The DOI matches its Crossref record; 30 of the 31 references it cites were found in a registry or an index.
Water, sanitation, and hygiene in schools: Status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia
Abstract
Adequate access to water, sanitation, and hygiene (WaSH) in schools impacts health, educational outcomes, and gender disparities. Little multi-country research has been published on WaSH in rural schools in Sub-Saharan Africa. In this multi-national cross-sectional WaSH study, we document WaSH access, continuity, quality, quantity, and reliability in 2270 schools that were randomly sampled in rural regions of six Sub-Saharan African countries: Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Data collection included: school WaSH surveys containing internationally established WaSH indicators, direct observation, and field- and laboratory-based microbiological water quality testing. We found 1% of rural schools in Ethiopia and Mozambique to 23% of rural schools in Rwanda had improved water sources on premises, improved sanitation, and water and soap for handwashing. Fewer than 23% of rural schools in the six countries studied met the World Health Organization's recommended student-to-latrine ratios for boys and for girls. Fewer than 20% were observed to have at least four of five recommended menstrual hygiene services (separate-sex latrines with doors and locks, water for use, waste bin). The low access to safe and adequate WaSH services in rural schools suggest opportunities for WaSH interventions that could have substantive impact on health, education, and gender disparities.
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“Regardless of all these hazards, females in marginalized areas continue to engage in open defecation due to limited sanitation facilities [32].”
From What if your husband doesn’t feel the pressure? An exploration of women’s involvement in WaSH decision making in Nyanchwa, Kenya. (2019) · cites this paper as [32]
Citations
Cites
Transforming Our World: The 2030 Agenda for Sustainable Development
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Effect of washing hands with soap on diarrhoea risk in the community: a systematic review
Curtis, V., & Cairncross, S. (2003) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(03)00606-6 · Cited by 1,208
Prüss‐Ustün, A., Bartram, J., Clasen, T., Colford, J. M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A. D., De France, J., Fewtrell, L., et al. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12329 · Cited by 1,198
Self-citationWright, J., Gundry, S., & Conroy, R. M. (2004) · Tropical Medicine & International Health · doi:10.1046/j.1365-3156.2003.01160.x · Cited by 881
Water, sanitation and hygiene for the prevention of diarrhoea
Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C., & Schmidt, W.-P. (2010) · International Journal of Epidemiology · doi:10.1093/ije/dyq035 · Cited by 667
Bain, R., Cronk, R., Wright, J., Yang, H., Slaymaker, T., & Bartram, J. (2014) · PLoS Medicine · doi:10.1371/journal.pmed.1001644 · Cited by 619
Self-citationA systematic review of the health and social effects of menstrual hygiene management
Sumpter, C., & Torondel, B. (2013) · PLoS ONE · doi:10.1371/journal.pone.0062004 · Cited by 518
A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools
Sommer, M., Caruso, B. A., Sahin, M., Calderon, T., Cavill, S., Mahon, T., & Phillips-Howard, P. A. (2016) · PLOS Medicine · doi:10.1371/journal.pmed.1001962 · Cited by 435
Safe access to safe water in low income countries: water fetching in current times
Sorenson, S. B., Morssink, C., & Campos, P. A. (2011) · Social Science & Medicine · doi:10.1016/j.socscimed.2011.03.010 · Cited by 370
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1 of the 31 references couldn’t be matched to a known paper.
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Effects of climate change on menstrual health and hygiene: A global mixed-methods systematic review
D’Mello-Guyett, L., Jaggarwal, N., Wilbur, J., Torondel, B., & Ranganathan, M. (2026) · PLOS Climate · doi:10.1371/journal.pclm.0001083
Njuguna, J., Kaundu, M., Kageri, J., Mwangi, L., Kibiru, E., Muthiru, C., Mwaniki, E., Gachao, T., Munyoro, M., Kinyua, C., et al. (2026) · Discover Public Health · doi:10.1186/s12982-026-03156-7
Biswas, D., Roberton, T., Ahmed, M., & Barrington, D. (2026) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2026.114931
The Water, Sanitation, and Hygiene (WASH) Challenges of the Sub-Saharan Africa Region
Nyika, J. M., & Onyari, E. K. (2026) · IGI Global eBooks · doi:10.4018/979-8-3373-9360-5.ch002
Metadata
- Authors
- Morgan, C., Bowling, M., Bartram, J., & Lyn Kayser, G.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Venue
- International Journal of Hygiene and Environmental Health
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 220
- Issue
- 6
- Pages
- 950-959
- ISSN
- 1438-4639 (ISSN-L)
- OpenAlex
- W2607172376
- Cited by
- 104
- References
- 31
- Citations by year
- 2026: 18 · 2025: 13 · 2024: 17 · 2023: 12 · 2022: 16 · 2021: 11 · 2020: 6 · 2019: 6 · 2018: 5
- FWCI
- 3.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Hygiene and Environmental Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- United States Agency for International Development
- World Health Organization
- Institute for Health Metrics and Evaluation
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
- Keywords
- school water, sanitation and hygiene, rural schools, sub-Saharan Africa, latrine access, handwashing with soap, water quality, gender inequality in education, school health
- MeSH terms
- Female, Humans, Hygiene, Male, Surveys and Questionnaires, Rural Population, Sanitation, Schools, Water Supply, Africa South of the Sahara
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