title: 'Fit for school' - a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in Cambodia, Indonesia and Lao PDR.
abstract: The Fit for School (FIT) programme integrates school health and Water, Sanitation and Hygiene interventions, which are implemented by the Ministries of Education in four Southeast Asian countries. This paper describes the findings of a Health Outcome Study, which aimed to assess the two-year effect of the FIT programme on the parasitological, weight, and oral health status of children attending schools implementing the programme in Cambodia, Indonesia and Lao PDR.
  
  
  
  The study was a non-randomized clustered controlled trial with a follow-up period of two years. The intervention group consisted of children attending public elementary schools implementing the FIT programme, including daily group handwashing with soap and toothbrushing with fluoride toothpaste, biannual school-based deworming; as well as construction of group handwashing facilities. Control schools implemented the regular government health education curriculum and biannual deworming. Per school, a random selection of six to seven-year-old grade-one students was drawn. Data on parasitological infections, anthropometric measurements, dental caries, odontogenic infections and sociodemographic characteristics were collected at baseline and at follow-up (24 months later). Data were analysed using the χ2-test, Mann Whitney U-test and multilevel logistic and linear regression.
  
  
  
  A total of 1847 children (mean age = 6.7 years, range 6.0-8.0 years) participated in the baseline survey. Of these, 1499 children were available for follow-up examination - 478, 486 and 535 children in Cambodia, Indonesia and Lao PDR, respectively. In all three countries, children in intervention schools had a lower increment in the number of decayed, missing and filled permanent teeth between baseline and follow-up, in comparison to children in controls schools. The preventive fraction was 24% at average. The prevalence of soil-transmitted helminth infection (which was unexpectedly low at baseline), the prevalence of thinness and the prevalence of odontogenic infections did not significantly differ between baseline and follow-up, nor between intervention and control schools.
  
  
  
  The study found that the FIT programme significantly contributed to the prevention of dental caries in children. This study describes the challenges, learnings and, moreover, the importance of conducting real-life implementation research to evaluate health programmes to transform school settings into healthy learning environments for children. The study is retrospectively registered with the German Clinical Trials Register, University of Freiburg (Trial registration number: DRKS00004485, date of registration: 26th of February, 2013).
authors.affiliation: Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, Gustav Mahlerlaan 3004, 1081LA, Amsterdam, The Netherlands. D.Duijster@acta.nl.|Department of Epidemiology and Public Health, University College London, Torrington Place 1-19, London, WC1E 6BT, UK. D.Duijster@acta.nl.
authors.forename: Denise
authors.initials: D
authors.lastname: Duijster
authors.affiliation: Gesellschaft für Internationale Zusammenarbeit (GIZ), L.P. Leviste cor Rufino Street, Makati City, Metro Manila, Philippines.
authors.forename: Bella
authors.initials: B
authors.lastname: Monse
authors.affiliation: Gesellschaft für Internationale Zusammenarbeit (GIZ), L.P. Leviste cor Rufino Street, Makati City, Metro Manila, Philippines.
authors.forename: Jed
authors.initials: J
authors.lastname: Dimaisip-Nabuab
authors.affiliation: Social Basic Services Bureau of West Java, Governor's Office, Jl. Diponegoro No. 22, Citarum, Bandung Wetan, Bandung, West Java, 40115, Indonesia.
authors.forename: Pantjawidi
authors.initials: P
authors.lastname: Djuharnoko
authors.affiliation: Department of Preventive Dentistry and Pediatric Dentistry, University Hospital Jena, Friedrich Schiller University Jena, Bachstraße 18, 07743, Jena, Germany.
authors.forename: Roswitha
authors.initials: R
authors.lastname: Heinrich-Weltzien
authors.affiliation: Department of Epidemiology and Public Health, University College London, Torrington Place 1-19, London, WC1E 6BT, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Hobdell
authors.affiliation: Institute of Human Genetics, University Hospital Jena, Friedrich Schiller University Jena, Kollegiengasse 10, 07740, Jena, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Kromeyer-Hauschild
authors.affiliation: Department of School Health of the Ministry of Education, Youth and Sport of the Kingdom of Cambodia, Street 380, Chao Ponheahok Primary School, BKK1, Khann Chamkarmorn, Phnom Penh, Cambodia.
authors.forename: Yung
authors.initials: Y
authors.lastname: Kunthearith
authors.affiliation: Gesellschaft für Internationale Zusammenarbeit (GIZ), L.P. Leviste cor Rufino Street, Makati City, Metro Manila, Philippines.
authors.forename: Maria Carmela
authors.initials: MC
authors.lastname: Mijares-Majini
authors.affiliation: Gesellschaft für Internationale Zusammenarbeit (GIZ), L.P. Leviste cor Rufino Street, Makati City, Metro Manila, Philippines.
authors.forename: Nicole
authors.initials: N
authors.lastname: Siegmund
authors.affiliation: Department of Preschool and Primary Education, Ministry of Education and Sports, Ministry of Education Building No 1, Lane Xang Ave, P.O. Box 067, Vientiane Capital, Laos.
authors.forename: Panith
authors.initials: P
authors.lastname: Soukhanouvong
authors.affiliation: Department of Epidemiology and Health Promotion, College of Dentistry, New York University, 433 First Avenue, New York, NY, 10010, USA.
authors.forename: Habib
authors.initials: H
authors.lastname: Benzian
mesh_terms: D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002662:Child Health Services; D015331:Cohort Studies; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006373:Helminthiasis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007407:Interviews as Topic; D007812:Laos / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D009910:Oral Hygiene; D012499:Sanitation; D012572:School Health Services; D011795:Surveys and Questionnaires; D014881:Water Supply
keywords: Dental caries; Deworming; Handwashing; School health; Soil-transmitted helminth infection; Toothbrushing; Underweight; Water sanitation and hygiene