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Author Notes:

Correspondence: Shadi Saboori, Center for Global Safe Water, Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322. E-mail: ssaboor@emory.edu

Acknowledgments: The authors thank the study participants and acknowledge the hard work of our colleagues at the Great Lakes University of Kisumu and Cooperative for Assistance and Relief Everywhere, Inc., specifically Kelly Alexander, Malaika Cheney-Coker, Robert Dreibelbis, Dan Kaseje, Brooks Keene, Peter Lochery, Richard Muga, Alex Mwaki, Emily Awino Ogutu, Betty Ojeny, and Ben Okech.

Special thanks to Lily Lukorito and Michael Sanderson, who assisted in sample collection, processing of samples, and counting of plates in the laboratory.

Disclosures: This study was led by Emory University and conducted through a consortium led by Cooperative for Assistance and Relief Everywhere, Inc., USA.


Research Funding:

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

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


Journal Title:

American Journal of Tropical Medicine and Hygiene


Volume 89, Number 4


, Pages 698-708

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

©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.

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