School Water, Sanitation And Hygiene Research Articles

Impact of a school-based water and hygiene intervention on child health and school attendance in Addis Ababa, Ethiopia: a cluster-randomised controlled trial

BackgroundSchool-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance.MethodsThe WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2–4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7–16) in an ‘open cohort’. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March–June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat.ResultsOf 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94–112), 5987 enrolled at study initiation (23rd November–22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71–1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84–1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83–1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0–100 scale; 95% CI 0.05–6.59), and no evidence of effects on other secondary outcomes.ConclusionsThis large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes.Trial registrationClinicalTrials.gov, number NCT05024890.

Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study

BackgroundThe impact of access to improved water, sanitation and hygiene (WASH) and health education on large-scale deworming programs aimed at controlling soil-transmitted helminth (STH) and schistosome (SCH) infections has not been well studied. We assessed the additional impact of improved WASH infrastructure and health education at schools on STH and SCH infections in Ethiopia.MethodsThe study used a quasi-experimental design under which 30 schools were assigned to either an intervention (15 schools) or control (15 schools) arm. Both arms received a standard deworming treatment and lunch. In the intervention arm, improved WASH and health education were provided. At three consecutive time points (baseline in 2013, 2014 and 2015), the prevalence and intensity of STH and SCH infections and the nutritional status [hemoglobin concentrations and physical growth (height and weight)] were determined. To verify whether interventions were successfully implemented, the WASH status at school and the student knowledge, attitudes and practices related to WASH (WASH-KAP) were recorded. Differences in metrics between arms at baseline (2013) and follow-up (2015) were assessed both within and between the arms.ResultsA significant increase in scores for both the school WASH and student KAP was found in the intervention arm, indicating successful implementation of the intervention. The prevalence of any STH infection was significantly reduced in the intervention arm but not in the control arm (F = 4.486, p = 0.034). There was a significantly greater reduction in the intensity of infection of hookworm and Ascaris lumbricoides compared to baseline in both arms. The intervention did not affect school children’s height-for-age z-score (intervention arm * time coef = 0.12, p = 0.400) and body mass index-for-age z-scores (intervention * time coef = − 0.06, p = 0.526). Hemoglobin concentrations increased significantly more in the control than the intervention arm (coef = − 0.16, p = 0.006).ConclusionsAlthough the intervention did increase school WASH and student WASH-KAP, our study found poor evidence of the additional benefit of improved WASH and health education to deworming and school food programs on parasite re-infection and the health outcomes of children.Graphical

Improved water, Sanitation and Hygiene Facilities at School and their effect on educational achievement in basic level students in Nepal

ABSTRACT Schools with Water, Sanitation, and Hygiene (WASH) facilities can contribute to the well-being and educational achievements of pupils. The study aims to assess whether introducing WASH facilities in schools influences the educational achievements of pupils in Nepal. This research utilized a controlled before-and-after study with a quantitative, causal-comparative design. The research was conducted among 768 respondents, split between 384 in the schools with improved WASH facilities and 384 in the schools without improved school group. This study applied a stratified random sampling design, and the data were collected using a face-to-face method and administered through the structured survey tool. School WASH facilities have a significant association with educational achievements. Similarly, gender, ethnicity, grade, score, subjective norms, and intention have also significant association with educational achievements as do religion, attitudes, and self-efficacy. Students from improved school WASH facilities are more likely to obtain higher educational achievement (crude Odds Ratio (cOR) = 2.77; 95% confidence intervals (CI): 2.06 to 3.72, p < 0.001), even after adjusting for attitude, subjective norms, self-efficacy, and intention (adjusted OR (aOR) = 2.70; 95% CI: 1.99 to 3.67, p < 0.001), than those who are from the unimproved schools, keeping all socio-demographic characteristics constant. The effect is approximately four times larger (aOR = 8.31; 95% CI: 5.08 to 13.59, p < 0.001) than that exhibited by the above model, after adjusting for all socio-covariates and theory-based variables. In conclusion, improving school WASH facilities may need additional school interventions to overcome low educational achievements among students.

