1921
Volume 87, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

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 contamination on pupils' hands in western Kenya. A hygiene promotion and water treatment intervention did not reduce risk of 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.

[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.

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References

  1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375: 19691987.[Crossref]
    [Google Scholar]
  2. WHO, 2010. World Health Statistics: World Health Organization. Geneva: WHO.
    [Google Scholar]
  3. Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung IC, Schmidt W-P, 2010. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol 39: i193i205.[Crossref]
    [Google Scholar]
  4. Burton M, Cobb E, Donachie P, Judah G, Curtis V, 2011. The effect of handwashing with water or soap on bacterial contamination on hands. Int J Environ Res Public Health 8: 97104.[Crossref]
    [Google Scholar]
  5. Hoque BA, Mahalanabis D, Alam MJ, Islam S, 1995. Post-defecation handwashing in Bangladesh: practice and efficiency perspectives. Public Health 109: 1524.[Crossref]
    [Google Scholar]
  6. Curtis V, Schmidt W-P, Luby S, Florez R, Touré O, Biran A, 2011. Hygiene: new hopes, new horizons. Lancet Infect Dis 11: 312321.[Crossref]
    [Google Scholar]
  7. UNICEF, 2010. Raising Clean Hands: Advanced Learning, Health and Participation through WASH in Schools. New York: UNICEF.
    [Google Scholar]
  8. 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]
    [Google Scholar]
  9. Blanton E, Ombeki S, Oluoch GO, Mwaki A, Wannemuehler K, Quick R, 2010. Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households–Nyanza Province, western Kenya 2007. Am J Trop Med Hyg 82: 664671.[Crossref]
    [Google Scholar]
  10. Onyango-Ouma W, Aagaard-Hansen J, Jensen B, 2005. The potential of schoolchildren as health change agents in rural western Kenya. Soc Sci Med 61: 17111722.[Crossref]
    [Google Scholar]
  11. Saboori S, Mwaki A, Rheingans RD, 2010. Is soapy water a viable solution for handwashing in schools? Waterlines 29: 329336.[Crossref]
    [Google Scholar]
  12. Mathew K, Zacharia S, Shordt K, Snel M, Cairncross S, Biran A, Schmidt W-P, 2009. The sustainability and impact of school sanitation, water and hygiene education in southern India. Waterlines 28: 275292.[Crossref]
    [Google Scholar]
  13. Njuguna V, Karanja B, Thuranira M, Shordt K, Snel M, Cairncross S, Biran A, Schmidt W-P, 2008. The Sustainability and Impact of School Sanitation, Water and Hygiene Education in Kenya. UNICEF, ed. New York and Delft, The Netherlands: UNICEF and IRC International Water and Sanitation Centre.
    [Google Scholar]
  14. Lopez-Quintero C, Freeman P, Neumark Y, 2009. Hand washing among school children in Bogota, Colombia. Research and Practice 99: 94100.
    [Google Scholar]
  15. UNICEF, IRC, 2006. School Sanitation and Hygiene Education Results from the Assessment of a 6-Country Pilot Project. New York and Delft, The Netherlands: UNICEF and IRC International Water and Sanitation Centre.
    [Google Scholar]
  16. Pinfold JV, Horan NJ, 1996. Measuring the effect of a hygiene behavior intervention by indicators of behavior and diarrhoeal disease. Trans R Soc Trop Med Hyg 90: 366371.[Crossref]
    [Google Scholar]
  17. 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]
    [Google Scholar]
  18. Luby S, Agboatwalla M, Raza A, Sobel J, Mintz E, 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]
    [Google Scholar]
  19. Biran A, Schmidt W-P, Wright R, Jones T, Seshadri M, Isaac P, Nathan NA, Hall P, McKenna J, Granger S, Bidlinger P, Curtis V, 2009. The effect of a soap promotion and hygiene education campaign on handwashing behavior in rural India: a cluster randomized trial. Trop Med Int Health 14: 13031314.[Crossref]
