Access to waterless hand sanitizer improves student hand hygiene behavior in primary schools in Nairobi, Kenya
Open accessAbstract
Handwashing is difficult in settings with limited resources and water access. In primary schools within urban Kibera, Kenya, we investigated the impact of providing waterless hand sanitizer on student hand hygiene behavior. Two schools received a waterless hand sanitizer intervention, two schools received a handwashing with soap intervention, and two schools received no intervention. Hand cleaning behavior after toilet use was monitored for 2 months using structured observation. Hand cleaning after toileting was 82% at sanitizer schools (N = 2,507 toileting events), 38% at soap schools (N = 3,429), and 37% at control schools (N = 2,797). Students at sanitizer schools were 23% less likely to have observed rhinorrhea than control students (P = 0.02); reductions in student-reported gastrointestinal and respiratory illness symptoms were not statistically significant. Providing waterless hand sanitizer markedly increased student hand cleaning after toilet use, whereas the soap intervention did not. Waterless hand sanitizer may be a promising option to improve student hand cleansing behavior, particularly in schools with limited water access.
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All of the 13 publications that examined changes in WASH knowledge, attitudes and hygiene behaviours reported evidence of positive change among students in intervention schools including hand-washing with soap or sanitizer, improved knowledge of WASH-related diseases, and improved hygiene habits.
“All of the 13 publications that examined changes in WASH knowledge, attitudes and hygiene behaviours reported evidence of positive change among students in intervention schools including hand-washing with soap or sanitizer [8,16,29,30,31], improved knowledge of WASH-related diseases, and improved hygiene habits [7,13].”
From Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact (2019) · cites this paper as [16]
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Self-citation
- Authors
- Pickering, A. J., Davis, J., Blum, A. G., Scalmanini, J., Oyier, B., Okoth, G., Breiman, R. F., & Ram, P. K.
- Affiliations
- Stanford University (US)
- State University of New York (US)
- Corresponding author
- Ram, Pavani K.
- Venue
- The American Society of Tropical Medicine and Hygiene
- Published
- 2013-09-04
- Volume
- 89
- Issue
- 3
- Pages
- 411-418
- ISSN
- 0002-9637 (ISSN-L)
- 1476-1645
- PMC
- PMC3771275
- OpenAlex
- W1976035934
- Cited by
- 73
- References
- 32
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 14 · 2020: 9 · 2019: 8 · 2018: 6 · 2017: 4 · 2016: 7 · 2015: 8 · 2014: 1 · 2012: 1
- FWCI
- 4.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Tropical Medicine and Hygiene (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Emory University
- Gojo Industries
- Centers for Disease Control and Prevention
- Freeman Spogli Institute for International Studies, Stanford University
- University at Buffalo
- Stanford Bio-X
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- hand hygiene behavior, handwashing with soap, elementary school students, rhinorrhea, respiratory diseases, gastrointestinal diseases, Kibera
- MeSH terms
- Adolescent, Child, Child, Preschool, Hand Disinfection, Health Promotion, Humans, Kenya, Schools, Soaps, Students, Logistic Models, Self Report
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.
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