Usability and Acceptability of a SWASH Mobile Intervention for Behaviour Change in WASH Practices

Adequate access to Water, Sanitation, and Hygiene (WASH) is the principal determinant of human health and well-being. However, many African countries are facing challenges in implementing proper WASH practices. The School WASH (SWASH) Mobile App was developed using the Human Centred Design (HCD) approach, which leverages behavioural theories to track school students' sanitation and hygiene behaviours and encourage positive behaviour change. This study examined the usability and acceptability of the SWASH Mobile App. A qualitative research methodology was employed to assess in depth (i) whether the App achieves its intended objective of influencing WASH behaviour change in schools and (ii) challenges that affect its success. A total of 62 people from 20 schools' students, teachers, and community members in Tanzania participated in the study. The results demonstrated that the SWASH Mobile App was widely accepted and highly usable. The study further revealed that the main challenges were costly and unstable internet, difficulties in fetching pictures, and voting and lack of SWASH Mobile App awareness. The study recommends collaboration between schools and telecommunication companies for cost-effective internet access, the use of image compression techniques for faster access to pictures, and a marketing strategy to increase app awareness

Overview of Water Sanitation and Hygiene in School (WinS) Urban Areas, Indonesia

Objective: Indonesia is a developing country that still has water, sanitation and hygiene (WASH) problems. Only 16% of education units have access to all basic services such as water, sanitation and hygiene and as many as 43.5 million Indonesian children do not have access to basic drinking water, basic sanitation and hygiene at school. This can have an impact on increasing disease transmission in children at school. This study aimed to analyse the coverage of school WASH in Bekasi City so as to identify the constraints and problems of WASH in schools. Methodology: This type of research used a cross sectional design approach. The samples of this study were 30 schools in Bekasi City. The indicator data measured consists of 3, namely sanitation, hygiene and air. Results: The results of this study indicate that school WASH in Bekasi is good, this can be seen from the availability of WASH facilities in schools such as the availability of drinking water, easy access, waste management facilities, the availability of hand washing facilities and the existence of toilets that have been widely separated between men and women. Suggestions: The role of stakeholders and school sanitation programme holders is very important in the implementation of school WASH.

Motivating school communities towards behavior change and local ownership: a gamification intervention to prevent trachoma at primary schools in southern Ethiopia.

Ethiopia alone carries 49% of the global burden of trachoma, associated with a lack of safe water, sanitation and hygiene (WASH) and poor health practices. The aim of this study was to examine whether gamification among schoolchildren and promotion of local ownership of school WASH is associated with healthy behaviors and WASH infrastructure improvements. Application of the Accelerate gamification intervention for elimination of trachoma, with an emphasis on gamification among schoolchildren and community involvement in motivating face-washing, handwashing and functional use of latrines, was undertaken. The study was conducted over 9 mo in 223 rural schools from six districts within the intervention area, reaching 93 518 schoolchildren. At baseline, students were observed washing their hands after using latrines in 23 (10.3%) schools. This increased to 132 (59%) schools (p≤0.001) at follow-up. The number of latrines increased from 585 at baseline to 594 at follow-up (p=0.031). The availability of handwashing stations in schools increased from 31 (13.9%) with water access (8%) and soap (5%) to 155 (69.5%) schools with handwashing stations with water access in 153 (98.7%) (p<0.001) and soap in 121 (78%) (p<0.001). Motivational strategies such as gamification among schoolchildren and promotion of local ownership of school WASH may be associated with healthy behaviors and WASH infrastructure improvements.

Knowledge, attitudes, practices and acceptability of a school preventive chemotherapy programme for schistosomiasis and soil-transmitted helminths control in Angola.

