Abstract
ObjectivesTo explore whether a school-based water, sanitation and hygiene programme, which includes group hygiene activities, contributes to the formation of independent handwashing and toothbrushing habits among Filipino children.MethodsIn this cluster-randomised trial, twenty primary schools were randomly allocated to the intervention or control arm. Intervention schools received group handwashing facilities and implemented daily group handwashing and toothbrushing activities. A soap use to toilet event ratio was calculated to measure children’s independent handwashing behaviour after toilet use, and dental plaque accumulation on Monday morning was measured as a proxy indicator for children’s independent toothbrushing behaviour at home.ResultsFour months after implementation, handwashing and toothbrushing behaviours did not significantly differ between intervention and control schools. The mean soap use in intervention schools and control schools was 0.41 g and 0.30 g per toilet event, respectively (p = 0.637). Compared to baseline, mean plaque scores reduced by 4.2% and 3.5% in intervention and control schools, respectively (p = 0.857).ConclusionsAlthough health benefits have been established, school-based group handwashing and toothbrushing may not be sufficient to increase children’s uptake of independent hygiene behaviours.
Highlights
Children in low- and middle-income countries (LMICs) suffer from a high burden of preventable diseases and hygiene deficiencies are a common determinant
Objectives To explore whether a school-based water, sanitation and hygiene programme, which includes group hygiene activities, contributes to the formation of independent handwashing and toothbrushing habits among Filipino children
Interventions include the practice of daily group handwashing with soap and toothbrushing with toothpaste
Summary
Children in low- and middle-income countries (LMICs) suffer from a high burden of preventable diseases and hygiene deficiencies are a common determinant. Handwashing with soap (HWWS) is one of the most costeffective public health interventions (Curtis and Cairncross 2003) and is associated with a 30% reduction in incidence of diarrhoea (Wolf et al 2018) and 21% reduction in respiratory illness (Aiello et al 2008). The importance of a supportive school environment to promote hygiene ( HWWS) has been recognised globally through inclusion in the Sustainable Development Goals under target 4.A, which aims to achieve ‘access to handwashing facilities with water and soap in all schools’ by 2030 (United Nations Children’s Fund and World Health Organization 2018). School-based interventions targeting hygiene behaviour change are often limited to educating children about health risks associated with poor personal (oral) hygiene, despite evidence that knowledge transfer and awareness raising seldom lead to sustained behaviour change (Stein et al 2017; Watson et al 2017)
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