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Access to Waterless Hand Sanitizer Improves Student Hand Hygiene Behavior in Primary Schools in Nairobi, Kenya

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  • Civil and Environmental Engineering and Woods Institute for the Environment, Stanford University, Stanford, California; Kenya Medical Research Institute, Centers for Disease Control and Prevention—Kenya, Nairobi, Kenya; University at Buffalo, State University of New York, Buffalo, New York

Handwashing is difficult in settings with limited resources and water access. In primary schools within urban Kibera, Kenya, we investigated the impact of providing waterless hand sanitizer on student hand hygiene behavior. Two schools received a waterless hand sanitizer intervention, two schools received a handwashing with soap intervention, and two schools received no intervention. Hand cleaning behavior after toilet use was monitored for 2 months using structured observation. Hand cleaning after toileting was 82% at sanitizer schools (N = 2,507 toileting events), 38% at soap schools (N = 3,429), and 37% at control schools (N = 2,797). Students at sanitizer schools were 23% less likely to have observed rhinorrhea than control students (P = 0.02); reductions in student-reported gastrointestinal and respiratory illness symptoms were not statistically significant. Providing waterless hand sanitizer markedly increased student hand cleaning after toilet use, whereas the soap intervention did not. Waterless hand sanitizer may be a promising option to improve student hand cleansing behavior, particularly in schools with limited water access.

Author Notes

* Address correspondence to Pavani K. Ram, University at Buffalo, State University of New York, Room 270, Farber Hall, 3435 Main Street, Buffalo, NY 14214. E-mail: pkram@buffalo.edu

Financial support: This study was funded by Centers for Disease Control and Prevention—Kenya, Kenya Medical Research Institute, and the Freeman Spogli Institute for International Studies at Stanford University; GOJO Industries provided the alcohol-based hand sanitizer distributed to schools in this study.

Authors' addresses: Amy J. Pickering, Jennifer Davis, Annalise G. Blum, and Jenna Scalmanini, Civil and Environmental Engineering and Woods Institute for the Environment, Stanford University, Stanford, CA, E-mails: amyjanel@stanford.edu, jennadavis@stanford.edu, annaliseblum@gmail.com, and jenscal6@gmail.com. Beryl Oyier, George Okoth, and Robert F. Breiman, Kenya Medical Research Institute, Centers for Disease Control and Prevention—Kenya, Nairobi, Kenya, E-mails: adhiamboyier@gmail.com, gokoth@ke.cdc.gov, and rfbreiman@emory.edu. Pavani K. Ram, University at Buffalo, State University of New York, Buffalo, NY, E-mail: pkram@buffalo.edu.

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