1921
Volume 89, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

We assessed whether supplying soap to primary schools on a regular basis increased pupil hand washing and decreased 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 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.

[open-access] 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.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.12-0387
2013-10-09
2017-11-18
Loading full text...

Full text loading...

/deliver/fulltext/14761645/89/4/698.html?itemId=/content/journals/10.4269/ajtmh.12-0387&mimeType=html&fmt=ahah

References

  1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, , 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 21512161.[Crossref]
  2. Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt W-P, , 2011. The effect of handwashing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health 8: 97104.[Crossref]
  3. Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung ICH, Schmidt W-P, , 2010. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol 39: i193i205.[Crossref]
  4. Rabie T, Curtis V, , 2006. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 11: 258267.[Crossref]
  5. Borghi J, Guinness L, Ouedraogo J, Curtis V, , 2002. Is hygiene promotion cost-effective? A case study in Burkino Faso. Trop Med Int Health 7: 110.[Crossref]
  6. Pittet D, Mourouga P, , 1999. Compliance with handwashing in a teaching hospital. Ann Intern Med 130: 126130.[Crossref]
  7. Lankford MG, Zembower TR, Trick WE, Hacek DM, Noskin GA, Peterson LR, , 2003. Influence of role models and hospital design on hand hygiene of health care workers. Emerg Infect Dis 9: 217.[Crossref]
  8. Curtis V, Biran A, Deverell K, Hughes C, Bellamy K, Drasar B, , 2003. Hygiene in the home: relating bugs and behaviour. Soc Sci Med 57: 657672.[Crossref]
  9. Scott BE, Lawson DW, Curtis V, , 2007. Hard to handle: understanding mothers' handwashing behaviour in Ghana. Health Policy Plan 22: 216224.[Crossref]
  10. Curtis V, Schmidt W, Luby S, Florez R, Touré O, Biran A, , 2011. Hygiene: new hopes, new horizons. Lancet Infect Dis 11: 312321.[Crossref]
  11. Schmidt W-P, Aunger R, Coombes Y, Maina PM, Matiko CN, Biran A, Curtis V, , 2009. Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure. Trop Med Int Health 14: 15341541.[Crossref]
  12. Arnold SM, , 2002. Epidemiology of viral respiratory infections. Am J Med 112: 412.[Crossref]
  13. Longini I, Jr Koopman J, Monto A, Fox J, , 1982. Estimating household and community transmission parameters for influenza. Am J Epidemiol 115: 736751.[Crossref]
  14. Mikolajczyk RT, Akmatov MK, Rastin S, Kretzschmar M, , 2007. Social contacts of school children and the transmission of respiratory-spread pathogens. Epidemiol Infect 136: 813822.
  15. Bowen A, Ma H, Ou J, Billhimer W, Long T, Mintz E, Hoekstra RM, Luby S, , 2007. A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools. Am J Trop Med Hyg 76: 11661173.
  16. Guinan M, McGuckin M, Ali Y, , 2002. The effect of a comprehensive handwashing program on absenteeism in elementary schools. Am J Infect Control 30: 217220.[Crossref]
  17. Nandrup-Bus I, , 2009. Mandatory handwashing in elementary schools reduces absenteeism due to infectious illness among pupils: a pilot intervention study. Am J Infect Control 37: 820826.[Crossref]
  18. Freeman MC, Greene LE, Dreibelbis R, Saboori S, Muga R, Brumback B, Rheingans R, , 2012. Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial. Trop Med Int Health 17: 380391.
  19. Dongre AR, Deshmukh PR, Boratne AV, Thaware P, Garg BS, , 2007. An approach to hygiene education among rural Indian school going children. Online J Health Allied Sci 6: 16.
  20. Onyango-Ouma W, Aagaard-Hansen J, Jensen BB, , 2005. The potential of schoolchildren as health change agents in rural western Kenya. Soc Sci Med 61: 17111722.[Crossref]
