Impact of a Hygiene Curriculum and the Installation of Simple Handwashing and Drinking Water Stations in Rural Kenyan Primary Schools on Student Health and Hygiene Practices

Minal K. Patel Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Julie R. Harris Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Patricia Juliao Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Benjamin Nygren Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Vincent Were Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Steve Kola Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Ibrahim Sadumah Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Sitnah Hamidah Faith Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Ronald Otieno Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Alfredo Obure Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Robert M. Hoekstra Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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Robert Quick Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya

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School-based hygiene and water treatment programs increase student knowledge, improve hygiene, and decrease absenteeism, however health impact studies of these programs are lacking. We collected baseline information from students in 42 schools in Kenya. We then instituted a curriculum on safe water and hand hygiene and installed water stations in half (“intervention schools”). One year later, we implemented the intervention in remaining schools. Through biweekly student household visits and two annual surveys, we compared the effect of the intervention on hygiene practices and reported student illness. We saw improvement in proper handwashing techniques after the school program was introduced. We observed a decrease in the median percentage of students with acute respiratory illness among those exposed to the program; no decrease in acute diarrhea was seen. Students in this school program exhibited sustained improvement in hygiene knowledge and a decreased risk of respiratory infections after the intervention.

Author Notes

* Address correspondence to Minal K. Patel, Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A04, Atlanta, GA 30333. E-mail: hgo9@cdc.gov
† Deceased.

Financial support: Funding was provided by the Centers for Disease Control and Prevention and USAID's Global Health Bureau.

Authors' addresses: Minal K. Patel, Julie R. Harris, Patricia Juliao (c/o Minal Patel), Benjamin Nygren, Robert M. Hoekstra, and Robert Quick, Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: hgo9@cdc.gov, ggt5@cdc.gov, patricia.d.juliao@gsk.com, ghz8@cdc.gov, rth6@cdc.gov, and rxq1@cdc.gov. Vincent Were, Kenya Medical Research Institute, Nairobi, Kenya, E-mail: vincentwere@yahoo.com. Steve Kola, Ibrahim Sadumah, Sitnah Hamidah Faith, and Ronald Otieno, NICHE Project, Kisumu, Kenya, E-mails: stvkola@yahoo.co.uk, sitnahfaith@yahoo.com, and ronotieno@yahoo.com.

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