The Impact of School Water, Sanitation, and Hygiene Interventions on the Health of Younger Siblings of Pupils: a Cluster-Randomized Trial in Kenya

Abstract

Diarrhea accounts for 700 000 deaths per year among children younger than 5 years, 1 or 10.5% of total under-5 mortality. 2 These deaths are largely preventable. An estimated 85% of diarrhea mortality is attributed to unsafe drinking water, inadequate sanitation, and substandard hygiene practices. 3 A recent meta-analysis calculated reductions in diarrhea associated with hand-washing promotion, water quality improvements, and improvements in excreta disposal of 48%, 17%, and 36%, respectively. 4 These estimates have been widely adopted in the international health community. 5,6 Although some studies have found limited evidence of health impact associated with water supply improvements, 7 emerging research suggests that relationships between water supply and diarrhea may be mediated by several factors, including collection time and distance to source. 8,9Estimates of the health impact of water, sanitation, and hygiene (WASH) interventions on children younger than 5 years are derived from interventions that promote or improve services and practices in domestic environments. 4 The impact of WASH improvements at institutions-such as schools-on child diarrhea remains underexplored. WASH interventions in schools can influence diarrheal outcomes among children younger than 5 years who themselves are not attending school through 2 primary pathways. First, these interventions may result in the diffusion of improved practices and behaviors to domestic environments and the broader community. important to understand the extent to which school interventions affect younger children. We analyzed data from a cluster-randomized trial in Kenya to quantify the impact of school WASH improvements on parent-reported diarrhea and clinic visits for gastrointestinal symptoms among children younger than 5 years living in households within the catchment areas of study schools. METHODSOur study was embedded within a larger trial that assessed the health and educational impacts of WASH improvements carried out in schools in Nyanza Province, Kenya. Following a rapid assessment of school conditions conducted by the Ministry of Education, we divided schools into 2 study groups according to water availability: water-available schools had a dry season water source within 1 kilometer; water-scarce schools had no improved water source within 2 kilometers and no dry season source of any kind within 1 kilometer. We excluded schools that met government-mandated pupil-to-latrine ratios (25 to 1 for girls, 30 to 1 for boys) from the study. 22Objectives. We examined the impact of school water, sanitation, and hygiene (WASH) interventions on diarrhea-related outcomes among younger siblings of school-going children.Methods. We conducted a cluster-randomized trial among 185 schools in Kenya from 2007 to 2009. We assigned schools to 1 of 2 study groups according to water availability. Multilevel logistic regression models, adjusted for baseline measures, assessed differences between intervention and control arms in 1-week period prevalence of diarrhea and 2...

Context matters: a multicountry analysis of individual‐ and neighbourhood‐level factors associated with women's sanitation use in sub‐Saharan Africa

“…Health‐related education and awareness are often considered leading factors influencing user sanitation preferences and decisions . In fact, many community‐focused sanitation adoption and implementation programmes rely largely on health education and training .…”

“…As previous studies have suggested that attitudes in certain non‐Christian religions may influence sanitation practices , a binary Christian/non‐Christian variable was also included. A variable for women's primary drinking water source was also used, given earlier research that suggests people's sanitation use may be influenced by the availability of water . Some scholars have also suggested that women, in particular, may revert to unimproved sanitation alternatives rather than walk to a shared or public facility if they do not feel safe outside their homes .…”

Impact of Regular Soap Provision to Primary Schools on Hand Washing and E. coli Hand Contamination among Pupils in Nyanza Province, Kenya: A Cluster-Randomized Trial

“…Between 2007 and 2009, a cluster-randomized trial assessing the health and educational impacts of various school-based WASH interventions was carried out by the SWASH+ program in 185 schools in three geographic strata in Nyanza Province, Kenya 18,22–25. Schools for this study were selected from those schools in the former SWASH+ study.…”

La mortalidad por enfermedades diarreicas en Costa Rica y sus inequidades geográficas

“…Diversos estudios sostienen la importancia de la vulnerabilidad de los sistemas de saneamiento ambiental y el incremento en la probabilidad de enfermar y morir por diarreas 9,11 . En lo que refiere a los sistemas de abastecimiento de agua, se reconoce en un meta análisis, que la calidad del agua entregada por estos, resulta muy relevante cuando se trata de explicar la probabilidad de padecimientos gastrointestinales en comunidades expuestas 12 En un estudio de intervención que se llevó a cabo en Kenya se evidenció que cuando la población escolar se expone a condiciones adecuadas de suministro de agua y saneamiento, se protegen de las diarreas respecto a un grupo de control no intervenido 18 . En un estudio prospectivo en Cambodia se evaluó una experiencia sobre suministro de agua segura y saneamiento que evidenció que es posible proteger a la población expuesta 19 .…”