  21. Saboori S, Mwaki A, Porter SE, Okech B, Freeman MC, Rheingans RD, , 2011. Sustaining school hand washing and water treatment programmes: lessons learned and to be learned. Waterlines 30: 298311.[Crossref]
  22. Greene LE, Freeman MC, Akoko D, Saboori S, Moe C, Rheingans R, , 2012. Impact of a school-based hygiene promotion and sanitation intervention on pupil hand contamination in western Kenya: a cluster randomized trial. Am J Trop Med Hyg 87: 385393.[Crossref]
  23. Freeman MC, Clasen T, Dreibelbis R, Greene LE, Saboori S, Brumback B, Muga R, Rheingans R, , 2013. The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial. Epidemiol Infect 24: 112.
  24. Garn J, Greene LE, Dreibelbis R, Saboori S, Rheingans R, Freeman MC, , 2013. A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrolment and gender parity in enrolment. J Water Sanitation Hygiene Dev. online June 10, 2013. doi:10.2166/washdev.2013.217.
  25. Dreibelbis R, Freeman MC, Greene LE, Saboori S, Rheingans R, , 2013. The Impact of School Water, Sanitation, and Hygiene Interventions on the Health of Younger Siblings of Pupils: a Cluster-Randomized Trial in Kenya. Am J Public Health. doi:10.2105/AJPH.2013.301412.
  26. Kenya National Bureau of Statistics (KNBS) & ICF MACRO, 2010. Kenya Demographic and Health Survey 2008–09. Calverton, MD: KNBS and ICF MACRO.
  27. Saboori S, Mwaki A, Rheingans RD, , 2010. Is soapy water a viable solution for handwashing in schools? Waterlines 29: 329336.[Crossref]
  28. Metwallya AM, Saad A, Ibrahim NA, Emam HM, El-Etrebya LA, , 2007. Monitoring progress of the role of integration of environmental health education with water and sanitation services in changing community behaviors. Int J Environ Health Res 17: 6174.[Crossref]
  29. Pinfold JV, , 1999. Analysis of different communication channels for promoting hygiene behavior. Health Educ Res 14: 629639.[Crossref]
  30. Rhee V, Mullany LC, Khatry SK, Katz J, LeClerq SC, Darmstadt GL, Tielsch JM, , 2008. Maternal and birth attendant hand washing and neonatal mortality in Southern Nepal. Arch Pediatr Adolesc Med 162: 603608.[Crossref]
  31. Scott BE, Schmidt WP, Aunger R, Garbrah-Aidoo N, Animashaun R, , 2007. Marketing hygiene behaviours: the impact of different communication channels on reported handwashing behaviour of women in Ghana. Health Educ Res 23: 392401.[Crossref]
  32. Wilson JM, Chandler GN, , 1993. Sustained improvements in hygiene behavior amongst village women in Lombok, Indonesia. Trans R Soc Trop Med Hyg 87: 615616.[Crossref]
  33. Curtis V, Kanki B, Cousens S, Diallo I, Kpozehouen A, Sangaré M, Nikiema M, , 2001. Evidence of behaviour change following a hygiene promotion programme in Burkina Faso. Bull World Health Organ 79: 518527.
  34. Haggerty PA, Muladi K, Kirkwood BR, Ashworth A, Manunebo M, , 1994. Community-based hygiene education to reduce diarrhoeal disease in rural Zaire: impact of the intervention on diarrhoel morbidity. Int J Epidemiol 23: 10501059.[Crossref]
  35. Jagals P, Nala NP, Tsubane TJ, Moabi M, Motaung KC, , 2004. Measuring changes in water-related health and hygiene practices by developing-community households. Water Sci Technol 50: 9197.
  36. Luby S, Agboatwalla M, Bowen A, Kenah E, Sharker Y, Hoekstra RM, , 2009. Difficulties in maintaining improved handwashing behavior, Karachi, Pakistan. Am J Trop Med Hyg 81: 140145.[Crossref]
  37. Luby SP, Agboatwalla M, Raza A, Sobel J, Mintz ED, Baier K, Hoekstra RM, Rahbar MH, Hassan R, Qureshi SM, Gangarosa EJ, , 2001. Microbiologic effectiveness of hand washing with soap in an urban squatter settlement, Karachi, Pakistan. Epidemiol Infect 127: 237244.[Crossref]
  38. Sobel J, Mahon B, Mendoza CE, Passaro D, Cano F, Baier K, Racioppi F, Hutwagner L, Mintz ED, , 1998. Reduction of fecal contamination of street-vended beverages in Guatemala by a simple system for water purification and storage, handwashing, and beverage storage. Am J Trop Med Hyg 59: 380387.
