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

Elizabeth Blanton Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Cooperative for Assistance and Relief Everywhere, Inc. (CARE) Kenya, Kisumu, Kenya

Search for other papers by Elizabeth Blanton in
Current site
Google Scholar
PubMed
Close
,
Sam Ombeki Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Cooperative for Assistance and Relief Everywhere, Inc. (CARE) Kenya, Kisumu, Kenya

Search for other papers by Sam Ombeki in
Current site
Google Scholar
PubMed
Close
,
Gordon Otieno Oluoch Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Cooperative for Assistance and Relief Everywhere, Inc. (CARE) Kenya, Kisumu, Kenya

Search for other papers by Gordon Otieno Oluoch in
Current site
Google Scholar
PubMed
Close
,
Alex Mwaki Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Cooperative for Assistance and Relief Everywhere, Inc. (CARE) Kenya, Kisumu, Kenya

Search for other papers by Alex Mwaki in
Current site
Google Scholar
PubMed
Close
,
Kathleen Wannemuehler Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Cooperative for Assistance and Relief Everywhere, Inc. (CARE) Kenya, Kisumu, Kenya

Search for other papers by Kathleen Wannemuehler in
Current site
Google Scholar
PubMed
Close
, and
Rob Quick Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Cooperative for Assistance and Relief Everywhere, Inc. (CARE) Kenya, Kisumu, Kenya

Search for other papers by Rob Quick in
Current site
Google Scholar
PubMed
Close
Restricted access

We installed drinking water and handwashing stations in 17 rural schools and trained teachers to promote water treatment and hygiene to pupils. We gave schools flocculent-disinfectant powder and hypochlorite solution for water treatment. We conducted a baseline water handling survey of pupils' parents from 17 schools and tested stored water for chlorine. We trained teachers and students about hygiene, installed water stations, and distributed instructional comic books to students. We conducted follow-up surveys and chlorine testing at 3 and 13 months. From baseline to 3-month follow-up, parental awareness of the flocculent-disinfectant increased (49–91%, P < 0.0001), awareness of hypochlorite remained high (93–92%), and household use of flocculent-disinfectant (1–7%, P < 0.0001) and hypochlorite (6–13%, P < 0.0001) increased, and were maintained after 13 months. Pupil absentee rates decreased after implementation by 26%. This school-based program resulted in pupil-to-parent knowledge transfer and significant increases in household water treatment practices that were sustained over 1 year.

Author Notes

*Address correspondence to Elizabeth Blanton, Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A–38, Atlanta, GA 30030. E-mail: eblanton@cdc.gov

Financial support: The Procter and Gamble Company exclusively funded the study but did not contribute to study design, data analysis, or interpretation of results.

Authors' addresses: Elizabeth Blanton, Kathleen Wannemuehler, and Robert Quick, Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: eblanton@cdc.gov, kwannemuehler@cdc.gov, and rquick@cdc.gov. Sam Ombeki, Gordon Otieno Oluoch, and Alex Mwaki, CARE Kenya, Kisumu, Kenya, E-mails: ombeki@ksm.care.org.ke, gordon@ksm.care.org.ke, and alex@ksm.care.org.ke.

  • 1.

    Boschi-Pinto C, Velebit L, Shibuya K, 2008. Estimating child mortality due to diarrhoea in developing countries. Bull World Health Organ 86: 710717.

  • 2.

    Central Bureau of Statistics (CBS) [Kenya] MoHMK, and ORC Macro, 2004. Kenya Demographic and Health Survey 2003. Calverton, MD: CBS, MOH, and ORC Macro.

  • 3.

