Assessing the impact of a school‐based latrine cleaning and handwashing program on pupil absence in N yanza P rovince, K enya: a cluster‐randomized trial
Open accessAbstract
Objectives: 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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
There is some evidence that improved hand-washing with soap at school, provision of sanitary pads, maintained and clean latrines can reduce absence in school-aged children, but a few studies found that school-based WASH interventions had no impact on student attendance.
“There is some evidence that improved hand-washing with soap at school, provision of sanitary pads, maintained and clean latrines can reduce absence in school-aged children (c.f. [11,18,35,37,42]), but a few studies found that school-based WASH interventions had no impact on student attendance [36,40].”
From Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact (2019) · cites this paper as [36]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSeveral publications emphasise that combined interventions that include multiple components-for example, latrine construction, hygiene promotion, latrine maintenance, and sustained provision of resources such as soap and water for handwashing-are more effective at reducing WASH-related diseases than single interventions such as construction of latrines.
“Several publications emphasise that combined interventions that include multiple components—for example, latrine construction, hygiene promotion, latrine maintenance, and sustained provision of resources such as soap and water for handwashing—are more effective at reducing WASH-related diseases than single interventions such as construction of latrines [11,21,36].”
From Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact (2019) · cites this paper as [36]
The Introduction (page not available) says the benefits of school sanitation and hygiene improvements may depend on latrine conditions and consistent access to soap and water; it also reports that latrine construction alone did not reduce absence in an earlier trial. But the Discussion (page not available) reports no reduction in absence from this study’s added cleaning and handwashing package. The paper does not establish that combined interventions reduce WASH-related diseases more effectively than latrine construction alone. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The Effect of Handwashing with Water or Soap on Bacterial Contamination of Hands
Burton, M., Cobb, E., Donachie, P., Judah, G., Curtis, V., & Schmidt, W.-P. (2011) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph8010097 · Cited by 318 · see citing works
McMahon, S. A., Winch, P. J., Caruso, B. A., Obure, A. F., Ogutu, E. A., Ochari, I. A., & Rheingans, R. D. (2011) · BMC International Health and Human Rights · doi:10.1186/1472-698x-11-7 · Cited by 316 · see citing works
Self-citationTalaat, M., Afifi, S., Dueger, E., El-Ashry, N., Marfin, A., Kandeel, A., Mohareb, E., & El-Sayed, N. (2011) · Emerging Infectious Diseases · doi:10.3201/eid1704.101353 · Cited by 238 · see citing works
Freeman, M. C., Greene, L. E., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B., & Rheingans, R. (2012) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2011.02927.x · Cited by 228 · see citing works
Self-citationBOWEN, A., MA, H., OU, J., BILLHIMER, W., LONG, T., MINTZ, E., HOEKSTRA, R. M., & LUBY, S. (2007) · The American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2007.76.1166 · Cited by 208 · see citing works
O'REILLY, C. E., FREEMAN, M. C., RAVANI, M., MIGELE, J., MWAKI, A., AYALO, M., OMBEKI, S., HOEKSTRA, R. M., & QUICK, R. (2008) · Epidemiology and Infection · doi:10.1017/s0950268807008060 · Cited by 159 · see citing works
Self-citationGreene, L. E., Freeman, M. C., Akoko, D., Saboori, S., Moe, C., & Rheingans, R. (2012) · The American Society of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2012.11-0633 · Cited by 123 · see citing works
Self-citationBlanton, E., Ombeki, S., Oluoch, G. O., Mwaki, A., Wannemuehler, K., & Quick, R. (2010) · The American Society of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2010.09-0422 · Cited by 114 · see citing works
Dreibelbis, R., Greene, L. E., Freeman, M. C., Saboori, S., Chase, R. P., & Rheingans, R. (2013) · International Journal of Educational Development · doi:10.1016/j.ijedudev.2012.07.002 · Cited by 84 · see citing works
Self-citationSaboori, S., Greene, L. E., Moe, C. L., Freeman, M. C., Caruso, B. A., Akoko, D., & Rheingans, R. D. (2013) · The American Society of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.12-0387 · Cited by 53 · see citing works
Self-citationCaruso, B. A., Dreibelbis, R., Ogutu, E. A., & Rheingans, R. (2014) · Journal of Water, Sanitation and Hygiene for Development · doi:10.2166/washdev.2014.028 · Cited by 27 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 19
- ALEXANDER KT DREIBELBIS R FREEMAN MC OJENY B RHEINGANS R 2013 Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya J Water Health 11 507 19 23981878
- CAIRNCROSS S HUNT C BOISSON S BOSTOEN K CURTIS V FUNG IC SCHMIDT WP 2010 Water, sanitation and hygiene for the prevention of diarrhoea International journal of epidemiology 39 i193 i205 20348121 PMC2845874
- CROFTS T FISHER J 2012 Menstrual hygiene in Ugandan schools: An investigation of low-cost sanitary pads Journal of Water, Sanitation and Hygiene for Development 2 50 58
- FREEMAN M CLASEN T DREIBELBIS R SABOORI S GREENE L BRUMBACK B MUGA R RHEINGANS R 2014 The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial Epidemiology and infection 142 340 351 23702047 PMC9151148
