Impact of a School-Based Hygiene Promotion and Sanitation Intervention on Pupil Hand Contamination in Western Kenya: A Cluster Randomized Trial

• Type of Material: Article
• Authors: Leslie E Greene, Emory University; Matthew Freeman, Emory University; Daniel Akoko, Emory University; Shadi Saboori, Emory University; Christine L Moe, Emory University; Richard Rheingans, Emory University
• Language: English
• Date: 2012-09-05
• Publisher: American Society of Tropical Medicine and Hygiene
• Publication Version: Final Published Version
• Copyright Statement: ©The American Society of Tropical Medicine and Hygiene
• Final Published Version (URL): http://dx.doi.org/10.4269%2Fajtmh.2012.11-0633
• Title of Journal or Parent Work: American Journal of Tropical Medicine and Hygiene
• ISSN: 0002-9637
• Volume: 87
• Issue: 3
• Start Page: 385
• End Page: 393
• Grant/Funding Information: This study was supported by the Bill and Melinda Gates Foundation and Global Water Challenge.
• Research Categories: Health Sciences, Public Health

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.