The impact of school water, sanitation, and hygiene interventions on the health of younger siblings of pupils: a cluster-randomized trial in Kenya.
OBJECTIVE
We examined the impact of school water, sanitation, and hygiene (WASH) interventions on diarrhea-related outcomes among younger siblings of school-going children.


METHODS
We conducted a cluster-randomized trial among 185 schools in Kenya from 2007 to 2009. We assigned schools to 1 of 2 study groups according to water availability. Multilevel logistic regression models, adjusted for baseline measures, assessed differences between intervention and control arms in 1-week period prevalence of diarrhea and 2-week period prevalence of clinic visits among children younger than 5 years with at least 1 sibling attending a program school.


RESULTS
Among water-scarce schools, comprehensive WASH improvements were associated with decreased odds of diarrhea (odds ratio [OR] = 0.44; 95% confidence interval [CI] = 0.27, 0.73) and visiting a clinic (OR = 0.36; 95% CI = 0.19, 0.68), relative to control schools. In our separate study group of schools with greater water availability, school hygiene promotion and water treatment interventions and school sanitation improvements were not associated with differences in diarrhea prevalence between intervention and control schools.


CONCLUSIONS
In water-scarce areas, school WASH interventions that include robust water supply improvements can reduce diarrheal diseases among young children.
Robert Dreibelbis is with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Robert Dreibelbis is also with the Hubert Department of Global Health, and Matthew C. Freeman, Leslie E. Greene, and Shadi Saboori are with the Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA. Richard Rheingans is with the Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville.
Robert
R
Dreibelbis
Matthew C
MC
Freeman
Leslie E
LE
Greene
Shadi
S
Saboori
Richard
R
Rheingans
D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006235:Hand Disinfection; D006293:Health Promotion; D006801:Humans; D006920:Hygiene; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012499:Sanitation; D035781:Siblings; D013334:Students; D014871:Water Microbiology; D018508:Water Purification; D014881:Water Supply