- FREEMAN MC CLASEN T BROOKER SJ AKOKO DO RHEINGANS R 2013 The impact of a school-based hygiene, water quality and sanitation intervention on soil-transmitted helminth reinfection: a cluster-randomized trial The American journal of tropical medicine and hygiene 89 875 883 24019429 PMC3820330
- HAYES RJ BENNETT S 1999 Simple sample size calculation for cluster-randomized trials International journal of epidemiology 28 319 26 10342698
- KOOPMAN JS 1978 Diarrhea and school toilet hygiene in Cali, Colombia Am J Epidemiol 107 412 20 665657
- LE TT LUU NH RHEINLANDER T DALSGAARD A KONRADSEN F 2012 Sanitation behavior among schoolchildren in a multi-ethnic area of Northern rural Vietnam BMC public health 12 140 22353490 PMC3305623
- LUBY SP KADIR MA YUSHUF SHARKER MA YEASMIN F UNICOMB L SIRAJUL ISLAM M 2010 A community-randomised controlled trial promoting waterless hand sanitizer and handwashing with soap, Dhaka, Bangladesh Tropical medicine & international health: TM & IH 15 1508 16 20958896
- MAJRA JP GUR A 2010 School environment and sanitation in rural India Journal of global infectious diseases 2 109 11 20606963 PMC2889647
- MCMAHON S CARUSO BA OBURE A OKUMU F RHEINGANS RD 2011a Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya Tropical medicine & international health: TM & IH 16 1536 40 21906214
- PICKERING AJ JULIAN TR MARKS SJ MATTIOLI MC BOEHM AB SCHWAB KJ DAVIS J 2012 Fecal contamination and diarrheal pathogens on surfaces and in soils among Tanzanian households with and without improved sanitation Environmental science & technology 46 5736 5743 22545817
- PORTNEY L WATKINS M 1999 Foundations of Clinical Research: Applications to Practice Prentice Hall
- RABIE T CURTIS V 2006 Handwashing and risk of respiratory infections: a quantitative systematic review Tropical medicine & international health 11 258 267 16553905 PMC7169664
- RAJARATNAM G PATEL M PARRY JV PERRY KR PALMER SR 1992 An outbreak of hepatitis A: school toilets as a source of transmission J Public Health Med 14 72 7 1599746
- SINCLAIR RG GERBA CP 2011 Microbial contamination in kitchens and bathrooms of rural Cambodian village households Letters in applied microbiology 52 144 9 21198693 PMC7197759
- SOMMER M ACKATIA-ARMAH N CONNOLLY S SMILES D 2014 A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia Compare: A Journal of Comparative and International Education 1 21
- THOMAS ME TILLETT HE 1973 Sonne dysentery in day schools and nurseries: an eighteen-year study in Edmonton The Journal of hygiene 71 593 602 4518360 PMC2130586
- ZIEGELBAUER K SPEICH B MAUSEZAHL D BOS R KEISER J UTZINGER J 2012 Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis PLoS Med 9 e1001162 22291577 PMC3265535
Cited by
Sorted by citations
McMichael, C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16030359 · Cited by 220 · see citing works
“Several publications emphasise that combined interventions that include multiple components—for example, latrine construction, hygiene promotion, latrine maintenance, and sustained provision of resources such as soap and water for handwashing—are more effective at reducing WASH-related diseases than single interventio…”
BackgroundInfluentialTrinies, V., Garn, J. V., Chang, H. H., & Freeman, M. C. (2016) · The American Society of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.15-0757 · Cited by 106 · see citing works
Self-citationDe Buck, E., Van Remoortel, H., Hannes, K., Govender, T., Naidoo, S., Avau, B., Veegaete, A. V., Musekiwa, A., Lutje, V., Cargo, M., et al. (2017) · Campbell Systematic Reviews: Better Evidence for a Better World · doi:10.4073/csr.2017.7 · Cited by 99 · see citing works
Gera, T., Shah, D., & Sachdev, H. S. (2018) · Indian Pediatrics · doi:10.1007/s13312-018-1279-3 · Cited by 77 · see citing works
Sanitation and hygiene practices among primary school learners in Ngamiland district, Botswana
Thakadu, O. T., Ngwenya, B. N., Phaladze, N. A., & Bolaane, B. (2018) · Physics and Chemistry of the Earth, Parts A/B/C · doi:10.1016/j.pce.2018.02.006 · Cited by 27 · see citing works
- Authors
- Caruso, B. A., Freeman, M. C., Garn, J. V., Dreibelbis, R., Saboori, S., Muga, R., & Rheingans, R.
- Affiliations
- Emory University (US)
- University of Oklahoma (US)
- Tropical Institute Of Community Health And Development (KE)
- University of Florida (US)
- Corresponding author
- Caruso, Bethany A.
- Venue
- Tropical Medicine & International Health
- Publisher
- Wiley
- Published
- 2014-07-24
- Volume
- 19
- Issue
- 10
- Pages
- 1185-1197
- ISSN
- 1360-2276 (ISSN-L)
- 1365-3156
- PMC
- PMC4876949
- OpenAlex
- W2099300372
- Cited by
- 72
- References
- 11
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 5 · 2023: 8 · 2022: 11 · 2021: 10 · 2020: 3 · 2019: 9 · 2018: 3 · 2017: 4 · 2016: 4 · 2015: 2 · 2014: 1
- FWCI
- 3.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Tropical Medicine & International Health (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Figshare (submittedVersion)
- Appalachian State University
- Funders
- Bill & Melinda Gates Foundation
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Social Sciences › Safety Research › Poverty, Education, and Child Welfare
- Keywords
- handwashing with soap, school absenteeism, school water, sanitation and hygiene, latrine use, school toilets, hygiene education, Nyanza Province
- MeSH terms
- Absenteeism, Child, Diarrhea, Disinfection, Female, Hand Disinfection, Humans, Hygiene, Kenya, Male, Sanitation, Schools, Soaps, Students, Toilet Facilities, Water
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