    [Google Scholar]
  20. Sobel J, Mahon B, Mendoza CE, Passaro D, Cano F, Baier K, Racioppi F, Hutwagner L, Mintz E, 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.
    [Google Scholar]
  21. 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.
    [Google Scholar]
  22. 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]
    [Google Scholar]
  23. Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, Kandeel A, Mohareb E, El-Sayed N, 2011. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerg Infect Dis 17: 619625.[Crossref]
    [Google Scholar]
  24. Freeman MC, Greene LE, Dreibelbis R, Saboori S, Muga R, Brumback B, Rheingans RD, 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.
    [Google Scholar]
  25. Biran A, Rabie T, Schmidt W-P, Juvekar S, Hirve S, Curtis V, 2008. Comparing the performance of indicators of hand-washing practices in rural Indian households. Trop Med Int Health 13: 278285.[Crossref]
    [Google Scholar]
  26. 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]
    [Google Scholar]
  27. MOE, 2008. National School Water, Sanitation, and Hygiene Promotion Strategy: 2008–2015. Nairobi: Republic of Kenya Ministry of Education.
    [Google Scholar]
  28. USEPA, 2003. Method 10029: Total Coliforms and E. coli Membrane Filtration Method. Washington, DC: USEPA.
    [Google Scholar]
  29. Luby SP, Agboatwalla M, Billhimer W, Hoekstra RM, 2007. Field trial of a low cost method to evaluate hand cleanliness. Trop Med Int Health 12: 765771.[Crossref]
    [Google Scholar]
  30. Hayes RJ, Moulton LH, 2009. Cluster Randomized Trials. CRC CH, ed. Boca Raton, FL: Taylor & Francis Group, 227229.[Crossref]
    [Google Scholar]
  31. Lingaas E, Fagernes M, 2009. Development of a method to measure bacterial transfer from hands. J Hosp Infect 72: 4349.[Crossref]
    [Google Scholar]
  32. Aunger R, Schmidt W-P, Ranpura A, Coombes Y, Maina PM, Matiko CN, Curtis V, 2010. Three kinds of psychological determinants for hand-washing behavior in Kenya. Soc Sci Med 70: 383391.[Crossref]
    [Google Scholar]
  33. Koopman JS, 1978. Diarrhea and school toilet hygiene in Cali, Colombia. Am J Epidemiol 107: 412420.[Crossref]
    [Google Scholar]
  34. McMahon SA, Caruso BA, Obure AF, Okumu F, Rheingans RD, 2011. Anal cleansing practices and fecal contamination: a preliminary investigation of behaviors and conditions in schools in rural Nyanza Province, Kenya. Trop Med Int Health 16: 15361540.[Crossref]
    [Google Scholar]
  35. 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]
    [Google Scholar]
  36. 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 00: 17.
    [Google Scholar]
  37. Sandora TJ, Shih M-C, Goldmann DA, 2008. Reducing absenteeism from gastrointestinal and respiratory illness in elementary school students: a randomized, controlled trial of an infection-control intervention. Pediatrics 121: e1555e1562.[Crossref]
    [Google Scholar]
  38. Kaltenthaler EC, Pinfold JV, 1995. Microbiological methods for assessing handwashing practice in hygiene behavior studies. J Trop Med Hyg 98: 101106.
    [Google Scholar]
  39. 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]
    [Google Scholar]
  40. Jensen P, Aalbaek B, Aslam R, Dalsgaard A, 2001. Specificity for field enumeration of Escherichia coli in tropical surface waters. J Microbiol Methods 45: 135141.[Crossref]
    [Google Scholar]
  41. Sidibe M, Curtis V, 2007. Can hygiene be cool and fun? Insights from school children in Senegal. Program WBWaS, ed. Sanitation and Hygiene Series: Water and Sanitation Program.
    [Google Scholar]
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  • Received : 11 Oct 2011
  • Accepted : 20 May 2012
  • Published online : 05 Sep 2012
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