title: The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial.
abstract: The impact of improved water, sanitation, and hygiene (WASH) access on mitigating illness is well documented, although impact of school-based WASH on school-aged children has not been rigorously explored. We conducted a cluster-randomized trial in Nyanza Province, Kenya to assess the impact of a school-based WASH intervention on diarrhoeal disease in primary-school pupils. Two study populations were used: schools with a nearby dry season water source and those without. Pupils attending 'water-available' schools that received hygiene promotion and water treatment (HP&WT) and sanitation improvements showed no difference in period prevalence or duration of illness compared to pupils attending control schools. Those pupils in schools that received only the HP&WT showed similar results. Pupils in 'water-scarce' schools that received a water-supply improvement, HP&WT and sanitation showed a reduction in diarrhoea incidence and days of illness. Our study revealed mixed results on the impact of improvements to school WASH improvements on pupil diarrhoea.
authors.affiliation: Center for Global Safe Water, Department of Environmental Health, Emory University, Atlanta, GA, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Freeman
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Clasen
authors.affiliation: Center for Global Safe Water, Hubert Department of Global Health, Emory University, Atlanta, GA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Dreibelbis
authors.affiliation: Center for Global Safe Water, Department of Environmental Health, Emory University, Atlanta, GA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Saboori
authors.affiliation: Center for Global Safe Water, Department of Environmental Health, Emory University, Atlanta, GA, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Greene
authors.affiliation: Department of Biostatistics, University of Florida, FL, USA.
authors.forename: B
authors.initials: B
authors.lastname: Brumback
authors.affiliation: Tropical Institute for Community Health and Development, Great Lakes University of Kisumu, Kenya.
authors.forename: R
authors.initials: R
authors.lastname: Muga
authors.affiliation: Department of Global and Environmental Health, University of Florida, FL, USA.
authors.forename: R
authors.initials: R
authors.lastname: Rheingans
mesh_terms: D002648:Child; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D006920:Hygiene; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012499:Sanitation / Q000379:methods*; D012572:School Health Services; D013334:Students / Q000706:statistics & numerical data; D014881:Water Supply