Effect of School-Based Educational Water, Sanitation, and Hygiene Intervention on Students’ Knowledge in a Resource-Constrained Setting

Abstract

BackgroundGlobally, diarrhea is one of the major causes of under-5 mortality. India accounts for the highest number of childhood deaths globally. Therefore, facilitating the implementation of water, sanitation, and hygiene (WASH)-related interventions for adolescents in schools and communities is crucial. In the present study, we investigated the effectiveness of a school-based educational WASH intervention in improving students’ knowledge on prevention and management of diarrhea in Ujjain district, India.MethodsThe present pre–post intervention study with a two-stage (schools and classrooms) cluster sampling was conducted on 1781 students studying in 8th to 12th grades in schools located in Ujjain, Madhya Pradesh, India. The intervention comprised an educational training session by using a WASH training module. The means of pre- and post-intervention scores were compared using repeated measure analysis of variance. A multivariate quantile regression model was used to test the correlation between the change in score after intervention and the independent variables. A P value of <0.05 was considered statistically significant.ResultsThe proportions of students possessing knowledge on the treatment of diarrhea, use of zinc tablets during an episode of diarrhea, and the symptoms and signs of severe pediatric diarrhea were 28%, 27%, and 27%, respectively, before intervention. These proportions increased significantly (P < 0.001) after the educational intervention to 72%, 73%, and 74%, respectively. The mean post-intervention knowledge score (34.13) was significantly higher than the mean pre-intervention score (15.17) (F = 16513.36, P < 0.001). Age was significantly associated with the knowledge score at the 25th and higher quantile (q). Gender exhibited a greater effect at q10th. School location was positively associated at q25th and higher. School type was strongly associated at low quantiles (q10th and q25th). School medium exhibited a greater association at low quantiles (≤q25th).ConclusionWASH- and diarrhea-related knowledge among higher secondary school students increased after the educational intervention. Further research is required to evaluate the social demographic characteristics associated with change in the knowledge score to better evaluate school-based educational WASH interventions and improve the management and prevention of diarrhea.