title: Sanitation behavior among schoolchildren in a multi-ethnic area of Northern rural Vietnam.
abstract: BACKGROUND
  In Vietnam, efforts are underway to improve latrine use in rural and remote areas with particular focus on increasing coverage of sanitation in schools. However, there is a lack of information on how the school program affects latrine use by schoolchildren and at community level. This paper analyzes sanitation use among schoolchildren in a multi-ethnic area to inform future school-based sanitation promotion programmes.
  
  
  METHODS
  A combination of quantitative and qualitative methods was applied during a 5 months period in six primary and secondary schools and in the homes of schoolchildren in four different ethnic villages in Northern rural Vietnam. Using a structured questionnaire, 319 children were interviewed face-to-face to collect quantitative data. Qualitative methods included extensive observations at schools and in the homes of 20 children, a single day's diary writings of 234 children, in-depth interviews with children (20), their parents (20) and school staff (10), and focus group discussions with parents (4) and teachers (6), and picture drawing with children (12).
  
  
  RESULTS
  All surveyed schools had student latrines. However, the observed schoolchildren most commonly urinated and defecated in the open. Main barriers for latrine use included inadequate number of latrines, limited accessibility to latrines, lack of constant water supply in latrines and lack of latrine maintenance by school management. Programs promoting latrine use for children were not conducted in either schools or communities and were not established as a preferred social norm in such settings. Children perceived existing school latrines as unappealing and expressed a wish to have basic, functional, clean, and colorful school latrines with privacy.
  
  
  CONCLUSIONS
  The paper shows that the current school based sanitation promotion is insufficient to change sanitation behavior of school children irrespective of their ethnicity. It is important that schools, households and communities work more closely together to increase use and uptake of latrine use among schoolchildren. Also, the contractors of latrine facilities must work more closely with local school management when constructing latrines, including identifying location, design and appropriate systems of water supply. A separate budget needs to be allocated to allow the school to maintain the sanitation infrastructure and keep it hygienic and appealing for users.
authors.affiliation: Department of Environmental Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. lethithanhxuan@hmu.edu.vn
authors.forename: Thi Thanh Xuan
authors.initials: TT
authors.lastname: Le
authors.forename: Ngoc Hoat
authors.initials: NH
authors.lastname: Luu
authors.forename: Thilde
authors.initials: T
authors.lastname: Rheinländer
authors.forename: Anders
authors.initials: A
authors.lastname: Dalsgaard
authors.forename: Flemming
authors.initials: F
authors.lastname: Konradsen
mesh_terms: D002648:Child; D005006:Ethnicity; D005260:Female; D017144:Focus Groups; D006293:Health Promotion; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D012424:Rural Population; D012499:Sanitation / Q000379:methods*; D012574:Schools; D011795:Surveys and Questionnaires; D014038:Toilet Facilities; D014744:Vietnam