Schistosomiasis and soil-transmitted helminth (STH) control programs require target population engagement, assessed through knowledge, attitudes and practices (KAP) surveys. We report the results of a KAP survey of Angolan schoolchildren supported by a school preventive chemotherapy (PC) programme, without or with a school water, sanitation and hygiene (WASH) programme (PC+/WASH- and PC+/WASH+, respectively); and schoolchildren without a school PC or WASH program (PC-/WASH-). Schoolchildren from PC+/WASH- (N = 218), PC+/WASH+ (N = 250) and PC-/WASH- (N = 254) schools were interviewed. Descriptive statistics were used to report demographics and survey responses. Chi-square or Fisher's exact test was used to compare PC+/WASH- schoolchildren with (i) PC+/WASH+ and (ii) PC-/WASH- schoolchildren. A lower proportion of PC+/WASH- schoolchildren used latrines and a higher proportion practised open defecation at school compared with PC+/WASH+ schoolchildren. A lower proportion of PC+/WASH- schoolchildren always washed their hands after toileting and before meals at school compared with PC+/WASH+ schoolchildren. However, the PC+/WASH- schoolchildren reported better toileting and handwashing practices at school compared to PC-/WASH- schoolchildren. Over 90% of PC+ schoolchildren agreed with schistosomiasis and STH control and accepted schoolteacher PC delivery. Expanding the integration of both school PC and WASH programs will improve health behaviours relevant to reduce the risk of schistosomiasis and STHs in schoolchildren. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.

Water, Sanitation, and Hygiene Policies and the Enhancement of Quality Education in Lower and Upper Basic Schools within Region One Education Directorate, The Gambia

This study focused on the importance of School Water, Sanitation, and Hygiene (WASH) policy in enhancing the quality of education in Lower and Upper Basic Schools within Region One Education Directorate of The Gambia. The study utilised a mixed-methods approach, combining qualitative analysis of policy documents with quantitative data obtained from questionnaires administered to head teachers. The Human Rights-Based Approach (HRBA) and Systems Thinking provide valuable theoretical lenses to analyse the lack of WASH policies. The HRBA emphasises the recognition of WASH as a fundamental human right, while the Systems Thinking approach considers the interconnectedness and complexity of the WASH system. The findings indicated that a significant number of schools in the region lack a WASH policy or rely on general directives, leading to inconsistent approaches and practices in addressing WASH issues. This inconsistency results in inadequate provision of WASH facilities, ineffective hygiene education, and a lack of clear learning objectives for students. The absence of WASH-related guidance in key school management tools and policy documents further exacerbates the challenges. The study highlighted the need for a comprehensive School WASH policy to oversee, regulate, and provide guidance for the implementation of WASH standards in educational institutions. Recommendations included developing and implementing a comprehensive School WASH policy, enhancing the curriculum framework to ensure the coverage of WASH topics, providing clear guidelines and resources, incorporating WASH into policy documents, conducting capacity-building and awareness programmes, and establishing a robust monitoring and evaluation system.

WASH and drinking water quality considerations in schools in reflection of the sustainable development goals – a review

Abstract Poor drinking water quality has been linked to negative health outcomes across the world. Drinking water quality is an essential part of safe water, sanitation, and hygiene (WASH). Safe WASH in schools is linked with the achievement of sustainable development goals (SGDs), specifically, SDG 6. It is unclear whether water quality is always assessed as part of WASH in schools. This study focused on determining the consideration of water quality aspects during WASH assessment in schools by examining published studies. A systematic online review of the literature was conducted to identify studies that reported on the assessment of WASH facilities in schools. Titles, abstracts, and full text of retrieved articles were screened. Seventy-five studies were identified. Thirty-two studies considered drinking water quality analysis as part of WASH in schools. Chemical (66%), microbial (59%), and physical (38%) parameters were included in drinking water quality analysis, with lead (Pb), and Escherichia coli being mostly included. This study reveals that some studies did not include an evaluation of drinking water quality, though it reflects an important exposure pathway between WASH services and health outcomes. It is, therefore, recommended that routine water quality monitoring be included in school WASH to ensure learner's health is protected.

