Impact of a school-based hygiene promotion and sanitation intervention on pupil hand contamination in Western Kenya: a cluster randomized trial

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

Figure 1.

(A and B) Percentage of pupils with presence of any and high levels (≥ 100 colony-forming units (CFU)/hand) of Escherichia coli on their hands at schools receiving hygiene promotion and water treatment (HP&WT), additional sanitation (San + HP&WT), and control schools at baseline and follow-up. *n for baseline; follow-up

Figure 2.

(A and B) Percentage of pupils with presence of any Escherichia coli on their hands, by gender, at schools receiving hygiene promotion and water treatment (HP&WT), additional sanitation (San + HP&WT), and control schools at baseline and follow-up. *n for baseline; follow-up.

Figure 3.

(A and B) Percentage of pupils with high levels (≥ 100 colony-forming units (CFU)/hand) of Escherichia coli on their hands, by gender, at schools receiving hygiene promotion and water treatment (HP&WT), additional sanitation (San + HP&WT), and control schools at baseline and follow-up. *n for baseline; follow-up.