Evaluation of Leading Safety Performance of Primary School Buildings in Alexandria , Egypt : Cross-Sectional Study

Background: Unsafe school buildings may adversely affect students, teachers, administrative workers, cleaning workers, and visitors. Objective(s): The aim of the present study was to evaluate the leading safety performance of public, private, and experimental primary school buildings in Alexandria, Egypt. Methods: A cross-sectional study was conducted in 30 primary schools in Alexandria selected by stratified cluster sampling. Two observational checklists were designed, validated, and used; including school building safety inspection checklist (SBSIC), and classroom safety inspection checklist (CSIC). The completed checklists were reviewed and coded. The safety performances (SP) for each category and for the overall checklists were then calculated. Results: The SP in private primary schools and classrooms [(66.1±13.0%), (68.7±12.5)] were higher than that of experimental [(59.9±14.0%), (65.1±14.2%)] and public ones [(39.3±7.8%), (46.0±11.8%) respectively]. The most common causes of reduced school SP were "the absence of protective measures against vectors & insects," "the non-daily refuse disposal," "the non-inspected play areas." Other causes included "the irregular fire drills," "the absence of the alarm system," "the non-earthed electrical equipment," "the absence of emergency plan," and "the unmarked tripping/slipping locations." The most frequent unsafe classroom conditions were "the absence of classroom alarm point," "the on-board glare," and "the non-compliant windows to class area ratios." Conclusion: Many safety violations were found to occur in Alexandria primary schools. This would cause a reduction of the safety performance and consequently a lack of safety management. Safety performance in private schools was better than that in experimental and public ones.


INTRODUCTION
rimary education stage usually occurs in primary schools, which are occupied by students, teachers, administrative employees, and cleaning workers.The World Health Organization (WHO) defines a health-promoting school as "one that constantly strengthens its capacity as a healthy setting for living, learning and working". (1)The American Academy of Pediatrics defines a "healthful school environment" as "one that protects students and staff against immediate injury or disease and promotes prevention activities and attitudes against known risk factors that might lead to future disease or disability."School safety management is a vital element of the healthy school environment, which is an essential part of the teaching and learning activities.It focuses on controlling the accident promoting factors within the school. (2)According to the proverb "you cannot manage what you cannot measure," it is essential to assess safety performance in order to manage safety.Previously, safety performance was measured by calculation of accident parameters, including frequency rate, severity rate, fatality rate, and frequency severity index (lagging indicators).Nowadays, it is periodically assessed using both P Original Article lagging and leading indicators.Leading safety performance is regularly used by employing the traditional safety checklist with yes, no, or not applicable responses.It aims at finding out the accident promoting factors and immediately executing the suitable corrective actions to prevent it. (3)n Egypt, leading school safety performance is not periodically assessed.Hence, school safety cannot be managed.To bridge this gap it is important to assess the current situation of school safety.So, the aim of the present study was to evaluate the leading safety performance of public, private, and experimental primary school buildings in Alexandria, Egypt.

METHODS
A cross-sectional study design was conducted in primary schools in Alexandria, Egypt.Multistage stratified cluster sampling from Alexandria public, private, and experimental primary schools was conducted to cover all educational zones, including Eastern, Western, Central, El-Gomrok, El-Montazah, El-Amreya and Borg el Arab.According to the WHO practical manual 1991 (4) , the minimum sample size was 26 clusters at 95% confidence level and 5% expected error.It was raised to 30 schools.Two classrooms were randomly selected from each school.The sample was selected using a multistage stratified cluster sampling technique.The strata were classified into public, private and experimental primary schools in Alexandria.The seven educational zones in Alexandria Governorate (Eastern, Western, Middle, El-Gomrok, El-Montazah, El-Amreya and Borg El-Arab) were included in the present study.
Two observational checklists were designed after extensive literature review, school building and classroom safety inspection checklists (SBSIC and CSIC).The two checklists were designed with Yes, No or Not Applicable responses.(7)(8) The first checklist (SBSIC) consisted of six categories, including housekeeping, maintenance, fire safety, electrical safety, emergency preparedness, in addition to ground safety, which had eight, four, eleven, ten, nine, and ten statements, with score ranges of (0-8), (0-4), (0-11), (0-10), (0-9), and (0-10) respectively added to the school data.The second checklist (CSIC) had three main categories, including classroom conditions, safety and emergency preparedness, as well as indoor air quality, which had eight, twenty eight, and six statements in the checklist, with score ranges of (0-8), (0-28), and (0-6) respectively in addition to the classroom data.
An occupational safety professor in High Institute of Public Health, Alexandria University was consulted to review the two checklists, which were later tested for their validation.This was conducted through completing the checklists by three researchers for the same five schools.Those schools were not included within the study sample.Pearson's correlation coefficients were calculated for the results of the first and second; first and third; as well as for second and third researchers respectively. (9)he data were collected using the validated checklists.The completed checklists were reviewed and coded.The safety performance (percent safety score) for each category and for the overall checklist were then calculated according to equations (1) and (2).It was classified into "poor" (<60%), "moderate" (60-70%), "satisfactory" (70-80%), and "Good" (≥80%). (9)ere SP of SBSIC is the safety performance of school building inspection checklist, SP of CSIC of Class-1 is the safety performance of first classroom inspection checklist, and SP of CSIC of Class-2 is the safety performance of second classroom inspection checklist.
The data were entered and statistically analyzed using IBM SPSS 21 software package (IBM SPSS Statistics, Somers, NY, USA).The safety performance (% safety score) was checked for normality using One-Sample Kolmogorov-Smirov Test.One-Way ANOVA and the estimated at 95% confidence interval (C.I).The results were considered significant at P-value ≤ 0.05. (10,11)