Design, Methods, and Select Baseline Results from a School Nutrition Project for Adolescents in Bangladesh

BackgroundThe School Nutrition for Adolescents Project (SNAP) provided weekly iron and folic acid (WIFA) supplementation and menstrual hygiene management (MHM) support for girls; actions to improve water, sanitation, and hygiene (WASH) practices; and behavior change interventions to adolescents aged 10–19 y in 65 intervention schools in 2 districts of Bangladesh. ObjectivesWe aimed to describe the project design and select baseline results of students and school project implementers. MethodsGirls (n = 2244) and boys (n = 773) in 74 schools (clusters) and project implementers [headteachers (n = 74), teachers (n = 96), and student leaders (n = 91)] participated in a survey assessing nutrition, MHM, and WASH knowledge and experience. Hemoglobin, inflammation-adjusted ferritin, retinol-binding protein, and serum and RBC folate (RBCF) levels in girls were measured. School WASH infrastructure was observed and drinking water was tested for E. coli. ResultsIFA and deworming tablet intake in the last 1 and 6 mo were 4% and 81% for girls and 1% and 86%, respectively. Applying the Minimum Dietary Diversity for Women (MDD-W) tool, most (63%–68%) girls and boys achieved minimum dietary diversity. Fewer adolescents (14%–52%) had ever heard of anemia, IFA tablets, or worm infestation than project implementers (47%–100%). Girls (35%) missed school during menstruation; 39% reported of ever leaving school due to unexpected menstruation. The micronutrient status and deficiency severity varied: anemia (25%), RBCF insufficiency (76%), risk of serum folate deficiency (10%), deficiencies of iron (9%), and vitamin A (3%). WASH in school sustainable development goal (SDG) indicators achievement varied: basic drinking water service (70%), basic sanitation service (42%), and basic hygiene service (3%); 59% of sampled drinking water access points complied with WHO E. coli standards. ConclusionsThere is room for improvement of nutrition and health awareness, practices, micronutrient status, SDG basic WASH in-school services, and E coli contamination in school drinking water.This trial was registered in clinicaltrials.gov as NCT05455073.

English

Girl-child self-esteem, self-confidence and coping capacity with positive effects on their school performance is increase when. Water, sanitation and hygiene (WASH) topics are included in health education. This review explored the relationship and effect of sanitary facilities in schools on Girl-child participation, health impact on Girl-child education, the state of sanitary facilities and sanitary behaviors in public Junior High Schools and as well identified sustainable solutions and made recommendations on how to provide adequate sanitary facilities to reduce inequality in schools. This qualitative review gathered and analyzed secondary data at both global and local levels (with focus on the Ghana experience). Results: availability of sanitary facilities in schools has the potential to reduce students&rsquo; absenteeism especially among the girl child. Poor sanitary facilities have an adverse impact on girls&rsquo; privacy and comfort. Girls&rsquo; inability to manage their menstrual hygiene affects their participation during events at school because of panic over outflow. Girls avoid eating or drinking during the day to further avoid using the sanitary facilities making it difficult to concentrate while in school. This study shows that school WASH issues are associated with health conditions like vector-borne illnesses among others and embarrassment in school toilets. The state of hygienic conveniences and services in schools are poor and inadequate. For schools with basic amenities, they are in an awful state as a result of neglect. Therefore, it is vital to provide adequate sanitary facilities in schools. This will improve the health and wellbeing of the gild child in Ghanaian schools. &nbsp; Key words: Gender, girl-child education, health, hygiene, sanitation, water.

