Abstract
Handwashing with soap effectively reduces exposure to diarrhea-causing pathogens. Interventions to improve hygiene and sanitation conditions in schools within low-income countries have gained increased attention; however, their impact on schoolchildren's exposure to fecal pathogens has not been established. Our trial examined whether a school-based water, sanitation, and hygiene intervention reduced Escherichia coli contamination on pupils' hands in western Kenya. A hygiene promotion and water treatment intervention did not reduce risk of E. coli presence (relative risk [RR] = 0.92, 95% confidence interval [CI] = 0.54–1.56); the addition of new latrines to intervention schools significantly increased risk among girls (RR = 2.63, 95% CI = 1.29–5.34), with a non-significant increase among boys (RR = 1.36, 95% CI = 0.74–2.49). Efforts to increase usage of school latrines by constructing new facilities may pose a risk to children in the absence of sufficient hygiene behavior change, daily provision of soap and water, and anal cleansing materials.
Highlights
~1.3 million children under 5 years of age die each year due to diarrhea.[1]
Our study found that an intervention consisting of schoolbased hygiene promotion and water treatment did not impact pupils’ risk of having E. coli hand contamination
We found no reduction in hand contamination in intervention schools as originally hypothesized
Summary
~1.3 million children under 5 years of age die each year due to diarrhea.[1]. Pupils may act as agents of WASH behavior change in the community.[8,9,10] Despite increased global efforts to improve school WASH infrastructure and behavior, lack of soap or handwashing at schools in low-income countries in particular has been cited as a major challenge, with some studies reporting as few as 2–7% providing soap for children.[11,12,13,14,15]
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