel 80 44.4

Long waiting times 75 41.7

Poor attitude of staff 70 38.9

Inadequate drugs or medical supplies 90 50.0

Distance/accessibility 55 30.6

Embarrassment or stigma 40 22.2

Other (e.g., lack of privacy) 20 11.1

Table 4.3 shows that the most frequently cited challenges were lack of awareness (52.8%) and

inadequate drug supply (50%). Long wait times and staff attitude were also significant

concerns."

Table 4.4 Response to Influence of Perception on Health-Seeking Behavior

33
 Statements Agree (SA+A) Disagree (SD+D)
F % F % Mean

My opinion affects 50 27.8 3.00

whether I seek help 130 72.2
at SHS
I prefer self- 120 66.7 60 33.3 2.92
medication due to
lack of trust in SHS
Positive experiences 150 83.3 30 16.7 3.22
motivate me to
return to SHS

I would advise 145 80.6 35 19.4

others to
use SHS

Aggregate mean 3.09

Table 4.4 shows a generally favorable view of School Health Services (SHS) among the

students. The mean scores for all the statements ranged from 2.92 to 3.22, with an aggregate

mean of 3.09.

Table 4.5 Response to Awareness of Preventive Services

34
 Services Frequency Percentage (%)

Health education/awareness programs 120 66.7

Immunization services 70 38.9
Screening for communicable diseases 90 50.0
Provision of handwashing/sanitizing facilities 110 61.1
Isolation for sick students 40 22.2
Posters/flyers distribution 85 47.2
Counseling on hygiene practices 100 55.6

Table 4.5 shows that health education/awareness programs recorded the highest awareness level

at 66.7%, indicating that most students recognize educational initiatives, possibly due to regular

talks, seminars, or visible campaigns within the school environment. Handwashing/sanitizing

facilities and counseling on hygiene practices followed closely with 61.1% and 55.6% awareness

respectively. These figures suggest that students are fairly informed about basic hygiene-

promoting services, likely because they are physically present and routinely used. Screening for

communicable diseases was reported by 50%, showing moderate awareness. This might point to

occasional or targeted screening efforts, such as during outbreaks or health weeks. Posters and

flyers had a 47.2% response, implying that while materials are available, their impact or

visibility may be limited. Immunization services showed a low awareness level of 38.9%, and

isolation for sick students was the least known service at only 22.2%. These low percentages

reflect a potential gap in communication or underutilization of these crucial services.

4.7 Open-Ended Responses

Q1: Describe the role of School Health Services in preventing disease spread

35
Many respondents described school health services as essential in promoting health education,

raising awareness, and providing early treatment. They noted that SHS help prevent the

spread of infections through activities such as hygiene campaigns, health screenings, and

prompt care for sick students while others complained about their dissatisfaction with SHS.

“The school health service is indispensable in preventing disease spread amongst students and

staffs alike: if used effectively”

“Nonchalant attitude.”

Q2: Suggestions for improving SHS

Students suggested hiring more qualified staff, improving public awareness of SHS, and

upgrading facilities and equipment. They also recommended reducing waiting times, improving

staff attitude, and ensuring privacy during consultations. Some called for more health campaigns

across faculties.

“Better/more supplies and drugs.”

“Restructuring of the whole unit by giving orientation to the staff on how to take proper care of
the students”

4.2 Summary of Findings

 Objective 1: To assess the level of perception towards the role of school health services

(SHS) in reducing communicable diseases

The study shows that most respondents view School Health Services (SHS) positively.

About 86.1% agreed SHS help prevent communicable diseases and improve student

health, while 85.6% believed they reduce the spread of infections. However, only 61.1%

36
 felt there was enough awareness about SHS, and the same percentage expressed

confidence in the services. With an aggregate mean score of 3.02, the overall perception

is positive, though improvements in communication and trust are still needed.

 Objective 2: To identify challenges faced by students in utilizing school health services.

The study identified several key challenges affecting the utilization of School Health

Services (SHS). A lack of awareness was the most reported issue, cited by 52.8% of

respondents. This was followed by inadequate drugs or medical supplies (50%), a

shortage of medical personnel (44.4%), long waiting times (41.7%), and poor staff

attitude (38.9%). These findings highlight that both resource constraints and service

delivery issues significantly hinder the effectiveness and accessibility of SHS.

 Objective 3: To explore how students' perceptions of the health services influence their

health-seeking behaviors.