Factors influencing access to basic water, sanitation, and hygiene (WASH) services in schools of Bishoftu Town, Ethiopia: a cross-sectional study

Access to basic water, sanitation and hygiene services is the most effective mechanism to reduce many infectious diseases. WASH in schools related to better educational outcomes although adequate water, sanitation, and hygiene services were unavailable to millions of school-age children in Ethiopia. Therefore, it is crucial to assess the level of WASH coverage and identify factors affecting access to basic water, sanitation, and hygiene services. A cross-sectional study was carried out among 82 school facilities. A structured questionnaire and an observational checklist were used to gather the data. Water samples were taken from the schools' water storage. Descriptive and multivariable logistic regression analyses were used to analyze the data. In this study, 74.7%, 61. 3% and 37.3% of the schools had access to basic drinking water, sanitation, and hygiene services, respectively. Additionally, 21.3%, 29.4%, and 30.7% of the schools had access to limited drinking water, sanitation, and hygiene services, respectively. However, 4%, 9.3%, and 32% of the schools lacked water, sanitation, and hygiene services, respectively. We discovered that schools with male heads were 7% less likely to have access to basic hygiene services (AOR = 0.07 with 95% CI 0.01–0.5) than those with female directors. In addition, schools with hygiene and environmental health clubs had an 11.8-fold higher access rate to basic hygiene services (AOR = 11.8 with 95% CI 1.35–104) than schools without such clubs. Besides, schools that conduct WASH lessons at least once a week were 8.63 times more likely to use basic hygiene services (AOR = 8.63; 95% CI 1.18–63.22) than schools that did not. This study offers scientific evidence that could be used for sound decisions to fill the school WASH gaps. This is a unique study in determining the level of WASH coverage and identifying factors affecting access to basic hygiene services. The investigation provides some insights into how access to WASH services can be improved at the grassroots level. Federal and regional governments should implement effective interventions that assist schools to attain Sustainable Development Goal 6 by 2030. School administrators and other partner organizations should take proactive measures to enhance and maintain the WASH services.

Water, sanitation and hygiene (WASH) in schools in Brazil pre-and peri-COVID-19 pandemic: Are schools making any progress?

The previous paucity of data and research on water, sanitation and hygiene (WASH) in schools in Brazil have been preventing an assessment of how safe and healthy schools are to reopen during the COVID-19 pandemic. This study aimed first to assess the current situation of WASH in schools in Brazil and, second, to evaluate to what extent Brazilian schools have been making any progress in providing WASH since the beginning of the COVID-19 pandemic. Data on WASH conditions in schools in Brazil was retrieved from the 2020 and 2021 Brazilian National School Census (BNSC). For the first objective, frequencies of 31 variables were calculated for the whole country and regions, considering all 173,700 schools from BNSC of 2021. Five main variables were considered as indicators of adequate WASH infrastructure in schools. T-test and ANOVA were used to assess differences in these five variables according to the locality, management model and regions. For the second objective only schools presented in both datasets (n=170,422) were considered to compare WASH in schools pre- and peri-COVID-19 pandemic. Frequencies of 31 variables were calculated for the whole country and regions before and during the pandemic. Paired t-tests were conducted when differences in variables across the years were observed. At the present moment, the majority of schools in Brazil have bathrooms (97%), drinking water with quality suitable for human consumption (95%), improved sanitation facilities (78%) and solid waste collection (70%). Between 2020 and 2021, there was a mix of improvements and deterioration in the school's WASH infrastructure in all regions of the country. Overall, solely considering the WASH infrastructure, schools in the South and Southeast regions of the country are better prepared for the safe reopening. Nevertheless, public schools, schools located in rural areas and the North and Northeast regions of the country, are more in need of WASH interventions. Results indicate that little progress was achieved, and schools in Brazil are still in need of improvements.

The Status of School Water, Sanitation, and Hygiene Services in Addis Ababa, Ethiopia: Progress Towards Achieving the SDG 6.

