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Cited by 91Menstrual Health and DisordersChild Nutrition and Water AccessSchool Health and Nursing Education

Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls?

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Alexander, Kelly, Oduor, Clifford, Nyothach, Elizabeth, Laserson, Kayla, Amek, Nyaguara, Eleveld, Alie, Mason, Linda, Rheingans, Richard +7 more·2014·Water
DOI 10.3390/w6051453
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Abstract

Water, sanitation and hygiene (WASH) programs in African schools have received increased attention, particularly around the potential impact of poor menstrual hygiene management (MHM) on equity for girls’ education. This study was conducted prior to a menstrual feasibility study in rural Kenya, to examine current WASH in primary schools and the resources available for menstruating schoolgirls. Cross-sectional surveys were performed in 62 primary schools during unannounced visits. Of these, 60% had handwashing water, 13% had washing water in latrines for menstruating girls, and 2% had soap. Latrines were structurally sound and 16% were clean. Most schools (84%) had separate latrines for girls, but the majority (77%) had no lock. Non-governmental organizations (NGOs) supported WASH in 76% of schools. Schools receiving WASH interventions were more likely to have: cleaner latrines (Risk Ratio (RR) 1.5; 95% Confidence Intervals [CI] 1.0, 2.1), handwashing facilities (RR 1.6, CI 1.1, 2.5), handwashing water (RR 2.7; CI 1.4, 5.2), and water in girls’ latrines (RR 4.0; CI 1.4, 11.6). Schools continue to lack essential WASH facilities for menstruating girls. While external support for school WASH interventions improved MHM quality, the impact of these contributions remains insufficient. Further support is required to meet international recommendations for healthy, gender-equitable schools.

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  • In this study, school absence during menstruation was independently associated with negative attitudes and perceptions about menstruation, not having a gender-separated unlocked toilet for girls at schools, and being forbidden from activities during menstruation.

    “In our study, school absence during menstruation was independently associated with negative attitudes and perceptions about menstruation, not having a gender-separated unlocked toilet for girls at schools and being forbidden from activities during menstruation, factors that are similar to other studies.7 9 10 21 24–27”

    From Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey (2017) · cites this paper as [9]

    The Discussion (section 4; page not provided) reports that few schools had private, lockable facilities and says poor WASH conditions may hinder attendance during menstruation. This supports the similarity of the toilet-related factor, but the paper does not establish an independent association with absence or address negative attitudes or being forbidden from activities. The independent associations are described as findings of the citing authors’ own study, not this source. (LLM, conf=0.84)

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  • Girls lack water, soap, privacy, and space to change.

    “Studies have shown girls lack water, soap, privacy, and space to change [19]; adequate time to manage their menses comfortably, safely, and with dignity [20–22]; and hygienic sanitary products and sometimes underwear [7,23,24].”

    From A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools (2016) · cites this paper as [19]

  • Access to adequate water and sanitation is limited in informal settlements, contributing to girls' challenges managing menstruation at school.

    “Access to adequate water and sanitation is limited in informal settlements, contributing to girls’ challenges managing menstruation at school, especially when they cannot access materials to absorb menstrual blood and appropriate facilities for hygiene.”

    From Physical, social, and political inequities constraining girls’ menstrual management at schools in informal settlements of Nairobi, Kenya. (2017) · cites this paper as [5]

  • Poor conditions of WASH facilities contribute to girls' challenges managing menstruation in Kenya.

    “Studies show that poor conditions of WASH facilities contribute to girls’ challenges managing menstruation in Kenya [3, 5].”

    From Physical, social, and political inequities constraining girls’ menstrual management at schools in informal settlements of Nairobi, Kenya. (2017) · cites this paper as [5]

  • Girls may not have adequate facilities at school such as safe, private, and clean toilets equipped with functional door locks, water for personal hygiene, or disposal facilities.

    “They may not have adequate facilities at school such as safe, private, and clean toilets equipped with functional door locks, water for personal hygiene, or disposal facilities [5, 6, 10–12].”

    From Physical, social, and political inequities constraining girls’ menstrual management at schools in informal settlements of Nairobi, Kenya. (2017) · cites this paper as [5]

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1 of the 38 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Sommer, M.; Vasquez, E.; Worthington, N.; Sahin, M. WASH in schools empowers girls' education. In Proceedings of the Menstrual Hygiene Management in Schools Virtual of the Conference 2012, New York, NY,USA, 27 September 2012.

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Authors
Alexander, K., Oduor, C., Nyothach, E., Laserson, K., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C., Mohammed, A., Ombok, M., Obor, D., Odhiambo, F., Quick, R., & Phillips-Howard, P.
Affiliations
  • Liverpool School of Tropical Medicine (GB)
  • Kenya Medical Research Institute (KE)
  • Centers for Disease Control and Prevention (US)
  • Kenya Medical Research Institute, Center for Global Health Research, Kisumu 1578-40100, Kenya
  • Safe Water and AIDS Project, Kisumu 40100, Kenya
  • University of Florida (US)
  • Liverpool John Moores University (GB)
  • Ministry of Health (KE)
  • Child and Reproductive Health, Department of Clinical Studies, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
Corresponding author
Alexander, Kelly
ORCID
Venue
Water
Publisher
MDPI AG
Published
2014-05-22
Volume
6
Issue
5
Pages
1453-1466
ISSN
2073-4441 (ISSN-L)
DOI
10.3390/w6051453
OpenAlex
W2097879493
Cited by
90
References
38
Citations by year
2026: 4 · 2025: 10 · 2024: 7 · 2023: 8 · 2022: 13 · 2021: 7 · 2020: 6 · 2019: 7 · 2018: 4 · 2017: 10 · 2016: 6 · 2015: 8
FWCI
7.92
Type
journal article
Language
en
Open access
Licence
Locations
  • Water (publishedVersion, cc-by)
  • LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Figshare (submittedVersion)
  • Appalachian State University
Funders
  • Deutsche Gesellschaft für Internationale Zusammenarbeit
  • Centers for Disease Control and Prevention
  • Medical Research Council
  • FP7 International Cooperation
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
Keywords
menstrual hygiene management, school sanitation, handwashing facilities, latrines, elementary school, rural Kenya, gender equity in education, soap availability

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