The study found that students’ perceptions significantly influence their engagement with

School Health Services (SHS). About 72.2% reported that their personal opinion affects

their decision to seek help from SHS, while 66.7% preferred self-medication due to a lack

of trust. On the other hand, 83.3% stated that positive experiences encouraged them to

return, and 80.6% said they would recommend SHS to others. With an aggregate mean

score of 3.09, the data clearly indicate that trust and previous experiences play a key role

in students’ willingness to use SHS.

 Objective 4: To assess the availability of communicable disease preventive measures in

SHS.

The study revealed that the most commonly known School Health Services (SHS)

include health education programs (66.7%), handwashing and sanitizing facilities

37
(61.1%), and hygiene counseling (55.6%). However, less-known services such as

immunization (38.9%) and isolation for sick students (22.2%) were identified. These

findings suggest that while basic hygiene education is well-publicized, more critical

services like immunization and isolation are underutilized or poorly communicated to

students.

38
 CHAPTER FIVE

DISCUSSIONOF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

5.1 Introduction

This chapter discusses the findings of the study, summary, conclusion and recommendations of

the study.

5.2 Discussion of Findings

5.2.1 Socio-Demographic Data

Looking at the socio-demographic characteristics of the respondents, a majority of them fell

within the age group of 19-21 years, representing 41.7% of the total sample. This was followed

by those in the 16-18 age group, which accounted for 33.3% of the respondents. Respondents

aged between 22-24 years made up 16.7%, and those above 25 years represented 8.3%. This

shows that most of the participants were relatively young, with a large proportion in their late

teens and early twenties, which is consistent with the 100-level student population of Ahmadu

Bello University, Zaria. In terms of gender, the study sample was fairly balanced, with 52.8% of

respondents being female and 47.2% male. This gender distribution is reflective of the overall

student population in the university, indicating no significant gender shift in the sample.

Regarding awareness of school health services (SHS), an overwhelming majority of the

respondents, 83.3%, reported that they had heard of SHS, while 16.7% had not. This suggests

that SHS is relatively well-known among the students, which aligns with the university's efforts

to provide health services and promote them to students. As for the use of SHS, 58.3% of

respondents indicated they had used the services, while 41.7% had not. This is a relatively high

39
rate of service utilization, but it also indicates that there is room for improvement in encouraging

more students to access SHS, especially considering the awareness level is high. When compared

to studies such as Odebiyi et al. (2019) at Afe Babalola University, Nigeria, who highlighted the

importance of raising awareness about health services it showed that students who had positive

perceptions of health services were more likely to participate in preventive health measures such

as vaccination and routine check-ups.

5.2.2 Perception towards the Role of School Health Services

The majority of respondents (86.1%) agreed that School Health Services (SHS) are important in

preventing communicable diseases, indicating strong awareness of their role. Most students

(59%) learned about SHS within the university, which aligns with the high level of knowledge

about its significance in promoting health. Additionally, 86.1% of students agreed that the school

health unit plays a vital role in improving student health, and 85.6% acknowledged its

contribution to reducing infections. However, while many students recognize the importance of

SHS, 61.1% felt that the university does not create enough awareness about disease prevention,

and only 61.1% expressed confidence in SHS’s ability to manage health concerns. This suggests

that while students are aware of SHS, there is room for improvement in both awareness

campaigns and the quality of services offered. These findings align with studies such as Dieu-My

et al (2021), which show that students exhibit health seeking behaviors and are aware of the

importance of SHS but may have concerns regarding barriers to accessing care.

40
5.2.3 Challenges in Utilizing School Health Services

The study identified several challenges to accessing School Health Services (SHS). 52.8% of

respondents cited lack of awareness about SHS as a major challenge, indicating communication

gaps. 44.4% reported inadequate medical personnel, and 50% highlighted a lack of drugs or

medical supplies, suggesting resource limitations. 41.7% of respondents experienced long

waiting times, which was also a key concern in this study, where 37% identified it as a major

barrier. Additionally, 38.9% mentioned poor staff attitude, which contributed to 67% of students

feeling uncomfortable accessing SHS. Other challenges included 30.6% citing

distance/accessibility and 22.2% mentioning embarrassment or stigma. These findings reflect

broader issues such as resource shortages and social factors that hinder SHS utilization, similar

to challenges reported in other studies. These findings are consistent with those of similar

studies, such as Linda (2024), where issues like long wait times and lack of trust in the services

were reported as major obstacles. Improving these areas could lead to better utilization of SHS

among students.