Ethical Considerations
The study was approved by the Institutional Review Board and the Ethics Committee of High Institute of Public Health.The study conformed to the principles of Helsinki declaration (2013) and the international ethics guidelines.Confidentiality of collected information was ensured.

RESULTS
Regarding validation of the checklists, the correlation coefficients of the overall SP in schools and classrooms between the first and second researchers were 0.81, 0.87; the second and third were 0.84, 0.90; and between the first and third were 0.83, 0.89 respectively.The SP showed non-significant Kologorov Smirov Test (p>0.05, at 95% C.I.).The housekeeping SP in private schools was good (84.0%), while that of experimental and public schools were satisfactory (70.0%) and poor (41.0%) respectively (Figure 1).The SPs of the housekeeping category were significantly varied (p≤0.05, at C.I.=95%) among different school types.Further analysis disclosed the significant differences between public and private as well as between public and experimental schools (p≤0.05, at C.I.=95%).The reduction of the housekeeping SP below the 100% was attributed to the safety standards' violations.The major unsafe housekeeping conditions were "the absence of protective measures against vectors & insects" (100.0%,50.0%, 66.7%), and "the non-daily disposal of Refuse" (100.0%,12.5%, and 50.0%) in public, private, and experimental schools respectively as illustrated in (Table 2).The poor SPs of the maintenance (<60%) in each of public, private, and experimental schools (Figure 1) were obvious in the non-conformity with the safety benchmarks.One-Way ANOVA Test revealed significant variation in maintenance SP among the three school types (p≤0.05, at C.I.=95%).Meanwhile, significant differences in maintenance SP were noticed between public and private schools as well as between public and experimental ones (p≤0.05, at C.I.=95%).The most frequent unsafe maintenance condition was "the noninspected play areas" (100.0%,87.5%, and 100.0%) for public, private, and experimental schools respectively (Table 2).The fire-safety SP in private schools was moderate (65.0%), while that of experimental (38.0%) and public (8.0%) were poor (Figure 1).The fire SP showed highly significant variation (p≤0.05, at C.I.=95%) among different school types (One-Way ANOVA Test).Further analysis showed significant differences between public and private as well as between public and experimental schools (p≤0.05, at C.I.=95%).The most frequent unsafe condition was "the irregular fire drills" that present 100.0%,75.0%, and 83.3% of public, private, and experimental schools respectively."The absence of the alarm system" was found in 100.0% of public, 62.5% of private, and 83.3% of the experimental schools (Table 3).Concerning the SP of the electrical safety, it was poor at the three school types (28.0%, 48.0%, and 30.0%respectively), although the difference was not significant (Figure 1).The main unsafe electrical safety condition was "the non-earthed electrical equipment" at all of the studied schools (Table 3).The safety performance of the emergency preparedness was poor in the public, private, and experimental schools (6.0%, 31.0%, and 30.0%respectively), with no significant difference was between the three school types (p>0.05, at C.I.=95%) (Figure 1).The most frequent unsafe emergency condition was "the absence of emergency planning manual" (100.0%,87.5%, and 83.4% respectively) (Table 4).Considering the SP of the ground safety, it was the highest for experimental schools (73% Satisfactory), followed by private (70% Satisfactory) and public (48% poor) ones (Figure 1).One-Way ANOVA Test indicated the highly significant variation of SP between the three school types (p≤0.05, at C.I.=95%).Further analysis disclosed statistically significant difference between public and private as well as between public and experimental schools (p≤0.05, at C.I.=95%).As obvious in table (4), the unsafe condition of the highest frequency was "the unmarked tripping/slipping locations" (93.8%, 100.0%, and 83.3%) in public, private, and experimental schools respectively.According to the classrooms' SP, it was the highest at private schools (69% moderate), followed by experimental (65% moderate) and public (46% poor) ones (Figure 1), and it was statistically significant (p≤0.05, at C.I.=95%) at different school types.Additional statistical analysis declared significant differences between public and private as well as between public and experimental schools (p≤0.05, at C.I.=95%).The most recurrent unsafe classroom situations were "the absence of classroom alarm point" (100.0%,87.5%, and 83.3%), "the onboard glare" (75.0%, 50.0%, and 75.0%), and "the non-compliant windows to class area ratios" (71.9%, 75.0%, and 58.3%) in public, private, and experimental schools respectively.

