according to the who , over 3 000 000 children under the age of five die each year due to 
 causes related to environmental risk factors . identification of recognized environmental health risk factors 
 is considered to be one of the most important objectives of health policy , as it relates to 
 the everyday work of medical health - care professionals including family doctors , 
 pediatricians , and nurses .
determination of mentioned risk factors will allow implementation 
 of proper preventive measures , and a system of providing parents and teachers with 
 information about health risks will , in turn , decrease the risks which may improve the effectiveness of health care .
the who green page questionnaire was designed as a potential tool to determine and monitor 
 children s environmental conditions in all places where they live and develop .
it can be a 
 valuable source of supplemental information acquired in the course of children s and 
 parents appointments with family physicians , and it may also be a great support for doctors 
 in determining children s environmental risks at home and school .
the who green page questionnaire has not yet been analyzed in terms of its practical 
 utility with respect to medical diagnostics . the expected goal of this research was to assess the possibility of implementation of the 
 who green page as a tool to supplement basic medical interviews with potential environmental 
 health risk factors for children and determination of real risk factors currently existing 
 in home and school environments .
the who green page questionnaire was implemented with parents of children from urban , 
 suburban , and rural environments who visited a family practice doctor .
due to exclusion of questionnaires 
 missing the majority of data ( more than 50% of the answers were missing ) , the responses of 
 159 patients were analyzed . when we analyzed the questionnaires with less than 50% of the 
 questions unanswered , the denominator for percentage calculation was lower than that for the 
 159 parents .
wilk test was carried out . for measurable ( quantitative ) 
 variables , arithmetic means , and standard deviations
were calculated , while for qualitative 
 variables , the frequency ( percentage ) was determined .
the analysis of qualitative variables 
 was based on contingency tables and the  test . to compare quantitative 
 variables in two non - related and related groups ,
wallis test was conducted for means of variables that did not meet 
 the criteria for variance analysis .
in total 159 parents took part in the study , including 87 parents of girls ( 58% of the 
 examined ) and 63 parents of boys ( 42% of the examined ) .
the average age of the children was 
 11.2 years ( sd 6.2 , median 11 ) .
the children mostly lived with both parents ( 91.3% , 136 ) , 
 while 6.7% ( 10 ) of them lived with their mothers only .
the majority of the examined cases 
 came from urban areas ( 56.2% , 87 ) , while 38.3% ( 59 ) and 5.2% ( 8) were from rural and 
 suburban areas respectively ( p<0.05 ) .
overpopulation at home was noted only among 4.4% ( 7 ) of the 
 respondents .
domestic animals were present around the homes of 74.5% ( 117 ) of the respondents , and the 
 distribution of answers was statistically significant ( p<0.05 ) , as it relates to the 
 child s place of living .
contact with domestic animals was predominant in rural areas 
 ( animals were present in 91.53% of cases ) as opposed to urban and suburban areas ( 63.95% and 
 57.14% respectively ; p<0.05 ) .
it was noted that 24.3% ( 34 ) of caregivers expressed concern about their children s 
 environment ( vs 75.7% , 106 ) , which did not maintain statistically significant dependency 
 with the children s living environment ( p>0.05 ) .
knowledge and awareness of particular 
 existing environmental risks were noted in 23.7% ( 32 ) of the subjects .
most of the respondents ( 96.2% , 153 ) were aware of the presence of disease - transmitting 
 factors : 42.5% of the subjects knew disease - transmitting factors .
the distribution of the 
 answers to this question was dependent on the children s living environment  it was 
 distinctively different in rural areas ( disease - transmitting factors were identified by 
 64.3% of the examined ) as opposed to urban and suburban areas ( correct answers were given by 
 31.4% and 33.3% the examined respectively ) , p<0.05 .
in addition 7.0% ( 11 ) of the surveyed stated that their children had sustained injuries in 
 connection with road traffic prior to the questionnaire study , and one child had sustained 
 injuries in connection with fire .
the distribution of the answers to those questions was not 
 dependent on the children s living environment ( p>0.05 ) .
existing exposure to chemical substances ( pesticides and detergents ) was confirmed by 5.2% 
 ( 8) of the respondents , and 6.4% ( 10 ) of the respondents reported that their children had 
 been poisoned before the questionnaire as a result of contact with chemical substances . 

furthermore , 9.6% ( 15 ) maintained that there existed a threat from poisonous animals .
the 
 distribution of the answers to the questions about contact with chemical substances and 
 threat from poisonous animals was not dependent on the children s living environment 
 ( p>0.05 ) .
following analysis of the respondents answers , it was determined that the examined 
 children lived in a densely built - up area in 79.6% ( 125 ) of the cases and in a low - risk 
 geographical zone in 76.3% ( 119 ) of the cases .
the food they ate was of appropriate quality 
 according to 94.9% ( 149 ) of the respondents , the indoor air quality was considered to be 
 good by 81.5% ( 119 ) of the respondents , and the outdoor air quality was considered to be 
 average by 51.0% ( 80 ) of the respondents .
the land they lived on was seen as appropriate by 72.9% ( 113 ) of the 
 respondents , and 92.3% ( 143 ) of the examined thought that sewage was disposed of in an 
 appropriate way .
