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

Abstract

Abstract. We conducted a matched-control trial in Mali to assess the effectiveness of a comprehensive school-based water, sanitation, and hygiene (WASH) intervention on pupil absence, diarrhea, and respiratory infections. After completion of the intervention, data were collected from 100 beneficiary schools and 100 matched comparison schools in 5-6 sessions over a 14-month period. Data collection included roll calls to assess absenteeism and interviews with a subset of pupils to assess recent absence and disease symptoms. The odds of pupils being absent at roll call were 23% higher in beneficiary schools than in comparison schools (odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.06, 1.42). The odds of pupils reporting being absent due to diarrhea (OR: 0.73, 95% CI: 0.56, 0.94) or having had diarrhea (OR: 0.71, 95% CI: 0.60, 0.85) or respiratory infection symptoms (OR: 0.75, 95% CI: 0.65, 0.86) in the past week were lower in beneficiary schools compared with comparison schools. We found that a school-based WASH intervention can have a positive effect on reducing rates of illness, as well as absence due to diarrhea. However, we did not find evidence that these health impacts led to a reduction in overall absence. Higher absence rates are less likely attributable to the intervention than the result of an imbalance in unobserved confounders between study groups.

Evaluation of Immunoglobulin G Responses to Plasmodium falciparum and Plasmodium vivax in Malian School Children Using Multiplex Bead Assay

“…Detailed methods and results from the impact evaluation are found elsewhere. 14 Laboratory staff from the Centers for Disease Control and Prevention had no contact with children enrolled in the study nor any access to personal identifiers. A total of 805 Malian children, age range 4-17 years, in 42 elementary schools in the regions of Mopti, Sikasso, Koulikoro, and Bamako capital district provided dried blood spots (DBSs) for the study.…”

The Role of Adherence on the Impact of a School-Based Water, Sanitation, and Hygiene Intervention in Mali

“…As discussed earlier, an armed conflict resulted in a shift of the study site and impacted the availability of baseline data in the schools included in our evaluation. 9 Enumerators performed four to six unscheduled visits to each school following the completion of all intervention activities. At each visit, enumerators conducted observations of school WASH facilities, interviews with the school director, pupil surveys, and a roll call in all classes.…”

“…Further details on matching and selection are available elsewhere. 9 Data collection. The evaluation took place between January 2013 and May 2014, with a baseline collection occurring between December 2010 and April 2011 among schools initially selected for the intervention.…”

“…Results from an ITT analysis showed beneficiary schools had lower rates of selfreported diarrhea and respiratory infection symptoms and absence due to diarrhea, but higher rates of roll-call absence compared with the control schools. 9 The purpose of this article is to report on project fidelity and adherence *Address correspondence to Matthew C. Freeman, Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 2027, Atlanta, GA 30322.…”

“…[3][4][5][6][7][8] Improvements to WASH at schools have sometimes been shown to reduce diarrheal disease, 6,9 acute respiratory infections, 10 soil-transmitted helminth reinfections, 11 and absence among pupils. 3,12 However, these effects are often not consistent between studies and within studies they are dependent on study context and/or the subgroup of pupils under study.…”