  39. Hoque BA, , 2003. Handwashing practices and challenges in Bangladesh. Int J Environ Health Res 13: 8187.[Crossref]
  40. Pickering AJ, Julian TR, Mamuya S, Boehm AB, Davis J, , 2010. Bacterial hand contamination among Tanzanian mothers varies temporally and following household activities. Trop Med Int Health 16: 233239.[Crossref]
  41. Pickering AJ, Davis J, Walters SP, Horak HM, Keymer DP, Mushi D, Strickfaden R, Chynoweth JS, Liu J, Blum A, Rogers K, Boehm AB, , 2010. Hands, water, and health: fecal contamination in Tanzanian communities with improved, non-networked water supplies. Environ Sci Technol 44: 32673272.[Crossref]
  42. Pickering AJ, Boehm AB, Mwanjali M, Davis J, , 2010. Efficacy of waterless hand hygiene compared with handwashing with soap: a field study in Dar es Salaam, Tanzania. Am J Trop Med Hyg 82: 270278.[Crossref]
  43. Lopez-Quintero C, Freeman P, Neumark Y, , 2009. Hand washing among school children in Bogota, Colombia. Am J Public Health 99: 94101.[Crossref]
  44. O'Reilly CE, Freeman MC, Ravani M, Migele J, Mwaki A, Ayalo M, Ombeki S, Hoekstra RM, Quick R, , 2008. The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006. Epidemiol Infect 136: 8091.[Crossref]
  45. Curtis V, Cousens S, Mertens T, Traore E, Kanki B, Diallo I, , 1993. Structured observation of hygiene behaviours in Burkina Faso: validity, variability, and utility. Bull World Health Organ 71: 2332.
  46. Vindigni SM, Riley PL, Jhung M, , 2011. Systematic review: handwashing behaviour in low- to middle-income countries: outcome measures and behaviour maintenance. Trop Med Int Health 16: 466477.[Crossref]
  47. Hoque BA, Mahalanabis D, Alam MJ, Islam S, , 1995. Post-defecation handwashing in Bangladesh: practice and efficiency perspectives. Public Health 109: 1524.[Crossref]
  48. USEPA, 2003. Method No. 10029: Total Coliforms and E. coli Membrane Filtration Method. Washington, DC: USEPA.
  49. Vyas S, Kumaranayake L, , 2006. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21: 459468.[Crossref]
  50. Greene LE, Freeman MC, Akoko D, Saboori S, Moe C, Rheingans R, , 2012. Impact of a school-based hygiene promotion and sanitation interventions on pupil hand contamination in western Kenya: a cluster-randomized trial. Am J Trop Med Hyg 87: 385393.[Crossref]
  51. Bolt E, Shordt K, Krukkert I, , 2006. School Sanitation and Hygiene Education Results from the Assessment of a 6-Country Pilot Project. Delft, The Netherlands: International Water and Sanitation Centre.
  52. Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA, , 2008. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev 1: CD004265.
  53. Ram PK, Halder AK, Granger SP, Jones T, Hall P, Hitchcock D, Wright R, Nygren B, Islam MS, Molyneaux JW, Luby SP, , 2010. Is structured observation a valid technique to measure handwashing behavior? Use of acceleration sensors embedded in soap to assess reactivity to structured observation. Am J Trop Med Hyg 83: 10701076.[Crossref]
  54. Ram PK, Jahid I, Halder AK, Nygren B, Islam MS, Granger SP, Molyneaux JW, Luby SP, , 2011. Variability in hand contamination based on serial measurements: implications for assessment of hand-cleansing behavior and disease risk. Am J Trop Med Hyg 84: 510516.[Crossref]
  55. Luby SP, Kadir MA, Sharker MAY, Farzana Y, Unicomb L, Islam MS, , 2010. A community-randomized controlled trial promoting waterless hand sanitizer and handwashing with soap, Dhaka, Bangladesh. Trop Med Int Health 15: 15081516.[Crossref]
  56. Kaltenthaler EC, Pinfold JV, , 1995. Microbiological methods for assessing handwashing practice in hygiene behaviour studies. J Trop Med Hyg 98: 101106.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.12-0387
Loading
/content/journals/10.4269/ajtmh.12-0387
Loading

Data & Media loading...

  • Received : 19 Jun 2012
  • Accepted : 30 Jun 2013

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error