appropriate disposal of waste was confirmed by 87.9% ( 138 ) of the 
 respondents , and the noise level was considered low by 68.2% ( 107 ) of the examined .
exposure 
 to chemical substances was low according to 70.7% ( 111 ) of the respondents .
road traffic was 
 seen as low by 44.6% ( 70 ) of the examined ( table 
 1table 1abc  of environmental conditions homeschoolabcabcbuilt - up environment79.6% ( 125)20.4% ( 32)0.0% ( 0)60.8% ( 90)38.5% ( 57)0.7% ( 1)geographical zone76.3% ( 119)23.1% ( 36)0.6% ( 1)71.3% ( 102)28.0% ( 40)0.7% ( 1)food94.9% ( 149)4.5% ( 7)0.6% ( 1)83.5% ( 111)15.8% ( 21)0.8% ( 1)indoor air quality81.5% ( 119)17.1% ( 25)1.4% ( 2)64.1% ( 84)34.4% ( 45)1.5% ( 2)outdoor air quality40.8% ( 64)51.0% ( 80)8.3% ( 13)35.0% ( 50)55.9% ( 80)9.1% ( 13)water - drinkable86.5% ( 128)13.5% ( 20)0.0% ( 0)82.1% ( 110)17.9% ( 24)0.0% ( 0)land / soil72.9% ( 113)25.8% ( 40)1.3% ( 2)63.2% ( 91)35.4% ( 51)1.4% ( 2)sewage disposal92.3% ( 143)7.7% ( 12)0.0% ( 0)88.0% ( 125)11.3% ( 16)0.7% ( 1)waste disposal87.9% ( 138)11.5% ( 18)0.6% ( 1)79.2% ( 114)20.1% ( 29)0.7% ( 1)noise68.2% ( 107)28.7% ( 45)3.2% ( 5)28.6% ( 42)51.7% ( 76)19.7% ( 29)exposure to chemical substances70.7% ( 111)28.7% ( 45)0.6% ( 1)65.3% ( 96)32.7% ( 48)2.0% ( 3)road traffic44.6% ( 70)43.9% ( 69)11.5% ( 18)25.2% ( 37)56.5% ( 83)18.4% ( 27)environmental risk factors : a , proper ; b , average ; c , potential . differences between 
 answers are statistically significant ( p<0.05 ) . ) . environmental risk factors : a , proper ; b , average ; c , potential .
( 90 ) of cases , the children schools were in very well - built areas , and the schools 
 were situated in low - risk geographical zones in 71.3% ( 102 ) of cases .
the food offered at 
 school was of proper quality according to 94.4% ( 149 ) of the examined .
indoor air quality at 
 schools was good according to 64.1% ( 84 ) of the respondents , and outdoor air quality was 
 considered to be average by 55.9% ( 80 ) .
the land where their schools stand was considered appropriate by 63.2% ( 91 ) of 
 the examined , and 88.0% ( 125 ) of the examined thought that sewage was disposed of in an 
 appropriate way .
appropriate waste disposal was confirmed by 79.2% ( 114 ) of the respondents , 
 and the noise level was considered average by 51.7% ( 76 ) of the examined .
exposure to 
 chemical substances was low according to 65.3% ( 96 ) of the respondents .
road traffic was 
 seen as moderate by 56.5% ( 83 ) of the examined ( table 
 1 ) .
the majorities of the children involved in the environmental assessment were of school age , 
 lived with both parents , and came from urban areas .
the caregivers expressed minor concerns 
 about the children s living and study environments as well as low knowledge and awareness of 
 existing environmental risks .
a very low percentage of parents stated that their children sustained injuries in 
 connection with road traffic , and in one case , a child sustained injuries in connection with 
 fire ; these were not statistically significantly dependent on where they lived , exposure to 
 chemical substances , or threat from poisonous animals .
both the places they lived and studied were located in low - risk geographical zones . in the 
 opinions of the majority of the respondents , the food , indoor and outdoor air , tap water , 
 land , sewage and waste , noise level , exposure to chemical substances , and road traffic  
 were appropriate quality in both places .
this picture is positive and does not fully correspond with reality from the hygienic point 
 of view and after performing an environmental interview , which emphasizes people s low awareness of environmental 
 risks .
the questionnaire may prove to be a useful tool in determining the kind of potential 
 environmental risk factors that exist in children s living and study places .
the who green 
 page supplements the information of the basic medical interview by being a part the 
 patient s medical history .
 background : the objective of this study was to assess the possibility of 
 implementation of the who green page as a tool to supplement basic medical interviews with 
 environmental health risk factors for children.methods : the who green page questionnaire was tested on parents of children 
 who visited family practice doctors.results : a total of 159 parents took part in the study . it was noted that 
 24.3% of caregivers expressed concern about their children s environment without naming 
 the risk factors . 
 it was also found that 23.7% of the parents demonstrated knowledge and 
 awareness of existing real environmental risks , and 7.0% of them stated that their 
 children had sustained injuries in connection with road traffic prior to the questionnaire 
 study.conclusions : the who green page will provide additional information to the 
 basic medical interview and , if regularly updated , will allow for monitoring of changing 
 environmental conditions of children . 