Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya
Abstract
Water, sanitation, and hygiene (WASH) programs in schools have been shown to improve health and reduce absence. In resource-poor settings, barriers such as inadequate budgets, lack of oversight, and competing priorities limit effective and sustained WASH service delivery in schools. We employed a cluster-randomized trial to examine if schools could improve WASH conditions within existing administrative structures. Seventy schools were divided into a control group and three intervention groups. All intervention schools received a budget for purchasing WASH-related items. One group received no further intervention. A second group received additional funding for hiring a WASH attendant and making repairs to WASH infrastructure, and a third group was given guides for student and community monitoring of conditions. Intervention schools made significant improvements in provision of soap and handwashing water, treated drinking water, and clean latrines compared with controls. Teachers reported benefits of monitoring, repairs, and a WASH attendant, but quantitative data of WASH conditions did not determine whether expanded interventions out-performed our budget-only intervention. Providing schools with budgets for WASH operational costs improved access to necessary supplies, but did not ensure consistent service delivery to students. Further work is needed to clarify how schools can provide WASH services daily.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
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?
Very few intervention studies include a focus on menstrual hygiene management in schools in low-income countries.
“However, these studies are qualitative and/or descriptive; very few intervention studies include a focus on menstrual hygiene management in schools in low-income countries [39,40,43].”
From Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact (2019) · cites this paper as [43]
Cites
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-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
Flagged first, then by citations
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
“However, these studies are qualitative and/or descriptive; very few intervention studies include a focus on menstrual hygiene management in schools in low-income countries [39,40,43].”
BackgroundMethodInfluentialDreibelbis, R., Kroeger, A., Hossain, K., Venkatesh, M., & Ram, P. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13010129 · Cited by 151 · 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
Alexander, K., Oduor, C., Nyothach, E., Laserson, K., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C., Mohammed, A., et al. (2014) · Water · doi:10.3390/w6051453 · Cited by 90 · see citing works
Self-citationJordanova, T., Cronk, R., Obando, W., Medina, O., Kinoshita, R., & Bartram, J. (2015) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph120606197 · Cited by 62 · see citing works
Cliff Oduor, C. O., Kelly T. Alexander, K. T. A., Kelvin Oruko, K. O., Elizabeth Nyothach, E. N., Linda Mason, L. M., Frank O. Odhiambo, F. O. O., John Vulule, J. V., Kayla F. Laserson, K. F. L., & Penelope A. Phillips-Howard, P. A. P.-H. (2015) · Waterlines · doi:10.3362/1756-3488.2015.037 · Cited by 32 · see citing works
- Authors
- Alexander, K. T., Dreibelbis, R., Freeman, M. C., Ojeny, B., & Rheingans, R.
- Affiliations
- Emory University (US)
- Johns Hopkins University (US)
- CARE Kenya, Kisumu, Kenya
- University of Florida (US)
- Corresponding author
- Dreibelbis, Robert
- Venue
- Journal of Water and Health
- Publisher
- IWA Publishing
- Published
- 2013-05-02
- Volume
- 11
- Issue
- 3
- Pages
- 507-519
- ISSN
- 1477-8920 (ISSN-L)
- 1996-7829
- OpenAlex
- W2326002130
- Cited by
- 59
- References
- 2
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 2 · 2020: 6 · 2019: 6 · 2018: 1 · 2017: 4 · 2016: 4 · 2015: 5 · 2014: 2
- FWCI
- 3.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Water and Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- World Bank Group
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
- Keywords
- school water, sanitation and hygiene, elementary school, school budgets, handwashing with soap, drinking water treatment, latrine access, school absenteeism, resource-limited settings, Western Kenya
- MeSH terms
- Disinfectants, Female, Hand Disinfection, Health Education, Humans, Hygiene, Kenya, Male, Sanitation, Schools, Soaps, Toilet Facilities, Water Supply, Drinking 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
