RESULTS
The training programme was delivered to 18 primary schools; a total of 191 school personnel, that ranged from 3-25 attendees per school (median=9, IQR=6). Participating schools originated from all six districts in the county. 44% (8/18) of the schools were from the most densely populated district. All schools were state-funded and there were of small-to-medium size ranging from 29-428 pupils (median=128, SD±119).
29% (5/18) of the schools had pupils at risk of anaphylaxis and carried an AAI; two of these schools (12%) reported that a Personalised Allergy Action Plan (PAAP) was not available.
The response rate to the follow up survey was 78% (14/18). The schools’ characteristics (number of pupils registered, locality, socioeconomic status or size) of non-respondents did not differ compared to the respondents.
Fewer than half of the schools (39%, 7/18) reported confidence in dealing with an allergic reaction at baseline survey. Following the intervention, 86% (12/14) of schools stated they felt confident if faced with such emergency (p=0.016).
The majority of schools (94%, 17/18) reported that they had both procedures on identification of pupils with allergies on enrolment at school, and reduction of risks and management of allergic reactions (Table 3). Following training, all schools, 100% (14/14) reviewed their practice regarding the identification of pupils with allergies on admission and setting up a management plan. While only 45% (8/18) of the respondents reported that they helped pupils to manage their allergies (providing teaching material and practical skills) prior to training, all but one (93%, 13/14) had arranged or considered introducing such teaching sessions following the intervention (p=0.03).
Compared with 44% (8/18) of the schools who reported that they were prepared to manage a severe allergic reaction in a child with no previous history of allergy at baseline, 93% (13/14) reported so following the intervention (p=0.016) (Table 4).
It is of note that 35% (5/14) of the respondents stated that they introduced a standard management protocol for the first time following the training and all schools updated or implemented a standard management protocol (pre-training 78% vs post training 100%, p=0.25).
Arrangements for regular staff training were in place in the majority of schools (78%, 14/18). However, 50% (9/18) of the schools reported not offering in depth training for those who had frequent contact with children with severe allergies. In 44% (8/18) of the schools there were no arrangements in place to offer specialist training for those responsible for the health of these children. Post-training, 93% (13/14) of the schools reported that arrangements were made for regular training of all staff (pre-training 78%, vs post-training 93%, p=0.63) and 86% (12/14) offered in depth training (pre training 50% vs post-training 86%, p=0.57). However, only 57% (8/14) offered specialist training at follow-up (pre training 56%, vs post-training 57%, p=0.69).
More than one third of the schools, (39%, 7/18) reported that preventative measures for accidental exposure to food allergens such as a no food sharing policy were not in place prior to the training taking place. Post training, all schools reported they had adopted such a policy (pre-training 61% vs post- training 100%, p=0.03). 71% (10/14) of schools put in place special supervision for high risk pupils during meal times (pre training 56% (10/18), p=0.45). While 78% (14/18) of the schools reported initially that they followed a nuts-free policy, post intervention, only 57% (8/14) reported so (p=0.25) (Table 5).
Also, only one third of the schools, (33%,6/18) reported to have a ‘no eating policy on transport to and from school’. Following the intervention, the majority of the schools, (79%, 11/14) seemed to have reviewed this policy (pre-training 33% vs post training 79%, p=0.07).
The majority of schools (83%, w15/18) expressed the need for national guidelines on the management in school of children with severe allergies at the baseline survey and all of them did so post training (100% (14/14), p=0.63).
Similarly, post training 93% (11/18) schools either agreed or strongly agreed with the generic provision of AAI to be kept at school (pre-training 61% (11/18), p=0.125).