title: Assessing the impact of a school-based latrine cleaning and handwashing program on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial.
abstract: OBJECTIVE
  Improving school water, sanitation and hygiene (WASH) conditions reduces pupil absence and illness. However, these benefits may depend on the conditions of the latrines and availability of consumables. We sought to determine whether a low-cost, policy-relevant, environmental-level latrine cleaning intervention could improve latrine cleanliness, increase its use and reduce absenteeism.
  
  
  METHODS
  In a three-arm, cluster-randomized trial we assessed absence via periodical roll-call among 17 564 pupils in 60 schools that had previously received WASH improvements as part of the SWASH+ project. Latrine conditions and use were also assessed using structured observation. Latrine cleanliness increased significantly during the post-intervention period among schools receiving the latrine cleaning package compared to controls, as did handwashing with soap. We found no difference in latrine use and absence across arms.
  
  
  CONCLUSIONS
  The additive impact of cleaning may not have been strong enough to impact absence above and beyond reductions attributable to the original WASH infrastructure improvements and basic hygiene education the schools previously received. Improving latrine conditions is important for the dignity and well-being of pupils, and investments and strategies are necessary to ensure that school toilets are clean and pupil-friendly.
authors: Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA; Center for Global Safe Water at Emory University, Atlanta, GA, USA.
authors: Bethany A
authors: BA
authors: Caruso
authors: Matthew C
authors: MC
authors: Freeman
authors: Joshua V
authors: JV
authors: Garn
authors: Robert
authors: R
authors: Dreibelbis
authors: Shadi
authors: S
authors: Saboori
authors: Richard
authors: R
authors: Muga
authors: Richard
authors: R
authors: Rheingans
mesh_terms: D000041:Absenteeism; D002648:Child; D003967:Diarrhea; D004203:Disinfection; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D006920:Hygiene; D007630:Kenya; D008297:Male; D012499:Sanitation; D012574:Schools; D012915:Soaps; D013334:Students; D014038:Toilet Facilities; D014867:Water
chemical_list: D012915:Soaps; D014867:Water
keywords: Higiene; absence; assainissement; ausentismo; colegio; handwashing; hygiene; hygiène; latrine use; lavado de manos; lavage des mains; saneamiento; sanitation; school; uso de letrinas; utilisation des latrines; école