Impact of regular soap provision to primary schools on hand washing and E. coli hand contamination among pupils in Nyanza Province, Kenya: a cluster-randomized trial

Abstract

We assessed whether supplying soap to primary schools on a regular basis increased pupil hand washing and decreased Escherichia coli hand contamination. Multiple rounds of structured observations of hand washing events after latrine use were conducted in 60 Kenyan schools, and hand rinse samples were collected one time in a subset of schools. The proportion of pupils observed practicing hand washing with soap (HWWS) events was significantly higher in schools that received a soap provision intervention (32%) and schools that received soap and latrine cleaning materials (38%) compared with controls (3%). Girls and boys had similar hand washing rates. There were non-significant reductions in E. coli contamination among intervention school pupils compared with controls. Removing the barrier of soap procurement can significantly increase availability of soap and hand washing among pupils; however, we discuss limitations in the enabling policy and institutional environment that may have prevented reaching desired levels of HWWS.

Figure 1.

Flow chart of school enrollment and allocation and study analysis.

Figure 2.

The percent of primary schools with hand washing water and soap available in 60 primary schools in the HW, LC+HW, and control groups during baseline (May) and four follow-up visits in Nyanza Province, Kenya, from May to November of 2010.

Figure 3.

The proportion of pupils observed practicing hand washing with water only and hand washing with soap and water after latrine use in 60 primary schools in the HW, LC+HW, and control groups during baseline (May) and four follow-up visits in Nyanza Province, Kenya, from May to November of 2010.

Figure 4.

Distribution of log₁₀ E. coli contamination on pupils' hands in schools (n = 24) in the HW, LC+HW, and control groups in Nyanza Province, Kenya, from October to November of 2010.