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Cited by 49Child Nutrition and Water AccessSchool Health and Nursing EducationPoverty, Education, and Child Welfare

Design, Intervention Fidelity, and Behavioral Outcomes of a School-Based Water, Sanitation, and Hygiene Cluster-Randomized Trial in Laos

Open access
Chard, Anna, Freeman, Matthew·2018·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph15040570PMC PMC5923612
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Abstract

Evidence of the impact of water, sanitation, and hygiene (WASH) in schools (WinS) interventions on pupil absence and health is mixed. Few WinS evaluations rigorously report on output and outcome measures that allow for comparisons of effectiveness between interventions to be made, or for an understanding of why programs succeed. The Water, Sanitation, and Hygiene for Health and Education in Laotian Primary Schools (WASH HELPS) study was a randomized controlled trial designed to measure the impact of the United Nations Children’s Fund (UNICEF) Laos WinS project on child health and education. We also measured the sustainability of intervention outputs and outcomes, and analyzed the effectiveness of group hygiene activities on behavior change and habit formation. Here, we present the design and intermediate results from this study. We found the WinS project improved the WASH environment in intervention schools; 87.8% of schools received the intervention per design. School-level adherence to outputs was lower; on average, schools met 61.4% of adherence-related criteria. The WinS project produced positive changes in pupils’ school WASH behaviors, specifically increasing toilet use and daily group handwashing. Daily group hygiene activities are effective strategies to improve school WASH behaviors, but a complementary strategy needs to be concurrently promoted for effective and sustained individual handwashing practice at critical times.

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  • Evaluations of WASH interventions in low-resource settings often measure outcomes-such as diarrheal disease-via self-report, an approach prone to recall and social desirability biases, subjective interpretations of the definition of "diarrhea", and imprecise measurements of incidence.

    “And, importantly, evaluations of WASH interventions in low-resource settings often measure outcomes—such as diarrheal disease—via self-report, an approach prone to recall and social desirability biases, subjective interpretations of the definition of “diarrhea”, and imprecise measurements of incidence [9].”

    From Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact (2019) · cites this paper as [9]

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Research works printed but not linked: 19

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Cited by

Sorted by citations

Authors
Chard, A., & Freeman, M.
Affiliations
Emory University (US)
Corresponding author
Freeman, Matthew
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2018-03-22
Volume
15
Issue
4
Pages
570
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph15040570
PMC
PMC5923612
OpenAlex
W2791504582
Cited by
49
References
9
Citations by year
2026: 7 · 2025: 11 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 4 · 2020: 7 · 2019: 8
FWCI
3.93
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institute of Environmental Health Sciences (T32ES012870)
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
intervention fidelity, toilet use, pupil absence, child health, educational outcomes, behavior change, habit formation, intervention sustainability, elementary school, Laos
MeSH terms
Child, Environment, Female, Group Processes, Hand Disinfection, Humans, Hygiene, Laos, Male, Research Design, Sanitation, Schools, Water Supply, Health Behavior

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