Background: The Spiti Valley is a highly underserviced isolated desert mountain valley in the Indian Himalayas. Following a needs assessment identifying gastrointestinal diseases as a major health concern, sustainable programs were implemented at a local boarding school (Munsel-Ling School) in 2006 by the University of British Columbia (UBC), however, the long term impact of sanitation interventions in the community have not been rigorously addressed. This study evaluated the effectiveness of health education by assessing diarrheal rates, handwashing practices, and helminths infections by comparing it to data collected in 2011. Methods: This cross-sectional study was conducted at Munsel-Ling School in India. Students 6-18 years of age at the school were recruited if they were participating in the annual health screens. Students who did not meet the aforementioned criteria were excluded. Students were also excluded if language barriers were present. 258 students completed a standardized survey that evaluated hand washing practices, helminthic infections and drinking water sources (independent variables). The survey also included the modified Bristol Stool Scale for Children to identify children with diarrhea and dysentery (dependent variables). The analysis divided students into 3 cohorts (grades 3-5, 6-8, and 9-10) and a univariate logistic regression was performed. Ethics approval was granted by the UBC Behavioural Research Ethics Board (BREB) [certificate number: H14-00823]. Written assent was obtained from both the student and principal if the participant was under the age of 14. Written consent was obtained from students 14 years and older before the survey was administered. Findings: 51.9% of students reported episodes of diarrhea within the past 14 days using the modified Bristol Stool Scale for Children and WHO definitions and 17.4% reported dysentery. Predictive factors include age, cohort, and unsafe water sources. The oldest cohorts experienced significantly less diseases, with diarrheal and dysentery risk decreasing 11.8% and 8.9% for every year increase in age, respectively. Students who drank unsafe water had a 65% and 138% increased risk of diarrhea and dysentery. Handwashing before meals and toileting decreased diarrheal diseases risk by 78.3% but is not predictive for dysentery. Additionally, helminth infections were reported amongst 8.9% of the students. Diarrheal rates assessed amongst 126 students in 2011 reported 46.6% and 42.7% prevalence within the past 7 and 30 days respectively, and helminthes infections at 22.5%. Children are at an increased risk of malnutrition with diarrhea in many developing countries. It is anticipated that Munselling school will continue to deliver education surrounding good hygiene behaviour. Finally, the annual preventative anti-helminth treatment was shown to be beneficial in reducing the rates of selfreported helminth infections.
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