DISCUSSION
This study assessed the presence and application of the minimal safety standards in school buildings of different types.Ensuring school safety is a very important public health issue worldwide.Evaluation of safety performance (SP) is essential for safety management, (3) which is necessary for improving SP. (12) The SP in public schools, and classrooms were poor.This can be explained based on two factors, including safety expenditure, and lack of safety rules' enforcement.The first is too high as compared with the economic conditions in the Egypt.So, the private schools had the highest SP followed by experimental and public and ones.Safety rules in Egypt are enforced by the Ministry of Manpower and Immigration, which grants permits and approvals for any foundation after ensuring compliance with the minimal safety rules.Previously, it granted these permissions routinely for governmental foundations, but now it becomes stricter with both governmental and private institutions.There is strong relationship between housekeeping and safety performance as stated in two Finnish studies 1989, and 2014. (13,14) e housekeeping showed good SP in private, satisfactory in experimental, and poor in public schools.The major frequent causes of low SP in the present study were "the absence of protective measures against vectors and insects," and "non-daily refuse disposal."A Saudi study 1998 conducted safety inspection in large and small construction projects.It concluded that the housekeeping safety scores of large projects were good, while that of small projects were poor. (15)esigners and managers must consider the firesafety standards to ensure sustainability. (16)In this study; the fire SP was moderate for private schools, and poor for experimental and public ones.The most common fire hazards were "the irregular fire drills" as well as "the absence of the alarm system."In compliance with the present study, a Chinese study (1999) developed a fire-safety assessment system for existing buildings, and applied it on residence in Hong Kong.It found that the low safety score was observed for the alarm system. (17)In contrary to the present study, A US study 2009 checked 1052 public schools in Texas and revealed that the most frequent cause of reduced fire safety was the absence of fire sprinkler, and the absence of the alarm system was common in just 5.4% of the public schools. (18)he electrical safety performances were poor in the three school types.The unsafe electric situation of the highest popularity was "the non-earthed electrical equipment," which is an actual problem of nonindustrial buildings in Egypt.In agreement with the present work, the results of a study conducted in Tampere University of Technology 2010 revealed that the most common cause of electrical accidents was the failure to earth the electrical equipment. (19)he SP of the emergency preparedness was poor at the three school types.The most frequent violations were "the absence of emergency planning manual," and "the lack of evacuation maps."Similarly, the main emergency problems in Saudi and Turkish schools were the absence of emergency plan, long response time to incidents, and lack of emergency training. (20,21) e New Zealand study (2017) revealed that the most common emergencies were due to weather, fires, and earthquakes respectively, while the unusual crises were deaths of staff and students at school, and terrorism. (22)nsafe grounds may lead to falling, tripping, or slipping.The ground safety category revealed satisfactory SP for experimental and private schools, and poor for public ones.The most common unsafe situation was "the unmarked tripping/slipping In accordance with these results, the findings revealed from a project conducted in Kenyatta University to assess school safety reported that about 17% of school accidents occur due to ground problems, and more than one-quarter of the students' injuries are on the ground. (23)he classrooms' SP was moderate for private and experimental schools and poor for public ones.The most recurrent unsafe classroom situations at the classroom conditions, safety and emergency preparedness, and indoor air quality categories were "the on-board glare," "the absence of classroom alarm point," and "the non-compliant windows to class area ratios" respectively.Two studies conducted in Swedish and Arizona revealed the positive impact of classroom safety on the students' achievements and their ability to learn. (24,25)

CONCLUSIONS AND RECOMMENDATIONS
The findings of the present study can lead us to conclude that there are many safety violations that occur in Alexandria primary schools.This causes reduction of the safety performance and lack of safety management.Safety performances of private schools are better than that in experimental and public ones.Emergency preparedness category is of the least SP, while housekeeping is of the highest in the three school types.
It is recommended to activate the licensing and inspection roles of the Ministry of Manpower and Immigration to enable enforcement of safety standards.In addition, the decision makers in the Ministry of Education must train and motivate the health and safety committee for each school to implement the school safety standards.Moreover, they must provide the suitable financial allocations necessary for safety equipment.Also, they had to consider categories, including housekeeping, maintenance, fire safety, electrical safety, emergency preparedness, ground safety, and classroom safety.
Post-Hoc Multiple Comparison Least Significant Difference (LSD) Tests were used to check the significance of variation for variables of more than two classes.The significance of the results was Safety Performance % = No. of YES Responses × 100 No. of YES Responses + No. of NO Responses (2) The Number of Yes responses of the school = Number of Yes responses in SBSIC+ Number of Yes responses of CSIC of Class-1+Number of Yes responses of CSIC of Class-2

Figure 1 :
Figure 1: Primary Schools' Safety Performance (percent safety Scores) of different checklist categories at different school types in Alexandria, Egypt 2014.

Table 1 : Safety performance (percent safety scores) of primary schools and classrooms at different school types in Alexandria, Egypt 2014
*One-Way ANOVA Test; it is significant at P-value ≤ 0.0