Assessing the impact of a school-based latrine cleaning and handwashing program on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial

• Type of Material: Article
• Authors: Bethany A. Caruso, Emory University; Matthew Freeman, Emory University; Joshua V. Garn, Emory University; Robert Dreibelbis, University of Oklahoma; Shadi Saboori, Emory University; Richard Muga, Great Lakes University of Kisumu; Richard Rheingans, University of Florida
• Language: English
• Date: 2014-10
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 John Wiley & Sons Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1111/tmi.12360
• Title of Journal or Parent Work: Tropical Medicine and International Health
• ISSN: 1360-2276
• Volume: 19
• Issue: 10
• Start Page: 1185
• End Page: 1197
• Grant/Funding Information: This research was conducted under the umbrella of SWASH+. SWASH+ was funded by the Bill & Melinda Gates Foundation.
• Keywords: school; latrine use; absence; handwashing; hygiene; sanitation
• Research Categories: Health Sciences, Public Health; Environmental Sciences; Health Sciences, Hygiene

Abstract

Improving school water, sanitation and hygiene (WASH) conditions has been shown to be effective in reducing pupil absence and illness. However, the benefit of sanitation and hygiene promotion improvements at school may depend on the conditions of the latrines and availability of consumables. We employed a three-arm, cluster-randomized trial to determine if a low-cost, policy-relevant, environmental-level latrine cleaning intervention could a) improve latrine cleanliness, b) increase latrine use, and c) reduce absenteeism. We assessed absence via periodical roll-call among 17,564 pupils in 60 schools that previously received WASH Improvements as part of the SWASH+ project. Latrine conditions and use were also assessed using structured observation. Latrine cleanliness increased significantly during the post-intervention period among schools receiving the latrine-cleaning package compared to controls. Handwashing with soap increased as well in intervention schools relative to controls. We found no difference in latrine use and absence across arms. The additive impact of cleaning may not have been strong enough to impact absence above and beyond reductions attributable to the original WASH infrastructure improvements and basic hygiene education the schools previously received. Improving latrine conditions is important for the dignity and well being of pupils, and investments and strategies are necessary to ensure school sanitation environments are clean and pupil-friendly.