title: Impact of the provision of safe drinking water on school absence rates in Cambodia: a quasi-experimental study.
abstract: BACKGROUND
  Education is one of the most important drivers behind helping people in developing countries lift themselves out of poverty. However, even when schooling is available absenteeism rates can be high. Recently interest has focussed on whether or not WASH interventions can help reduce absenteeism in developing countries. However, none has focused exclusively on the role of drinking water provision. We report a study of the association between absenteeism and provision of treated water in containers into schools.
  
  
  RESULTS
  We undertook a quasi-experimental longitudinal study of absenteeism rates in 8 schools, 4 of which received one 20 L container of treated drinking water per day. The water had been treated by filtration and ultraviolet disinfection. Weekly absenteeism rates were compared across all schools using negative binomial model in generalized estimating equations. There was a strong association with provision of free water and reduced absenteeism (Incidence rate ratio = 0.39 (95% Confidence Intervals 0.27-0.56)). However there was also a strong association with season (wet versus dry) and a significant interaction between receiving free water and season. In one of the intervention schools it was discovered that the water supplier was not fulfilling his contract and was not delivering sufficient water each week. In this school we showed a significant association between the number of water containers delivered each week and absenteeism (IRR = 0.98 95%CI 0.96-1.00).
  
  
  CONCLUSIONS
  There appears to be a strong association between providing free safe drinking water and reduced absenteeism, though only in the dry season. The mechanism for this association is not clear but may in part be due to improved hydration leading to improved school experience for the children.
authors.affiliation: Norwich School of Medicine, University of East Anglia, Norwich, United Kingdom.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Hunter
authors.affiliation: Norwich School of Medicine, University of East Anglia, Norwich, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Risebro
authors.affiliation: 1001 fontaines pour demain, Caluire et Cuire, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Yen
authors.affiliation: 1001 fontaines pour demain, Caluire et Cuire, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Lefebvre
authors.affiliation: Teuk Saat 1001, Phnom Penh, Cambodia.
authors.forename: Chay
authors.initials: C
authors.lastname: Lo
authors.affiliation: Département Environnement et Santé Publique, Faculté de médecine de Nancy - Université de Lorraine, Nancy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hartemann
authors.affiliation: Fondation Mérieux, Lyon, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Longuet
authors.affiliation: 1001 fontaines pour demain, Caluire et Cuire, France.
authors.forename: François
authors.initials: F
authors.lastname: Jaquenoud
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D002160:Cambodia; D002648:Child; D060766:Drinking Water / Q000592:standards*; D006801:Humans; D012307:Risk Factors; D012574:Schools
chemical_list: D060766:Drinking Water