The provision of safe water, sanitation, and hygiene (WASH) facilities and services for schools is vital to students' health, development, and educational performance. However, school WASH coverage in developing countries remains low. This study aimed to assess the adequacy of WASH services in Addis Ababa, Ethiopia. A school-based quantitative cross-sectional study was conducted from January to March 2020 in 98 schools. A multistage sampling technique was used to select schools included in the study. Data were collected using observational checklists and pretested interviewer-administered questionnaires. We entered the data into EPI Info version 7.2.2.6 and analyzed using SPSS 22.0. Logistic regression was used to examine the associated factors with school WASH services. The basic school water, sanitation, and hygiene services were found to be 65.3%, 31.6%, and 36.7%, respectively. The facility-to-student ratio was 1:48 for drinking water point, 1:59 for toilet stance, and 1:147 for handwashing point. The analysis of facilities access by sex revealed that the toilet to student ratio was 1:68 for females and 1:49 for males, whereas the handwashing point-to-student ratio was 1:179 for females and 1:114 for males, indicating disparities in facilities access by sex. The non-functionality rates for drinking water, toilets, and handwashing facilities were 22.5%, 8%, and 19.5%, respectively. School ownership was significantly associated with the availability of basic water services [COR = 4.6, 95% CI: 1.466-14.426] and basic sanitation services [COR = 15, 95% CI: 3.27-68.28]. Moreover, the results demonstrate training on WASH [COR = 5, 95% CI: 1.087-23.018] and teaching programs on WASH [COR = 0.21, 95% CI: 0.056-0.810] were significantly associated with basic hygiene services. The provision of WASH facilities and services in schools was inadequate and not on track to meet the targets of SDG 6. Training, WASH education program, and stakeholder commitment and cooperation at all levels are required to achieve the goal.

School Water, Sanitation, and Hygiene: A Systematic Review of an Effect on Health, Attendance, Regularity, and Educational Achievements

The review was started aiming to assess the effect of school-based Water, Sanitation, and Hygiene (WASH) facilities on students’ health status, school regularity, and educational achievement. Two major academic and scientific research journals as Springer and PubMed have been selected, where WASH is the search engines, separately. There were 8,443 relevant publications found, with Springer having6, 888 and PubMed having 1,555. Among these publications, author synthesized 17 with abstracts and full articles, including references for this study. The findings of this study indicates that intervention of school WASH facilities have an effect on students’ health status, regularity in school attendance, and educational achievement. It protects students from various infectious diseases caused by poor WASH access; however, ways of handling it is equally important. The intervention in WASH facilities at school improves students’ health, school regularity, and educational achievements. Thus, the study strongly suggests interventions in school-based WASH facilities to make students healthier, more regular, and better academic performer.

School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines

BackgroundThe impacts of multicomponent school water, sanitation, and hygiene (WaSH) interventions on children’s health are unclear. We conducted a cluster-randomized controlled trial to test the effects of a school WaSH intervention on children’s malnutrition, dehydration, health literacy (HL), and handwashing (HW) in Metro Manila, Philippines.MethodsThe trial lasted from June 2017 to March 2018 and included children, in grades 5, 6, 7, and 10, from 15 schools. At baseline 756 children were enrolled. Seventy-eight children in two clusters were purposively assigned to the control group (CG); 13 clusters were randomly assigned to one of three intervention groups: low-intensity health education (LIHE; two schools, n = 116 children), medium-intensity health education (MIHE; seven schools, n = 356 children), and high-intensity health education (HIHE; four schools, n = 206 children). The intervention consisted of health education (HE), WaSH policy workshops, provision of hygiene supplies, and WaSH facilities repairs. Outcomes were: height-for-age and body mass index-for-age Z scores (HAZ, BAZ); stunting, undernutrition, overnutrition, dehydration prevalence; HL and HW scores. We used anthropometry to measure children’s physical growth, urine test strips to measure dehydration, questionnaires to measure HL, and observation to measure HW practice. The same measurements were used during baseline and endline. We used multilevel mixed-effects logistic and linear regression models to assess intervention effects.ResultsNone of the interventions reduced undernutrition prevalence or improved HAZ, BAZ, or overall HL scores. Low-intensity HE reduced stunting (adjusted odds ratio [aOR] 0.95; 95% CI 0.93 to 0.96), while low- (aOR 0.57; 95% CI 0.34 to 0.96) and high-intensity HE (aOR 0.63; 95% CI 0.42 to 0.93) reduced overnutrition. Medium- (adjusted incidence rate ratio [aIRR] 0.02; 95% CI 0.01 to 0.04) and high-intensity HE (aIRR 0.01; 95% CI 0.00 to 0.16) reduced severe dehydration. Medium- (aOR 3.18; 95% CI 1.34 to 7.55) and high-intensity HE (aOR 3.89; 95% CI 3.74 to 4.05) increased observed HW after using the toilet/urinal.ConclusionIncreasing the intensity of HE reduced prevalence of stunting, overnutrition, and severe dehydration and increased prevalence of observed HW. Data may be relevant for school WaSH interventions in the Global South. Interventions may have been more effective if adherence was higher, exposure to interventions longer, parents/caregivers were more involved, or household WaSH was addressed.Trial registration numberDRKS00021623.

