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Author Notes:

Address correspondence to Leslie E. Greene, Center for Global Safe Water, Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, CNR #2027, Atlanta, GA 30322. E-mail: lgreen4@emory.edu

We thank the study participants and acknowledge the hard work of our colleagues at the Great Lakes University of Kisumu, CARE, Water.org, and SANA, and specifically Patrick Alubbe, Babette Brumback, Robert Dreibelbis, Dan Kaseje, Brooks Keene, Peter Lochery, Alfred Luoba, John Migele, Alex Mwaki, Imelda Akinyi Ochari, Betty Ojeny, Ben Okech, Caroline Teti, Peter Waka, and Elizabeth Were.

Special thanks to Lily Lukorito who assisted in processing samples in the laboratory and Emily Awino Ogutu and Boniface Achuma, who assisted with counting plates.

The study was led by Emory University, and conducted through a consortium led by CARE USA.


Research Funding:

This study was supported by the Bill and Melinda Gates Foundation and Global Water Challenge.

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


Journal Title:

American Journal of Tropical Medicine and Hygiene


Volume 87, Number 3


, Pages 385-393

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

©The American Society of Tropical Medicine and Hygiene

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