Unsafe drinking water and inadequate handwashing facilities in primary schools increase the risk of absenteeism due to diarrhea and respiratory infections. To mitigate these risks, we provided 28 schools in rural Western Kenya with handwashing and drinking water stations (containers with lids and taps on metal stands), bleach for water treatment, soap for handwashing, and educational materials. We observed the use of the water stations and assessed teachers’ attitudes toward the intervention. Of 151 total handwashing stations, 69 (59%) were observed to have soap and water and treated drinking water 4 months after implementation; observations of pupils showed an increase in handwashing behavior in water stations located < 10 m, as compared with those >10 m, from latrines (p < .02). In focus groups, teachers reported improved cleanliness and decreased illness in pupils. Teacher training and installation of water stations resulted in observed improvements in pupils’ hygiene, particularly when water stations were located <10 m from latrines.
Prüss-UstünA. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health2014; 19: 894–905.
2.
FreemanMC. Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Trop Med Int Health2014; 19: 906–916.
3.
CurtisVCairncrossS. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis2003; 3: 275–281.
4.
RabieTCurtisV. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health2006; 11: 258–267.
5.
AielloAECoulbornRMPerezV. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health2008; 98: 1372–1381.
6.
MigeleJOmbekiSAyaloM. Diarrhea prevention in a Kenyan school through the use of a simple safe water and hygiene intervention. Am J Trop Med Hyg2007; 76: 351–353.
7.
BlantonE. Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households–Nyanza province, western Kenya, 2007. Am J Trop Med Hyg2010; 82: 664–671.
8.
BowenA. A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools. Am J Trop Med Hyg2007; 76: 1166–1173.
9.
O’ReillyCE. The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006. Epidemiol Infect2008; 136: 80–91.
10.
PatelMK. Impact of a hygiene curriculum and the installation of simple handwashing and drinking water stations in rural Kenyan primary schools on student health and hygiene practices. Am J Trop Med Hyg2012; 87: 594–601.
11.
DangourAD. Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children. Cochrane Database Syst Rev2013; 8: CD009382.
12.
LubySP. Difficulties in maintaining improved handwashing behavior, Karachi, Pakistan. Am J Trop Med Hyg2009; 81: 140–145.
13.
RamPK. Variability in hand contamination based on serial measurements: implications for assessment of hand-cleansing behavior and disease risk. Am J Trop Med Hyg2011; 84: 510–516.
14.
LubySPAgboatwallaMBillhimerW. Field trial of a low cost method to evaluate hand cleanliness. Trop Med Int Health2007; 12: 765–771.
15.
BiranA. Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial. Lancet Glob Health2014; 2: e145–e154.
16.
Centers for Disease Control and Prevention. Baseline data from the Nyando integrated child health and education project–Kenya, 2007. MMWR Morb Mortal Wkly Rep2007; 56: 1109–1113.
17.
National Bureau of Statistics-Kenya and ICF International. KDHS key findings. Rockville, MD: KNBS and ICF International, 2015.
18.
BergBL. Qualitative research methods for the social sciences, Boston, MA: Allyn and Bacon, 2001.
19.
PattonMQ. Qualitative research and evaluation methods, Thousand Oaks, CA: Sage Publications, 2002.
20.
Muhr T. Atlas.ti – the knowledge workbench. Visual qualitative data analysis management model building. Berlin: Scientific Software Development, 1997.
21.
MilesMBHubermanAM. Qualitative data analysis : an expanded sourcebook, Thousand Oaks, CA: Sage, 1994.
22.
StraussALCorbinJM. Basics of qualitative research : techniques and procedures for developing grounded theory, Thousand Oaks, CA: Sage Publications, 1998.
23.
AdamsJBartramJChartierY. Water, sanitation and hygiene standards for schools in low-cost settings, Geneva, Switzerland: World Health Organization, 2009.
24.
PrescottJ. Hand hygiene stations: building a culture of hand hygiene in a large urban teaching facility. Am J Infect Control2008; 36: E184–E185.
25.
World Bank. Are your hands clean enough? Study findings on handwashing with soap behaviour in Kenya. Washington, DC: World Bank, 2009.
26.
DreibelbisRKroegerAHossainK. Behavior change without behavior change communication: nudging handwashing among primary school students in Bangladesh. Int J Env Res Public Health2016; 13: E129.
27.
PickeringAJ. Access to waterless hand sanitizer improves student hand hygiene behavior in primary schools in Nairobi, Kenya. Am J Trop Med Hyg2013; 89: 411–418.
28.
SabooriS. Sustaining school hand washing and water treatment programmes: lessons learned and to be learned. Waterlines2011; 30: 298–311.
29.
FreemanMC. Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial. Trop Med Int Health2012; 17: 380–391.
30.
SabooriSMwakiARheingansRD. Is soapy water a viable solution for handwashing in schools?Waterlines2010; 9: 329–336.
31.
HullandKR. Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). BMC Public Health2013; 13: 877.
32.
GurleyES. Behaviour change intervention to reduce caregivers’ exposure to patients’ oral and nasal secretions in Bangladesh. Int J Infect Control2013; 9: 1–9.
33.
GravesJM. Teacher perspectives on implementing and sustaining a handwashing promotion intervention in Western Kenyan primary schools. Int Q Community Health Educ2013; 34: 159–170.