A qualitative cross-sectional study exploring the implementation of disability-inclusive WASH policy commitments in Svay Reing and Kampong Chhnang Provinces, Cambodia

BackgroundThe Government of Cambodia references core concepts of human rights of people with disabilities in their water, sanitation and hygiene (WASH) policies and guidance. However, few references clearly articulate activities to achieve these.MethodsThis cross-sectional study in Cambodia explores the implementation of core concepts of human rights referenced in Cambodia's WASH policies in Kampong Chhnang and Svay Reing Provinces: Individualized services, Entitlement/affordability, Participation, Family resource, Access. Seven government officials and 10 service providers working in Phnom Penh and the two provinces, 16 women and men with disabilities (aged 18–65+), and four caregivers living in the study sites were included. Purposive sampling was applied to select participants. In-depth interviews were conducted via Zoom and over the telephone and analyzed data thematically using Nvivo 12.ResultsThe Three Star Approach for WASH in Schools was noted as a promising approach for implementing policy commitments to make school WASH services accessible. However, policy commitments to disability-inclusive WASH were not always enacted systematically at all levels. Organizations of Persons with Disabilities faced challenges when advocating for disability rights at WASH sector meetings and people with disabilities were inconsistently supported to participate in commune WASH meetings. Poor access to assistive devices (e.g., wheelchair) and inaccessible terrain meant few people with disabilities could leave home and many had inadequate WASH services at home. Few could afford accessible WASH services and most lacked information and knowledge about how to improve WASH access for people with disabilities. Caregivers had no guidance about how to carry out the role and few had assistive devices (e.g., commodes, bedpans) or products (i.e., lifting devices), so supporting WASH for people with disabilities was physically demanding and time-consuming.ConclusionThis study has noted several areas where Cambodia's WASH systems are focusing efforts to ensure people with disabilities gain access to WASH, but it has also highlighted aspects where implementation of policy commitments could be strengthened. A more comprehensive and cross-sectoral approach to progressively realizing the rights to water and sanitation for people with disabilities and challenging disability discrimination more broadly could significantly disrupt the vicious cycle of poverty and disability.

Awareness and knowledge of environmental health among secondary school students from Mtwara town in Tanzania

