‘Fit for school’ – a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in Cambodia, Indonesia and Lao PDR

Abstract

BackgroundThe Fit for School (FIT) programme integrates school health and Water, Sanitation and Hygiene interventions, which are implemented by the Ministries of Education in four Southeast Asian countries. This paper describes the findings of a Health Outcome Study, which aimed to assess the two-year effect of the FIT programme on the parasitological, weight, and oral health status of children attending schools implementing the programme in Cambodia, Indonesia and Lao PDR.MethodsThe study was a non-randomized clustered controlled trial with a follow-up period of two years. The intervention group consisted of children attending public elementary schools implementing the FIT programme, including daily group handwashing with soap and toothbrushing with fluoride toothpaste, biannual school-based deworming; as well as construction of group handwashing facilities. Control schools implemented the regular government health education curriculum and biannual deworming. Per school, a random selection of six to seven-year-old grade-one students was drawn. Data on parasitological infections, anthropometric measurements, dental caries, odontogenic infections and sociodemographic characteristics were collected at baseline and at follow-up (24 months later). Data were analysed using the χ2-test, Mann Whitney U-test and multilevel logistic and linear regression.ResultsA total of 1847 children (mean age = 6.7 years, range 6.0–8.0 years) participated in the baseline survey. Of these, 1499 children were available for follow-up examination – 478, 486 and 535 children in Cambodia, Indonesia and Lao PDR, respectively. In all three countries, children in intervention schools had a lower increment in the number of decayed, missing and filled permanent teeth between baseline and follow-up, in comparison to children in controls schools. The preventive fraction was 24% at average. The prevalence of soil-transmitted helminth infection (which was unexpectedly low at baseline), the prevalence of thinness and the prevalence of odontogenic infections did not significantly differ between baseline and follow-up, nor between intervention and control schools.ConclusionsThe study found that the FIT programme significantly contributed to the prevention of dental caries in children. This study describes the challenges, learnings and, moreover, the importance of conducting real-life implementation research to evaluate health programmes to transform school settings into healthy learning environments for children.The study is retrospectively registered with the German Clinical Trials Register, University of Freiburg (Trial registration number: DRKS00004485, date of registration: 26th of February, 2013).

Comparing the behavioural impact of a nudge‐based handwashing intervention to high‐intensity hygiene education: a cluster‐randomised trial in rural Bangladesh

“…While abnormal school days due to local events and inclement weather were given as the primary reason for noncompliance, such events are likely to have negatively impacted handwashing rates. As has been noted in other studies, sustained management and monitoring of intervention activities are typically important factors in achieving positive hygiene behaviour change [26,61]. Despite these early compliance issues, our final compliance check at 24-25 weeks post-intervention found all schools to have the handwashing station fully set-up, suggesting that on normal school days, schools may have adopted handwashing station set-up as a part of their regular routine by this point.…”

Tingginya angka kecacingan pasca pengobatan massal filariasis (DEC dan Albendazole) di SDN Juku Eja Pagatan

“…21 Kegiatan intervensi, preventif dan promotif kecacingan berbasis sekolah dinyatakan efektif dan efisien baik dari sisi biaya maupun kesuksesan pengobatan karena adanya daya dukung dari pihak sekolah yang disegani oleh siswa. 11,22 Akan tetapi, tidak mengabaikan pula pentingnya intervensi, preventif dan promotif di lingkungan masyarakat umum atau di lingkungan desa khususnya lingkungan keluarga. Diduga prevalensi kecacingan di tingkat desa juga cukup tinggi, karena berdasarkan pengakuan dari salah satu orangtua siswa bahwa seluruh anggota keluarganya menderita kecacingan ditandai dengan keluarnya cacing gelang dari anus anak dan orangtua siswa.…”

“…Perbaikan WASH (Water, Sanitation and Hygiene) yang diterapkan bersamaan dengan pemberian drug mass administration dinyatakan mampu memutuskan siklus hidup STH ledakan kasus tidak akan mampu diatasi hanya dengan pemberian anthelminthik, 14 hal ini dikarenakan obat cacing hanya mengurangi angka kesakitan sementara dan tidak memberikan efek pencegahan terhadap reinfeksi. 22…”

Pilot evaluation of the therapeutic effect of Silver Diamine Fluoride (SDF) in Arresting dental caries in the primary teeth of Cambodian slum children

“…One of the most effective ways to address oral health problems in children is to target school groups and introduce school oral health programs which focus on caries prevention and management at population level. In Cambodia a number of initiatives have been implemented in recent years including SEAL Cambodia [3] and Fit for School [4]. A more recent initiative known as 'Healthy Kids Cambodia' has been started which differs from the other two approaches in that it is more comprehensive and involves progressive delivery of dental therapeutic interventions including the use of Silver Diamine Fluoride (SDF) to arrest primary tooth caries.…”

“…One of the key features of caries experience in Cambodian children is that the vast majority of lesions go untreated, and this has now been shown to be associated with failure of children to thrive [4,5]. In addition, untreated dental caries in children has also been shown to be associated with reduced quality of life, intermittent pain and infection, space loss, inattention and absenteeism from school, social problems and problems with speech development [6].…”