Impact of Regular Soap Provision to Primary Schools on Hand Washing and E. coli Hand Contamination among Pupils in Nyanza Province, Kenya: A Cluster-Randomized Trial

• Type of Material: Article
• Authors: Shadi Saboori, Emory University; Leslie E. Greene, Emory University; Christine L Moe, Emory University; Matthew Freeman, Emory University; Bethany Caruso, Emory University; Daniel Akoko, Emory University; Richard Rheingans, Emory University
• Language: English
• Date: 2013-10-09
• Publisher: American Society of Tropical Medicine and Hygiene
• Publication Version: Final Published Version
• Copyright Statement: ©The American Society of Tropical Medicine and Hygiene. This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
• Final Published Version (URL): http://www.ajtmh.org/content/89/4/698.full
• Title of Journal or Parent Work: American Journal of Tropical Medicine and Hygiene
• ISSN: 0002-9637
• Volume: 89
• Issue: 4
• Start Page: 698
• End Page: 708
• Grant/Funding Information: This study was supported by the Bill and Melinda Gates Foundation and the Global Water Challenge.
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

We assessed whether supplying soap to primary schools on a regular basis increased pupil hand washing and decreased Escherichia coli hand contamination. Multiple rounds of structured observations of hand washing events after latrine use were conducted in 60 Kenyan schools, and hand rinse samples were collected one time in a subset of schools. The proportion of pupils observed practicing hand washing with soap (HWWS) events was significantly higher in schools that received a soap provision intervention (32%) and schools that received soap and latrine cleaning materials (38%) compared with controls (3%). Girls and boys had similar hand washing rates. There were non-significant reductions in E. coli contamination among intervention school pupils compared with controls. Removing the barrier of soap procurement can significantly increase availability of soap and hand washing among pupils; however, we discuss limitations in the enabling policy and institutional environment that may have prevented reaching desired levels of HWWS.