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As in most countries worldwide, Sub-Saharan African countries are striving to build their human capital so they can compete for jobs and investments in an increasingly globalized world. In this region, which includes the largest number of countries that have not yet attained universal primary schooling, the ambitions and aspirations of Sub-Saharan African countries and their youth far exceed this basic goal. Over the past 20 years, educational levels have risen sharply across Sub-Saharan Africa. Already hard at work to provide places in primary schools for all children, most countries of the region are also rapidly expanding access to secondary and tertiary levels of education. Alongside this quantitative push is a growing awareness of the need to make sure that students are learning and acquiring the skills needed for life and work. Achieving education of acceptable quality is perhaps an even greater challenge than providing enough school places for all. Thus, Sub-Saharan African countries are simultaneously confronting many difficult challenges in the education sector, and much is at stake. This book gives those concerned with education in Sub-Saharan Africa an analysis of the sector from a cross-country perspective, aimed at drawing lessons that individual country studies alone cannot provide. A comparative perspective is useful not only to show the range of possibilities in key education policy variables but also to learn from the best performers in the region. (Although the report covers 47 Sub- Saharan African countries whenever possible, some parts of the analysis center on the region's low-income countries, in particular, a sample of 33 low-income countries). Although countries ultimately must make their own policy choices and decide what works best in their particular circumstances, Sub-Saharan African countries can benefit from learning about the experiences of other countries that are faced with, or have gone through, similar development paths. Given the large number of countries included in the analysis, the book finds that Sub-Saharan African countries have more choices and more room for maneuver than will appear if attention were focused on only one or a few country experiences. Countries can make better choices when understanding the breadth of policy choices available to them. They are well advised, however, to evaluate the applicability of policy options to their contexts and to pilot and evaluate the results for performance and subsequent improvement.

This report finds that in developing countries over the past 15 years, high priority was accorded to increasing enrolments in primary schools, but much less attention was directed to the crucial issue of whether children are learning adequately. The report recommends that countries, the World Bank and development partners give the same emphasis to learning outcomes as to access, so that the world's increasing investments in primary education have a far greater impact on poverty reduction and national development. The World Bank is the largest provider of external financial support to education in developing world. Since 1963, it has transferred about US$36.5 billion for education, over $14 billion of which has been for primary education. Its current lending portfolio consists of about 143 operations in 88 countries amounting to US$8.4 billion. (DIPF/Orig.).

Food consumption in children with ASD, subclinical ASD and with typical development (TD), and their adequacy to dietary recommendations was studied. A school population sample of 77 children with ASD, 40 with subclinical ASD, and 333 with TD participated. Compared to children with TD, pre-schoolers with ASD consumed fewer raw vegetables and less fish and eggs, while primary school children consumed fewer legumes, raw vegetables, citrus fruits, cheese/yogurt and olive oil, and more meat. All groups consumed an excess of sugar but those with ASD consumed even a greater amount than their peers. The higher prevalence of obesity found in primary school children with ASD may be the consequence of a less healthy eating pattern sustained over time.

This paper provides a comparative analysis of school-based management reforms in four Central American countries (EDUCO in El Salvador, PRONADE in Guatemala, PROHECO in Honduras, and Centros Autonomos in Nicaragua). It starts by providing a characterization of the models and then reviews how they have expanded community participation and empowerment and school decisionmaking autonomy. It then continues by analyzing the impact of community and school empowerment on the teaching-learning process, including measures of teacher effort. The paper assesses the impact of the models on several educational outcomes, relating this impact with the teaching-learning environment and community empowerment. Finally, the paper attempts to explain the impact of the reforms by discussing how variations in reform design, country contexts and actors’ assets can explain differences and similarities in result.The key conclusion of the paper is that school-based management models have led generally to greater community empowerment and teacher effort, resulting in: (a) a better use of the existing limited capacity of teachers and schools; (b) higher coverage in rural areas; (c) somewhat better student flows; and (d) learning outcomes at least as high as in traditional schools (while community-managed schools are generally established in the poorest and most isolated rural areas). A second set of key conclusions of the report is that the impact of community based schooling on student flows and learning outcomes could be greatly enhanced by a set of specific actions which largely aim at setting up the conditions for pedagogical improvement, improved management and empowerment at the local level, and sustainability of the models.