    Garrett V, Ogutu P, Mabonga P, Ombeki S, Mwaki A, Aluoch G, Phelan M, Quick RE, 2008. Diarrhoea prevention in a high-risk rural Kenyan population through point-of-use chlorination, safe water storage, sanitation, and rainwater harvesting. Epidemiol Infect 136: 19.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Makutsa P, Nzaku K, Ogutu P, Barasa P, Ombeki S, Mwaki A, Quick RE, 2001. Challenges in implementing a point-of-use water quality intervention in rural Kenya. Am J Public Health 91: 15711573.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Parker AA, Stephenson R, Riley PL, Ombeki S, Komolleh C, Sibley L, Quick R, 2006. Sustained high levels of stored drinking water treatment and retention of hand-washing knowledge in rural Kenyan households following a clinic-based intervention. Epidemiol Infect 134: 10291036.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Migele J, Ombeki S, Ayalo M, Biggerstaff M, Quick R, 2007. Diarrhea prevention in a Kenyan school through the use of a simple safe water and hygiene intervention. Am J Trop Med Hyg 76: 351353.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Global Water Challenge, 2009. Sustaining and Scaling School Water, Sanitation, and Hygiene Plus Community Impact (SWASH+). Nyanza Province, Kenya. Available at: http://www.globalwaterchallenge.org/progrmas/projects-detail.php?id=852. Accessed November 3, 2009.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Chiller TM, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Keswick BH, Luby SP, 2006. Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water. Bull World Health Organ 84: 2835.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Reller ME, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Olson CA, Baier KG, Keswick BH, Luby SP, 2003. A randomized controlled trial of household-based flocculant-disinfectant drinking water treatment for diarrhea prevention in rural Guatemala. Am J Trop Med Hyg 69: 411419.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Crump JA, Otieno PO, Slutsker L, Keswick BH, Rosen DH, Hoekstra RM, Vulule JM, Luby SP, 2005. Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: cluster randomised controlled trial. BMJ 331: 478.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer W, Keswick B, Hoekstra RM, 2006. Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial. Trop Med Int Health 11: 479489.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Doocy S, Burnham G, 2006. Point-of-use water treatment and diarrhoea reduction in the emergency context: an effectiveness trial in Liberia. Trop Med Int Health 11: 15421552.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Rogers EM, 1995. Diffusion of Innovations. New York: The Free Press.

  • 15.

    2008. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco: Jossey-Bass.

  • 16.

    Noor AM, Amin AA, Akhwale WS, Snow RW, 2007. Increasing coverage and decreasing inequity in insecticide-treated bed net use among rural Kenyan children. PLoS Med 4: e255.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Thevos AK, Kaona FA, Siajunza MT, Quick RE, 2000. Adoption of safe water behaviors in Zambia: comparing educational and motivational approaches. Educ Health (Abingdon) 13: 366376.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Colindres P, Mermin J, Ezati E, Kambabazi S, Buyungo P, Sekabembe L, Baryarama F, Kitabire F, Mukasa S, Kizito F, Fitzgerald C, Quick R, 2008. Utilization of a basic care and prevention package by HIV-infected persons in Uganda. AIDS Care 20: 139145.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Olembo L, Kaona FAD, Tuba M, Burnham G, 2004. Safe Water Systems: An Evaluation of the Zambia Chlorin Program. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Freeman MC, Quick RE, Abbott DP, Ogutu P, Rheingans R, 2009. Increasing equity of access to point-of-use water treatment products through social marketing and entrepreneurship: a case study in western Kenya. J Water Health 7: 527534.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Luby SP, Mendoza C, Keswick BH, Chiller TM, Hoekstra RM, 2008. Difficulties in bringing point-of-use water treatment to scale in rural Guatemala. Am J Trop Med Hyg 78: 382387.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Stockman LJ, Fischer TK, Deming M, Ngwira B, Bowie C, Cunliffe N, Bresee J, Quick RE, 2007. Point-of-use water treatment and use among mothers in Malawi. Emerg Infect Dis 13: 10771080.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P, 2007. The Hawthorne Effect: a randomised, controlled trial. BMC Med Res Methodol 7: 30.

  • 25.

    Fox NS, Brennan JS, Chasen ST, 2008. Clinical estimation of fetal weight and the Hawthorne effect. Eur J Obstet Gynecol Reprod Biol 141: 111114.

Past two years Past Year Past 30 Days
Abstract Views 1063 843 170
Full Text Views 660 19 6
PDF Downloads 378 23 7
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save