title: Access to waterless hand sanitizer improves student hand hygiene behavior in primary schools in Nairobi, Kenya.
abstract: Handwashing is difficult in settings with limited resources and water access. In primary schools within urban Kibera, Kenya, we investigated the impact of providing waterless hand sanitizer on student hand hygiene behavior. Two schools received a waterless hand sanitizer intervention, two schools received a handwashing with soap intervention, and two schools received no intervention. Hand cleaning behavior after toilet use was monitored for 2 months using structured observation. Hand cleaning after toileting was 82% at sanitizer schools (N = 2,507 toileting events), 38% at soap schools (N = 3,429), and 37% at control schools (N = 2,797). Students at sanitizer schools were 23% less likely to have observed rhinorrhea than control students (P = 0.02); reductions in student-reported gastrointestinal and respiratory illness symptoms were not statistically significant. Providing waterless hand sanitizer markedly increased student hand cleaning after toilet use, whereas the soap intervention did not. Waterless hand sanitizer may be a promising option to improve student hand cleansing behavior, particularly in schools with limited water access.
authors.affiliation: Civil and Environmental Engineering and Woods Institute for the Environment, Stanford University, Stanford, CA, USA. amyjanel@stanford.edu
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Pickering
authors.forename: Jennifer
authors.initials: J
authors.lastname: Davis
authors.forename: Annalise G
authors.initials: AG
authors.lastname: Blum
authors.forename: Jenna
authors.initials: J
authors.lastname: Scalmanini
authors.forename: Beryl
authors.initials: B
authors.lastname: Oyier
authors.forename: George
authors.initials: G
authors.lastname: Okoth
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Pavani K
authors.initials: PK
authors.lastname: Ram
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006235:Hand Disinfection / Q000379:methods*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007630:Kenya; D016015:Logistic Models; D012574:Schools; D057566:Self Report; D012915:Soaps; D013334:Students
chemical_list: D012915:Soaps