The education system in the Democratic Republic of Congo (DRC) has proved remarkably resilient in the face of economic crisis and armed conflict. Enrolment has grown at all levels but has been most rapid in higher education. During this period of conflict, the education sector was financed almost entirely by household contributions. The DRC is now faced with critical policy choices as it moves to a more efficient and equitable balance between public and private financing and in expanding and upgrading the quality of the system. Education in the Democratic Republic of Congo presents a comprehensive analysis of the current status of the education system in the DRC. Using data from a variety of sources, including government sources, special school surveys of public and private schools as well as parents, and achievement tests, the book presents analyses of student flows, public and private expenditures and student learning. The difficult trade-offs in sectoral objectives and strategies are highlighted through illustrative financial simulations that show the financial requirements by sub-sector and sources of financing.

Globally, anemia among school-age children (SAC) remains a serious public health problem, impacting their growth, development, educational attainment and future learning potential. National and subnational anemia prevalence among SAC in China has not been assessed recently. Based on data from Chinese Nutrition and Health Surveillance (2016–2017), the current anemia status of SAC in primary schools in China was investigated. Anemia prevalence of SAC in primary schools in China was 4.4%, dropping 63.6% compared with that in 2002. Even though anemia was no longer a significant public health problem at the national level, there were significant spatial disparities of anemia prevalence in different areas: anemia prevalence in 63% of provinces of northern and eastern China has lowered to below 5%, while in provinces of southern China, it was still ranging from 5% to 11.0%, about 3 times of other areas. For those children in southern China, mother’s education level (OR = 1.24, p = 0.04) and father’s education level (OR = 1.27, p = 0.01) below senior high school, eating meat less than 3 times per week (OR = 1.18, p = 0.01) were risk factors of anemia. Older age (OR = 0.35–0.72, p < 0.01) was a protective factor. Targeted interventions should be taken to improve SAC anemia in Southern China, despite anemia of SAC in primary schools no longer being a significant public health problem.

ObjectiveTo investigate the axial length (AL) elongation in primary school-age children during 3-year follow-up period and evaluate the associations of AL elongation with spherical equivalent (SE), AL at baseline, body height and weight.DesignA 3-year observational cohort study from 2014 to 2017.SettingJinshan Hospital of Fudan University in Shanghai.MethodsA total of 452 children successfully completed their measurements in the 3-year follow-up period. The mean age of those children was 6.9±0.7 years, ranging from 6 to 8 years, and 217 (42.7%) were boys. AL was measured with an ocular biometry system. Refractive error was measured using an auto-refractor without cycloplegia.ResultsThe mean changes of ALs were 0.27±0.28 mm, 0.52±0.40 mm and 0.89±0.51 mm over 1, 2 and 3 years, respectively. The mean changes of SEs were −0.27±0.80 D, −0.56±1.00 D and −0.95±1.41 D over 1, 2 and 3 years, respectively. Multivariate linear regression analysis revealed that mean change of AL was associated with mean change of SE at all points (all p<0.001). In addition, linear regression analysis revealed that AL elongation in the 3year follow-up period was associated with AL at baseline (R2=0.009, p=0.045).ConclusionsAL elongation is relatively high in the primary school-age children in Jinshan District, Shanghai. Effect strategies are needed to control AL elongation.

Background Alcohol use among children in low-resource settings has received limited attention. This study investigated the prevalence of and biopsychosocial factors associated with alcohol use among children aged 6 to 13 years enrolled in primary education in Uganda. Methods This cross-sectional study conducted in primary schools within Mbale district, employed stratified random sampling to select 470 child-parent dyads. Screening for child alcohol consumption utilized the validated Ugandan (Lumasaaba) version of the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool. Alcohol Use Disorder (AUD) was diagnosed using the AUD module of the Mini International Neuropsychiatric Interview for children and adolescents (MINI KID). Logistic regression analysis explored associations between alcohol consumption (CRAFFT cut-off score: 1 or more) and biopsychosocial factors (age, sex, nutrition, family dynamics, socioeconomic indicators, and school environment). Data analysis utilized STATA-17 statistical software. Results The median age of the participants was 11 years, with an interquartile range (IQR) of 9 to 12 years and a male to female ratio of 1:1.3. The screened prevalence of alcohol consumption among the children in the past 12 months was 25.2% (95% CI: 21.4–29.4) and 7.2% (95% CI: 5.1–10.0) were diagnosed with AUD. The study found a comparable prevalence of alcohol use between boys (25.0%, 95% CI: 19.4–31.5) and girls (25.4%, 95% CI: 20.0-31.1). Age-specific variations indicated that early adolescents (10 to 13 years), were more likely to consume alcohol 28.1% (95% CI: 23.5–33.3) compared to pre-adolescent children (6 to 9 years) 17.6% (95% CI: 11.9–25.1) in the past 12 months. Factors associated with alcohol use included single-parent households, lower caregiver education, low socioeconomic status, maternal drinking, food insecurity, under-weight, physical discipline by parents, peer influence, rural school attendance, and the school environment. Conclusion The prevalence of alcohol consumption among children in Mbale district, eastern Uganda was high with one-in-four primary-school-children aged 6 to 13 years consuming alcohol in the past year, and no significant gender differences. It highlights various interconnected factors associated with alcohol use among school-aged children. We recommend awareness campaigns at all levels, stricter implementation of alcohol policies, school prevention programs, and family-focused and socio-economic interventions. Nationwide school surveys should target pre-adolescent alcohol use.

