Understanding the burden and distribution of health conditions in Zambia’s school-aged population: evidence from the school health programme

Abstract Background School-aged children in low and middle-resource settings often face a high burden of preventable illnesses, yet health systems typically prioritise children under five. In 2023, 1.5 million deaths occurred globally among children aged 5 to 19 years, largely due to infectious diseases, especially in resource-limited settings. Despite growing evidence linking health and education outcomes, many school-aged children continue to experience untreated conditions that affect their ability to learn and thrive. Zambia’s School Health Programme (SHP) offers a promising model for addressing this gap through school-based health services. This study aims to understand the burden and distribution of diseases among school-aged children. Methods This study was a retrospective analysis of surveillance data collected from the SHP across 503 schools in 17 districts in five provinces of Zambia. Data was extracted from the clinical decision support system, covering the period from January 1 to December 31, 2024. Descriptive statistics were used to present the distribution of health conditions by age and province. QGIS was used to map the spatial distribution of health conditions. Crude rates were used to show the spatial distribution across districts and provinces. Results A total of 203,471 learners presenting for care at school health rooms were classified with 319,395 conditions by school health workers using the clinical decision support system. Of the suspected health conditions, respiratory conditions were the most common health condition, accounting for nearly 40% of all cases, followed by abdominal pain (27%), febrile illnesses (11%), and malaria (5%). Disease patterns varied by age and province, with older learners showing higher rates of suspected respiratory conditions and lower rates of malaria and diarrhoea. Northern and Luapula provinces had the highest prevalence of malaria (14% and 18%) and febrile illness (12% and 16%) respectively, while Lusaka showed the highest burden of suspected respiratory conditions (39%). Menstrual-related issues (3%), anaemia (1%), and rash (0.2%) were also classified, though at lower levels. For the spatial distribution, Mansa, Mwense and Kasama showed the highest burden of malaria and febrile illness. Conclusion School-aged children in Zambia carry a significant burden of health conditions. The SHP provides critical access to care for school-aged children. These findings support the scale-up of the school health model in Zambia and other low resource settings to better serve school-aged children.