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. 2017;42(5):568-584.
doi: 10.1080/02508060.2017.1335140. Epub 2017 Jun 26.

Assessing the environmental context of hand washing among school children in Limpopo, South Africa

Nicola Bulled  1 , Kara Poppe  2 , Khuliso Ramatsisti  3 , Londolani Sitsula  3 , Geoffrey Winegar  4 , Jabulani Gumbo  3 , Rebecca Dillingham  5 , James Smith  5
Affiliations

Assessing the environmental context of hand washing among school children in Limpopo, South Africa

Nicola Bulled et al. Water Int. 2017.

Abstract

Despite its simplicity and efficacy, the promotion of hand washing for disease prevention remains a challenge particularly in resource-limited settings. Here we report on a quasi-experimental school-based study that aimed to improve habitual hand washing. Significant increases in hand washing occurred following improvements in hygiene and sanitation facilities (School A: t=13.86, p=0.0052). Smaller increases in hand washing occurred following education (School A: t=2.63; p=0.012; School B, no infrastructure improvements: t=1.66, p=0.239). Health policy and programming need to pay greater attention to the interplay of the structural, social, and individual dimensions of unique contextual environments that influence habitual behaviours.

Keywords: South Africa; hand washing; hygiene and sanitation; quasi-experimental design; water borne disease.

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Figures

Figure 1
Figure 1
Figure 1a. Physical layout of School A, including water sources (municipal tap and borehole storage tanks servicing outside sinks), and toilet facilities (staff toilets, student toilet blocks by gender, pit latrines beyond school grounds). Not to scale. Figure 1b. Physical layout of School B, including water sources (community tap with surface water from local stream, borehole with tap beyond school grounds), and toilet facilities (community built pit latrines for students and faculty). Not to scale.
Figure 1
Figure 1
Figure 1a. Physical layout of School A, including water sources (municipal tap and borehole storage tanks servicing outside sinks), and toilet facilities (staff toilets, student toilet blocks by gender, pit latrines beyond school grounds). Not to scale. Figure 1b. Physical layout of School B, including water sources (community tap with surface water from local stream, borehole with tap beyond school grounds), and toilet facilities (community built pit latrines for students and faculty). Not to scale.
Figure 2
Figure 2
Photographic image of educational hand washing images placed in student toilet facilities in School A.
Figure 3
Figure 3
Quasi-Experimental study design involving School A and B. School A received both the physical environment intervention (improved hygiene and sanitation facilities) and the social environment intervention (educational activities to address knowledge and cultural practices). School B received only the social environment intervention.
See this image and copyright information in PMC

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