Background There is little research on alcohol and other drugs (AOD) use by school-age children in low-resource settings like Uganda. Including the voices of children in research can inform prevention and early intervention efforts for those at risk of AOD use. The aim of this study was to understand the perspectives of children aged 6 to 13 years regarding AOD in Uganda. Methods This qualitative study was conducted in Mbale district, Uganda from February to March 2020. Eight focus group discussions (FGDs) were conducted with 56 primary school-age children, stratified by age (6–9 and 10–13 years), sex (male and female), and school status (in school and out of school). All FGDs were conducted in either Lumasaaba or Luganda. The FGDs were audio-recorded, transcribed verbatim, and translated into English. Data were coded, and overarching themes were identified using thematic framework analysis. Results Two themes identified were (1) Children’s perceptions and experiences with AODs. The participants understood alcohol by its consistency, colour, odour, and by brand/logo. They described the types and quantities of AOD consumed by school-age children, brewing processes for homemade alcoholic drinks, and short and long-term consequences of the use of alcohol. (2) Contributing factors to childhood drinking included: Stress relief for children who experienced multiple adversities (orphaned, poverty-stricken, and hailing from broken homes), fitting in with friends, influence from families, and media exposure that made alcohol look cool. Children would start drinking at an early age) or were given alcohol by their parents, sometimes before they could start talking. In the community, alcohol and other drugs were cheap and available and children could drink from anywhere, including in the classroom. Conclusions Children eligible for primary education in Uganda can easily access and use AOD. Several factors were identified as contributing to alcohol and other drug use among children, including availability and accessibility, advertising, lack of parental awareness and supervision, peer influence, adverse childhood experiences, socioeconomic factors, and cultural norms. There is a need for multi-sectoral action for awareness of childhood AOD use and deliberate consideration of children in the planning, design, and implementation of research, policies, and programs for prevention and early intervention.

Our research aimed to examine children's sleeping habits from preschool to the end of elementary school age. Developing proper sleeping habits in childhood is essential, as it is decisive for the rest of our lives. A total of 339 children (160 males and 179 females) took part in the research, of which 145 were preschool-age children (3-7 years old), 72 lower-grade elementary school children (6-11 years old), and 122 upper-grade elementary school children (12-16 years old). The questionnaire was completed in a paper form (elementary school students) and online (kindergarten children). The research results show that most of the children spend enough time sleeping following the recommendations. In case of the kindergarten children, the younger ones also sleep in the afternoon on weekends (average of 3.66 years, 28.3%), and the older ones do not sleep in the afternoon either in kindergarten during the week or at home at the weekend (average of 5.22 years, 46.2%). The use of blue light typically increases with age; 39% of the preschoolers, 61% of the 6-11-year-olds, and 67% of the 12-16-year-olds use it before falling asleep. Sleep aids and rituals are used by 87.6% of the preschoolers, 67.4% of the 6-11-year-olds, and 34.4% of the 12-16-year-olds, because significantly more preschoolers find it more difficult to fall asleep than older children. At night, 40% of the preschoolers wake up at least once (due to biological needs - 46.3%), 32% of the 6-11-year-olds wake up at night (due to nightmares - 42.3%), and 41% of the 12-16-year-olds also wake up all night (due to biological needs - 31.9%, and due to noise - 29.8%). Although the children get enough sleep, significantly more upper-grade school children feel tired in the morning. It is essential to help sleep and eliminate factors that prevent falling asleep to create a healthy circadian rhythm in the life of children.