title: Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial.
abstract: OBJECTIVE
  There has been increased attention to access to water, sanitation and hygiene (WASH) at schools in developing countries, but a dearth of empirical studies on the impact. We conducted a cluster-randomized trial of school-based WASH on pupil absence in Nyanza Province, Kenya, from 2007 to 2008.
  
  
  METHODS
  Public primary schools nested in three geographical strata were randomly assigned and allocated to one of three study arms [water treatment and hygiene promotion (WT & HP), additional sanitation improvement, or control] to assess the effects on pupil absence at 2-year follow-up.
  
  
  RESULTS
  We found no overall effect of the intervention on absence. However, among schools in two of the geographical areas not affected by post-election violence, those that received WT and HP showed a 58% reduction in the odds of absence for girls (OR 0.42, CI 0.21-0.85). In the same strata, sanitation improvement in combination with WT and HP resulted in a comparable drop in absence, although results were marginally significant (OR 0.47, 0.21-1.05). Boys were not impacted by the intervention.
  
  
  CONCLUSIONS
  School WASH improvements can improve school attendance for girls, and mechanisms for gendered impacts should be explored. Incomplete intervention compliance highlights the challenges of achieving consistent results across all settings.
authors.affiliation: Hubert Department of Global Health, Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. mcfreem@emory.edu
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Freeman
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Greene
authors.forename: Robert
authors.initials: R
authors.lastname: Dreibelbis
authors.forename: Shadi
authors.initials: S
authors.lastname: Saboori
authors.forename: Richard
authors.initials: R
authors.lastname: Muga
authors.forename: Babette
authors.initials: B
authors.lastname: Brumback
authors.forename: Richard
authors.initials: R
authors.lastname: Rheingans
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006920:Hygiene; D007630:Kenya; D008297:Male; D016017:Odds Ratio; D058996:Quality Improvement; D012499:Sanitation; D012572:School Health Services; D012574:Schools; D012737:Sex Factors; D013334:Students; D014754:Violence; D018508:Water Purification