Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention

doi:10.3390/ijerph191610059

Randomized Controlled Trial

. 2022 Aug 15;19(16):10059.

doi: 10.3390/ijerph191610059.

Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention

Denise Duijster¹, Bella Monse², Marvin Marquez³, Ubo Pakes⁴, Nicole Stauf⁵, Habib Benzian⁶

Affiliations

¹ Department of Oral Public Health, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands.
² Regional Fit for School Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), 10th Floor, Bank of Makati Building, Ayala Avenue Extension near Corner Metropolitan Avenue, Makati City 1209, Philippines.
³ Population Institute, College of Social Science and Philosophy, University of the Philippines Diliman, Diliman, Quezon City 1101, Philippines.
⁴ Center for Environmental Informatics, University of the Philippines Cebu, Gorordo Avenue, Cebu City 6000, Philippines.
⁵ The Health Bureau Ltd., Whiteleaf Business Center, 11 Little Balmer, Buckingham MK18 1TF, UK.
⁶ WHO Collaborating Center Quality Improvement & Evidence-Based Dentistry, Department of Epidemiology & Health Promotion, College of Dentistry, New York University, 433 First Avenue, 7th Floor, New York, NY 10010, USA.

PMID: 36011699
PMCID: PMC9407854
DOI: 10.3390/ijerph191610059

Randomized Controlled Trial

Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention

Denise Duijster et al. Int J Environ Res Public Health. 2022.

. 2022 Aug 15;19(16):10059.

doi: 10.3390/ijerph191610059.

Authors

Denise Duijster¹, Bella Monse², Marvin Marquez³, Ubo Pakes⁴, Nicole Stauf⁵, Habib Benzian⁶

Affiliations

¹ Department of Oral Public Health, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands.
² Regional Fit for School Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), 10th Floor, Bank of Makati Building, Ayala Avenue Extension near Corner Metropolitan Avenue, Makati City 1209, Philippines.
³ Population Institute, College of Social Science and Philosophy, University of the Philippines Diliman, Diliman, Quezon City 1101, Philippines.
⁴ Center for Environmental Informatics, University of the Philippines Cebu, Gorordo Avenue, Cebu City 6000, Philippines.
⁵ The Health Bureau Ltd., Whiteleaf Business Center, 11 Little Balmer, Buckingham MK18 1TF, UK.
⁶ WHO Collaborating Center Quality Improvement & Evidence-Based Dentistry, Department of Epidemiology & Health Promotion, College of Dentistry, New York University, 433 First Avenue, 7th Floor, New York, NY 10010, USA.

PMID: 36011699
PMCID: PMC9407854
DOI: 10.3390/ijerph191610059

Abstract

This study evaluated the impact of packaged interventions for operation and maintenance (O&M) on the usability and cleanliness of toilets in public schools in the Philippines. In this cluster-randomized controlled trial, the divisions of Roxas City and Passi City were randomly assigned to the intervention or control group. Schools in Roxas City (n = 14) implemented the packaged O&M interventions; schools in Passi City (n = 16) formed the control group. Outcome variables were toilet usability-defined as accessible, functional and private-and toilet cleanliness, measured using the Sanitation Assessment Tool (SAT) and the Cleaner Toilets, Brighter Future (CTBF) instruments at baseline and at four months follow-up through direct observation of school toilets. SAT results showed that intervention schools had a 32.0% (4.6%; 59.3%) higher percentage of usable toilets than control schools at follow-up after full adjustment (p = 0.024). CTBF results found a similar result, although this was not statistically significant (p = 0.119). The percentage of toilets that were fully clean was 27.1% (3.7%; 50.6%) higher in intervention schools than in control schools after adjustment (p = 0.025). SAT results also showed an improvement in cleanliness of toilets in intervention schools compared to those in controls, but this did not remain significant after adjustment. The findings indicate that the additional implementation of O&M interventions can further stimulate progress towards reaching Water, Sanitation and Hygiene service levels aligned with the Sustainable Development Goals.

Keywords: Water, Sanitation and Hygiene (WASH); cleanliness; operation and maintenance; sanitation; schools; toilets.

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Conflict of interest statement

The authors declare that they have no conflict of interests. The company had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

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References

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[1] Amebelu A., Ban R., Bhagwan J., Chilengi R., Chandler C., Colford J.M., Cumming O., Curtis V., Evans B.E., Freeman M.C., et al. The Lancet Commission on water, sanitation and hygiene, and health. Lancet. 2021;398:1469–1470. doi: 10.1016/S0140-6736(21)02005-5. - DOI - PubMed

[2] Amebelu A., Ban R., Bhagwan J., Chilengi R., Chandler C., Colford J.M., Cumming O., Curtis V., Evans B.E., Freeman M.C., et al. The Lancet Commission on water, sanitation and hygiene, and health. Lancet. 2021;398:1469–1470. doi: 10.1016/S0140-6736(21)02005-5. - DOI - PubMed

[3] Fewtrell L., Kaufmann R.B., Kay D., Enanoria W., Haller L., Colford J.M., Jr. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta-analysis. Lancet Infect. Dis. 2005;5:42–52. doi: 10.1016/S1473-3099(04)01253-8. - DOI - PubMed

[4] Fewtrell L., Kaufmann R.B., Kay D., Enanoria W., Haller L., Colford J.M., Jr. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta-analysis. Lancet Infect. Dis. 2005;5:42–52. doi: 10.1016/S1473-3099(04)01253-8. - DOI - PubMed

[5] Prüss-Ustün A., Wolf J., Bartram J., Clasen T., Cumming O., Freeman M.C., Gordon B., Hunter P.R., Medlicott K., Johnston R. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. Int. J. Hyg. Environ. Health. 2019;222:765–777. doi: 10.1016/j.ijheh.2019.05.004. - DOI - PMC - PubMed

[6] Prüss-Ustün A., Wolf J., Bartram J., Clasen T., Cumming O., Freeman M.C., Gordon B., Hunter P.R., Medlicott K., Johnston R. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. Int. J. Hyg. Environ. Health. 2019;222:765–777. doi: 10.1016/j.ijheh.2019.05.004. - DOI - PMC - PubMed

[7] Strunz E.C., Addiss D.G., Stocks M.E., Ogden S., Utzinger J., Freeman M.C. Water, sanitation, hygiene, and soil-transmitted helminth infection: A systematic review and meta-analysis. PLoS Med. 2014;11:e1001620. doi: 10.1371/journal.pmed.1001620. - DOI - PMC - PubMed

[8] Strunz E.C., Addiss D.G., Stocks M.E., Ogden S., Utzinger J., Freeman M.C. Water, sanitation, hygiene, and soil-transmitted helminth infection: A systematic review and meta-analysis. PLoS Med. 2014;11:e1001620. doi: 10.1371/journal.pmed.1001620. - DOI - PMC - PubMed

[9] Jasper C., Le T.T., Bartram J. Water and sanitation in schools: A systematic review of the health and educational outcomes. Int. J. Environ. Res. Public Health. 2012;9:2772–2787. doi: 10.3390/ijerph9082772. - DOI - PMC - PubMed

[10] Jasper C., Le T.T., Bartram J. Water and sanitation in schools: A systematic review of the health and educational outcomes. Int. J. Environ. Res. Public Health. 2012;9:2772–2787. doi: 10.3390/ijerph9082772. - DOI - PMC - PubMed

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Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention

Affiliations

Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention

Authors

Affiliations

Abstract

Conflict of interest statement

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Cited by

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Research Materials