Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: results from the WASH HELPS cluster-randomized trial.

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  • Additional Information
    • Affiliation:
      Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
      School of Community Health Sciences, University of Nevada Reno, Reno, Nevada, USA
      Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Background: Water, sanitation, and hygiene (WASH) in schools is promoted by development agencies as a modality to improve school attendance by reducing illness. Despite biological plausibility, the few rigorous studies that have assessed the effect of WASH in schools (WinS) interventions on pupil health and school attendance have reported mixed impacts. We evaluated the impact of the Laos Basic Education, Water, Sanitation and Hygiene Programme - a comprehensive WinS project implemented by UNICEF Lao People's Democratic Republic (Lao PDR) in 492 primary schools nationwide between 2013 and 2017 - on pupil education and health.Methods: From 2014-2017, we conducted a cluster-randomized trial among 100 randomly selected primary schools lacking functional WASH facilities in Saravane Province, Lao PDR. Schools were randomly assigned to either the intervention (n = 50) or comparison (n = 50) arm. Intervention schools received a school water supply, sanitation facilities, handwashing facilities, drinking water filters, and behavior change education and promotion. Comparison schools received the intervention after research activities ended. At unannounced visits every six to eight weeks, enumerators recorded pupils' roll-call absence, enrollment, attrition, progression to the next grade, and reported illness (diarrhea, respiratory infection, conjunctivitis), and conducted structured observations to measure intervention fidelity and adherence. Stool samples were collected annually prior to de-worming and analyzed for soil-transmitted helminth (STH) infection. In addition to our primary intention-to-treat analysis, we conducted secondary analyses to quantify the role of intervention fidelity and adherence on project impacts.Results: We found no impact of the WinS intervention on any primary (pupil absence) or secondary (enrollment, dropout, grade progression, diarrhea, respiratory infection, conjunctivitis, STH infection) impacts. Even among schools with the highest levels of fidelity and adherence, impact of the intervention on absence and health was minimal.Conclusions: While WinS may create an important enabling environment, WinS interventions alone and as currently delivered may not be sufficient to independently impact pupil education and health. Our results are consistent with other recent evaluations of WinS projects showing limited or mixed effects of WinS.
    • Journal Subset:
      Europe; Peer Reviewed; Public Health; UK & Ireland
    • Special Interest:
      Evidence-Based Practice
    • Instrumentation:
      Basic Knowledge Assessment Tool (BKAT)
      Impact of Events Scale (IES)
      Functional Living Index: Cancer (FLIC) (Schipper et al)
    • ISSN:
      2047-2978
    • MEDLINE Info:
      PMID: NLM31360445 NLM UID: 101578780
    • Grant Information:
      T32 ES012870/ES/NIEHS NIH HHS/United States
    • Publication Date:
      20190915
    • Publication Date:
      20190917
    • DOI:
      http://dx.doi.org/10.7189/jogh.09.020402
    • Accession Number:
      138477287
  • Citations
    • ABNT:
      CHARD, A. N. et al. Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: results from the WASH HELPS cluster-randomized trial. Journal of Global Health, [s. l.], v. 9, n. 2, p. 1–7, 2019. DOI 10.7189/jogh.09.020402. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=138477287. Acesso em: 22 set. 2020.
    • AMA:
      Chard AN, Garn JV, Chang HH, Clasen T, Freeman MC. Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: results from the WASH HELPS cluster-randomized trial. Journal of Global Health. 2019;9(2):1-7. doi:10.7189/jogh.09.020402
    • APA:
      Chard, A. N., Garn, J. V., Chang, H. H., Clasen, T., & Freeman, M. C. (2019). Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: results from the WASH HELPS cluster-randomized trial. Journal of Global Health, 9(2), 1–7. https://doi.org/10.7189/jogh.09.020402
    • Chicago/Turabian: Author-Date:
      Chard, Anna N., Joshua V. Garn, Howard H. Chang, Thomas Clasen, and Matthew C. Freeman. 2019. “Impact of a School-Based Water, Sanitation, and Hygiene Intervention on School Absence, Diarrhea, Respiratory Infection, and Soil-Transmitted Helminths: Results from the WASH HELPS Cluster-Randomized Trial.” Journal of Global Health 9 (2): 1–7. doi:10.7189/jogh.09.020402.
    • Harvard:
      Chard, A. N. et al. (2019) ‘Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: results from the WASH HELPS cluster-randomized trial’, Journal of Global Health, 9(2), pp. 1–7. doi: 10.7189/jogh.09.020402.
    • Harvard: Australian:
      Chard, AN, Garn, JV, Chang, HH, Clasen, T & Freeman, MC 2019, ‘Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: results from the WASH HELPS cluster-randomized trial’, Journal of Global Health, vol. 9, no. 2, pp. 1–7, viewed 22 September 2020, .
    • MLA:
      Chard, Anna N., et al. “Impact of a School-Based Water, Sanitation, and Hygiene Intervention on School Absence, Diarrhea, Respiratory Infection, and Soil-Transmitted Helminths: Results from the WASH HELPS Cluster-Randomized Trial.” Journal of Global Health, vol. 9, no. 2, Dec. 2019, pp. 1–7. EBSCOhost, doi:10.7189/jogh.09.020402.
    • Chicago/Turabian: Humanities:
      Chard, Anna N., Joshua V. Garn, Howard H. Chang, Thomas Clasen, and Matthew C. Freeman. “Impact of a School-Based Water, Sanitation, and Hygiene Intervention on School Absence, Diarrhea, Respiratory Infection, and Soil-Transmitted Helminths: Results from the WASH HELPS Cluster-Randomized Trial.” Journal of Global Health 9, no. 2 (December 2019): 1–7. doi:10.7189/jogh.09.020402.
    • Vancouver/ICMJE:
      Chard AN, Garn JV, Chang HH, Clasen T, Freeman MC. Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: results from the WASH HELPS cluster-randomized trial. Journal of Global Health [Internet]. 2019 Dec [cited 2020 Sep 22];9(2):1–7. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=138477287