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Impact of a School-Based Hygiene Promotion and Sanitation Intervention on Pupil Hand Contamination in Western Kenya: A Cluster Randomized Trial

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Greene, Leslie E., Freeman, Matthew C., Akoko, Daniel, Saboori, Shadi, Moe, Christine, Rheingans, Richard·2012·The American Society of Tropical Medicine and Hygiene
DOI 10.4269/ajtmh.2012.11-0633PMC PMC3435337
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Abstract

Handwashing with soap effectively reduces exposure to diarrhea-causing pathogens. Interventions to improve hygiene and sanitation conditions in schools within low-income countries have gained increased attention; however, their impact on schoolchildren's exposure to fecal pathogens has not been established. Our trial examined whether a school-based water, sanitation, and hygiene intervention reduced Escherichia coli contamination on pupils' hands in western Kenya. A hygiene promotion and water treatment intervention did not reduce risk of E. coli presence (relative risk [RR] = 0.92, 95% confidence interval [CI] = 0.54–1.56); the addition of new latrines to intervention schools significantly increased risk among girls (RR = 2.63, 95% CI = 1.29–5.34), with a non-significant increase among boys (RR = 1.36, 95% CI = 0.74–2.49). Efforts to increase usage of school latrines by constructing new facilities may pose a risk to children in the absence of sufficient hygiene behavior change, daily provision of soap and water, and anal cleansing materials.

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Figure 1. (A and B) Percentage of pupils with presence of any and high levels (≥ 100 colony-forming units (CFU)/hand) of Escherichia coli on their hands at schools receiving hygiene promotion and water treatment (HP&WT), additional sanitation (San + HP&WT), and control schools at baseline and follow-up. *n for baseline; follow-up
Figure 1. (A and B) Percentage of pupils with presence of any and high levels (≥ 100 colony-forming units (CFU)/hand) of Escherichia coli on their hands at schools receiving hygiene promotion and water treatment (HP&WT), additional sanitation (San + HP&WT), and control schools at baseline and follow-up. *n for baseline; follow-upCC BY · PubMed Central
Figure 2. (A and B) Percentage of pupils with presence of any Escherichia coli on their hands, by gender, at schools receiving hygiene promotion and water treatment (HP&WT), additional sanitation (San + HP&WT), and control schools at baseline and follow-up. *n for baseline; follow-up.
Figure 2. (A and B) Percentage of pupils with presence of any Escherichia coli on their hands, by gender, at schools receiving hygiene promotion and water treatment (HP&WT), additional sanitation (San + HP&WT), and control schools at baseline and follow-up. *n for baseline; follow-up.CC BY · PubMed Central
Figure 3. (A and B) Percentage of pupils with high levels (≥ 100 colony-forming units (CFU)/hand) of Escherichia coli on their hands, by gender, at schools receiving hygiene promotion and water treatment (HP&WT), additional sanitation (San + HP&WT), and control schools at baseline and follow-up. *n for baseline; follow-up.
Figure 3. (A and B) Percentage of pupils with high levels (≥ 100 colony-forming units (CFU)/hand) of Escherichia coli on their hands, by gender, at schools receiving hygiene promotion and water treatment (HP&WT), additional sanitation (San + HP&WT), and control schools at baseline and follow-up. *n for baseline; follow-up.CC BY · PubMed Central

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Metadata

Authors
Greene, L. E., Freeman, M. C., Akoko, D., Saboori, S., Moe, C., & Rheingans, R.
Affiliations
Emory University (US)
Corresponding author
Greene, Leslie E.
ORCID
Venue
The American Society of Tropical Medicine and Hygiene
Publisher
American Society of Tropical Medicine and Hygiene
Published
2012-09-05
Volume
87
Issue
3
Pages
385-393
ISSN
  • 0002-9637 (ISSN-L)
  • 1476-1645
DOI
10.4269/ajtmh.2012.11-0633
PMC
PMC3435337
OpenAlex
W2150544519
Cited by
123
References
36
Citations by year
2026: 2 · 2024: 5 · 2023: 7 · 2022: 9 · 2021: 14 · 2020: 8 · 2019: 14 · 2018: 3 · 2017: 14 · 2016: 12 · 2015: 13 · 2014: 14 · 2013: 7 · 2012: 1
FWCI
10.46
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Tropical Medicine and Hygiene (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Bill and Melinda Gates Foundation
  • Emory University
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Food Safety and Hygiene
Keywords
hand hygiene, hand contamination, Escherichia coli, school sanitation, school latrines, hygiene promotion, fecal pathogens, elementary school students, diarrhea, sex differences, Western Kenya
MeSH terms
Adolescent, Child, Diarrhea, Escherichia coli, Female, Follow-Up Studies, Hand Disinfection, Humans, Hygiene, Kenya, Male, Poverty, Risk Factors, Sanitation, Schools, Soaps, Toilet Facilities, Cluster Analysis

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