5.2.4 Influence of Perception on Health-Seeking Behavior

Regarding perceptions and health-seeking behavior, the findings show that students' views

significantly influence their use of School Health Services (SHS). About 77.8% of respondents

agreed that their perception affects whether they seek help at SHS, indicating that trust and

experience play a strong role in utilization.

41
While 83.3% of respondents stated they would recommend SHS to others, suggesting a generally

positive impression, 66.7% still preferred self-medication due to a lack of trust in SHS. This

shows a gap between perceived usefulness and actual confidence in the services provided.

Furthermore, 83.3% of students agreed that positive past experiences motivated them to return to

SHS. This underlines the importance of quality care and staff behavior in shaping repeat visits

and trust in school health programs. Overall, while many students acknowledge the role and

importance of SHS, challenges such as trust and perceived effectiveness continue to influence

whether or not they seek care through these services.

5.2.5 Awareness of Preventive Services

In terms of awareness of preventive services provided by the School Health Services (SHS), the

findings reveal varying levels of knowledge among students. The majority of respondents

(66.7%) were aware of health education and awareness programs, which indicates that

informational efforts have been somewhat effective. Additionally, 61.1% reported awareness of

handwashing and sanitizing facilities, and 55.6% were aware of counseling on hygiene practices,

showing a fair understanding of basic preventive measures. However, awareness of more specific

services like immunization (38.9%) and isolation for sick students (22.2%) was relatively low.

This suggests that while general health education is reaching students, information about critical

preventive interventions may not be sufficiently communicated. Awareness of screening for

communicable diseases (50%) and the distribution of posters or flyers (47.2%) also reflects a

moderate level of visibility for SHS campaigns. These results highlight the need for improved

visibility and communication about all available services, especially those directly tied to

42
preventing the spread of infections, to enhance utilization and effectiveness of SHS among

students.

5.2 Conclusion

This study concludes that while students at A.B.U, Zaria generally perceive school health

services as important for preventing communicable diseases, there are significant barriers to fully

utilizing these services. The primary challenges identified include lack of awareness, inadequate

medical personnel, and accessibility issues. Therefore, it is evident that while SHS is seen as

important by students, the overall effectiveness of the service is limited by these barriers.

In conclusion, there is a clear need for improvements in the SHS to ensure that they meet the

needs of students and effectively contribute to reducing the spread of communicable diseases.

The study underscores the necessity of addressing both the perception and the practical

challenges faced by students in accessing these services.

5.3 Recommendations

Based on the findings of this study, the following recommendations are proposed:

 Increase awareness: The University should launch awareness campaigns to ensure that

students are informed about the existence and services offered by SHS. This could

include orientation programs, posters, social media campaigns, and faculty-specific

outreach initiatives.

 Improve staffing and training: The SHS unit should recruit more qualified medical

personnel to meet the demand for services. Additionally, training for staff in patient-

43
 centered care, communication, and disease management could improve service quality

and reduce student dissatisfaction.

 Upgrade facilities and resources: The SHS should be equipped with adequate medical

supplies, improve waiting areas, and ensure that medical personnel have access to

necessary tools for diagnosis and treatment.

 Reduce waiting times: To address the issue of long waiting times, SHS should explore

appointment scheduling or triage systems to prioritize urgent cases and reduce

overcrowding.

 Foster collaboration: SHS should collaborate with academic departments to integrate

health education into curricula and provide regular health screenings, ensuring that

students are continuously educated on disease prevention.

 Enhance privacy and reduce stigma: Ensuring confidentiality and improving the

overall atmosphere of the SHS could help reduce the stigma some students may feel

when seeking care, encouraging more students to access services when needed.

5.4 Limitations of the Study

While this study provides valuable insights, there are some limitations. The study was conducted

only among 100-level students at A.B.U, Zaria, and therefore, the results may not fully represent

the perceptions of students in other levels or faculties. Additionally, self-reported data could be

subject to biases, such as students overstating or understating their awareness or usage of SHS.

Future studies could expand the sample size to include students from different academic levels

and campuses.

44
5.5 Suggestions for Further Research

Future research could investigate the impact of SHS on actual student health outcomes such as

the reduction in the incidence of communicable diseases following the implementation of

targeted interventions. Additionally, a comparative study between institutions with varying levels

of health service provisions could provide a broader perspective on the effectiveness of school

health services. Finally, further studies could explore the students' satisfaction with specific

aspects of SHS, such as the quality of care, staff attitude, and the accessibility of services.

45
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