Impact of the Provision of Safe Drinking Water on School Absence Rates in Cambodia: A Quasi-Experimental Study

Abstract

Background: Education is one of the most important drivers for helping people in developing countries lift themselves out of poverty. However, even when schooling is available absenteeism rates can be high. Recently, focus is being given on whether or not WASH interventions can help reduce absenteeism in developing countries. However, none has focused exclusively on the role of drinking water provision. We report a study on the association between absenteeism and provision of treated water in containers maintained in schools. Methods and Findings: We undertook a quasi-experimental longitudinal study of absenteeism rates in 8 schools, 4 of which received one 20 l container of treated drinking water per day. The water had been treated by filtration and ultraviolet disinfection. Weekly absenteeism rates were compared across all schools using the negative binomial model in generalized estimating equations. There was a strong association between the provision of free water and reduced absenteeism (Incidence rate ratio = 0.39 (95% confidence intervals 0.27-0.56)). However, there was also a strong association with season (wet versus dry) and a significant interaction between receiving free water and season. In one of the intervention schools, it was discovered that the water supplier was not fulfilling his contract and was not delivering sufficient water each week. In this school, we showed a significant association between the number of water containers delivered each week and absenteeism (IRR = 0.98 95% CI 0.96-1.00). Conclusion: There appears to be a strong association between providing free and safe drinking water and reduced absenteeism, although only in the dry season. The mechanism for this association is not clear but may be in part due to improved hydration leading to improved school experience for the children.

Impact of Early Life Exposure to Environments with Unimproved Sanitation on Education Outcomes: Evidence from Bangladesh

“…These studies often focus on water and sanitation facilities at the school level (Jasper et al, 2012) and not at the community level. The provision of treated drinking water in schools helped reduce absenteeism in Cambodia (Hunter et al, 2014) and in the Nyanza Province of Kenya (Freeman et al, 2012). Similar results have been found for Indonesia (Duflo, 2001) and a number of other low-income countries (Jasper et al, 2012).…”

The Impact of a School-Based Water, Sanitation, and Hygiene Program on Absenteeism, Diarrhea, and Respiratory Infection: A Matched–Control Trial in Mali

“…In Cambodia, a quasi-experimental study found reductions in absence from provision of safe drinking water, though only in the dry season. 13 School-based randomized trials in China and Egypt found lower rates of both absenteeism and absenteeism related to certain illnesses among pupils that participated in handwashing interventions. 10,12 A handwashing trial among preschool children in Israel found no effect on overall absenteeism or absenteeism due to illness.…”

Assessing change in access to WASH in Palestinian schools

“…Other studies have shown that schools with poor water access during the dry season that received an improved water supply also saw improvements in hygiene promotion, water treatment, and sanitation as well as increased enrolment and better gender parity within this (Garn et al, 2013). Hunter et al (2015) found a strong association between free and safe drinking water and reduced absenteeism in the dry season in Laos, suggesting that improved hydration leads to a better school experience for children. In the West Bank and the Gaza Strip a positive relationship was found between educational level and attitudes and practice of washing hands before eating (Al-Khatib et al, 2015).…”