Students are provided with education, including environmental health education that they develop throughout their lives and the education empowers them to become active participants in the transformation of their communities. Therefore, this study aimed to examine awareness and knowledge about environmental health issues among secondary school students from Mtwara town in Tanzania. A questionnaire survey was used to collect data. Pearson's chi-square and Pearson correlation (R) tests were used to determine whether there was a statistically significant difference between the gender and study variables. A greater proportion of students had awareness and knowledge of infectious diseases (99.8% vs. 97.1%, p=0.004, X2=9.529, OR 1.028, 95% CI 1.005 – 1.051) and non-communicable diseases (98.1% vs. 95%, p=0.031, X2 = 5.370, OR 1.033, 95% CI 1.001 – 1.067). However, awareness of the term school water, sanitation and hygiene (SWASH) was very low among all students, with no statistically significant difference (26.1% vs. 25.5%, p = 0.927). Girls had more understanding of global warming (91.7% vs. 86.2%, p=0.033) and good ventilation prevented the spread of cough and mucus (62.1% vs. 54%, p=0.041) than male students. While no statistically significant difference between students' awareness and knowledge of pollution was observed (99.5% vs. 97.9%, p=0.104), there was a higher proportion of noise and land pollution awareness among students. Female students had higher awareness of noise pollution (70.2% vs. 56.9%, p=0.001) and land pollution (86.1% vs. 78.2%, p=0.010) than their peers. The results of this study add more knowledge to the existing information on students' awareness and knowledge of environmental health problems. The study recommends that programs to disseminate information related to environmental health should be maintained to sustain high student awareness and knowledge of environmental health.

Effects of Water, Sanitation, and Hygiene on the School Absenteeism of Basic Level Students in the Government School of Nepal

This study assesses the effect of improved water, sanitation, and hygiene (WASH) services on students’ absenteeism in government basic schools for 10–19 years old in Nepal. This study applied an ex post facto research design on two groups of students: with and without improved school WASH services. This study showed that students in schools with improved WASH services were more likely to be regular in attendance (80%) compared to those without (58%), p &amp;lt; 0.001. There was an association between students’ school absenteeism and student grades, p &amp;lt; 0.05. Moreover, the caste, religion, and grades of students were also associated with students’ school absenteeism, p &amp;lt; 0.001. The analysis further showed that students with improved WASH were more likely to be regular [crude odds ratios (COR) = 0.353; 95% confidence interval (CI); 0.256–0.487, p &amp;lt; 0.001] than those without. This trend was maintained across all demographics. It was significant even after the inclusion of all sociodemographic characteristics and increased rapidly [adjusted odds ratio (AOR) = 0.508; 95% CI; 0.334–0.773, p &amp;lt; 0.01]. The Brahmin/Chhetri-Terai and the Dalit students were more likely to be absent (COR = 0.315; 95% CI; 0.153–0.648, p &amp;lt; 0.01 and AOR = 0.274; 95% CI; 0.139–0.542, p &amp;lt; 0.001, respectively) than Brahmin/Chhetri-Hill, Janajati, and other castes. This study underscores the importance of WASH services in schools in reducing students’ school absenteeism. Access to WASH services is recommended with several awareness programs to reduce absenteeism and increase students’ school regularity.

Necessary conditions for sustainable water and sanitation service delivery in schools: A systematic review.

Access to water, sanitation, and hygiene (WASH) services confers significant health and economic benefits, especially for children, but only if those services can be delivered on a consistent basis. The challenge of sustainable, school-based WASH service delivery has been widely documented, particularly in resource-constrained contexts. We conducted a systematic review of published research that identifies drivers of, or tests solutions to, this challenge within low- and middle-income countries (PROSPERO 2020 CRD42020199163). Authors in the first group employ cross-sectional research designs and interrogate previously implemented school WASH interventions. Most conclude that dysfunctional accountability and information sharing mechanisms drive school WASH service delivery failures. By contrast, most of the interventions developed and tested experimentally by authors in the second group focus on increasing the financial and material resources available to schools for WASH service delivery. Overall, these authors find negligible impact of such infusions of cash, infrastructure, and supplies across a variety of sustainability outcome metrics. Taken together, the evidence suggests that sustainable service delivery depends on three simultaneously necessary components: resources, information, and accountability. Drawing upon theory and evidence from social psychology, public management, and political science, we identify priority knowledge gaps that can meaningfully improve the design of effective interventions. We also highlight the importance of both interdisciplinary collaboration and local expertise in designing WASH programming that aligns with sociocultural and institutional norms, and is thus more likely to generate sustainable impact.