Abstract
Many schools in low-income countries have inadequate access to water facilities, sanitation and hygiene promotion. A systematic review of literature was carried out that aimed to identify and analyse the impact of water, sanitation and hygiene interventions (WASH) in schools in low-income countries. Published peer reviewed literature was systematically screened during March to June 2018 using the databases PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and Google Scholar. There were no publication date restrictions. Thirty-eight peer reviewed papers were identified that met the inclusion criteria. The papers were analysed in groups, based on four categories of reported outcomes: (i) reduction of diarrhoeal disease and other hygiene-related diseases in school students; (ii) improved WASH knowledge, attitudes and hygiene behaviours among students; (iii) reduced disease burden and improved hygiene behaviours in students’ households and communities; (iv) improved student enrolment and attendance. The typically unmeasured and unreported ‘output’ and/or ‘exposure’ of program fidelity and adherence was also examined. Several studies provide evidence of positive disease-related outcomes among students, yet other assessments did not find statistically significant differences in health or indicated that outcomes are dependent on the nature and context of interventions. Thirteen studies provide evidence of changes in WASH knowledge, attitudes and behaviours, such as hand-washing with soap. Further research is required to understand whether and how school-based WASH interventions might improve hygiene habits and health among wider family and community members. Evidence of the impact of school-based WASH programs in reducing student absence from school was mixed. Ensuring access to safe and sufficient water and sanitation and hygiene promotion in schools has great potential to improve health and education and to contribute to inclusion and equity, yet delivering school-based WASH intervention does not guarantee good outcomes. While further rigorous research will be of value, political will and effective interventions with high program fidelity are also key.
Highlights
Schools with adequate water, sanitation and hygiene (WASH) facilities have: a reliable water system that provides safe and sufficient water, especially for hand-washing and drinking; sufficient number of toilets for students and teachers that are private, safe, clean, and culturally and gender appropriate; water-use and hand-washing facilities, including some close to toilets; and sustained hygiene promotion [1]
The initial search terms identified 1498 publications; 11 additional articles were identified from other sources
The studies in this review indicate that school-based WASH interventions can protect against diarrhoea and other WASH-related illness such as soil-transmitted helminths and acute respiratory infections, increase WASH-related knowledge and practices, and improve educational outcomes including reduced absence
Summary
Sanitation and hygiene (WASH) facilities have: a reliable water system that provides safe and sufficient water, especially for hand-washing and drinking; sufficient number of toilets for students and teachers that are private, safe, clean, and culturally and gender appropriate; water-use and hand-washing facilities, including some close to toilets; and sustained hygiene promotion [1]. Facilities should cater to all, including small children, girls of menstruation age, and children with disabilities. WASH conditions in schools in many low-income countries, are inadequate with associated detrimental effects on health and school attendance [2]. An evaluation by UNICEF [3] found that in schools in low-income countries, only 51% of schools had access to adequate water sources and only 45% had adequate sanitation. Public Health 2019, 16, 359; doi:10.3390/ijerph16030359 www.mdpi.com/journal/ijerph
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