Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools

Rosen, Laura; Manor, Orly; Engelhard, Dan; Brody, David L.; Rosen, Bruce; Peleg, Hannah; Meir, Marina; Zucker, David M.

doi:10.1016/j.ypmed.2005.09.012

Cited by 76 publications

(70 citation statements)

References 11 publications

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“…Our impact evaluation, like other studies before it, [9][10][11][14][15][16] showed mixed results. We found lower rates of self-reported diarrhea and respiratory infection symptoms among beneficiary schools compared with the comparison schools.…”

Section: Discussionmentioning

confidence: 42%

“…10,12 A handwashing trial among preschool children in Israel found no effect on overall absenteeism or absenteeism due to illness. 14 In Kenya, no overall effect of a comprehensive WASH intervention was found, although a reduction in absence was found among girls. 15 Similarly, null findings were found when schools were provided latrine cleaning and handwashing supplies.…”

Section: Introductionmentioning

confidence: 98%

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The Impact of a School-Based Water, Sanitation, and Hygiene Program on Absenteeism, Diarrhea, and Respiratory Infection: A Matched–Control Trial in Mali

Trinies¹,

Garn²,

Chang³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. We conducted a matched-control trial in Mali to assess the effectiveness of a comprehensive school-based water, sanitation, and hygiene (WASH) intervention on pupil absence, diarrhea, and respiratory infections. After completion of the intervention, data were collected from 100 beneficiary schools and 100 matched comparison schools in 5-6 sessions over a 14-month period. Data collection included roll calls to assess absenteeism and interviews with a subset of pupils to assess recent absence and disease symptoms. The odds of pupils being absent at roll call were 23% higher in beneficiary schools than in comparison schools (odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.06, 1.42). The odds of pupils reporting being absent due to diarrhea (OR: 0.73, 95% CI: 0.56, 0.94) or having had diarrhea (OR: 0.71, 95% CI: 0.60, 0.85) or respiratory infection symptoms (OR: 0.75, 95% CI: 0.65, 0.86) in the past week were lower in beneficiary schools compared with comparison schools. We found that a school-based WASH intervention can have a positive effect on reducing rates of illness, as well as absence due to diarrhea. However, we did not find evidence that these health impacts led to a reduction in overall absence. Higher absence rates are less likely attributable to the intervention than the result of an imbalance in unobserved confounders between study groups.

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Section: Discussionmentioning

confidence: 42%

Section: Introductionmentioning

confidence: 98%

The Impact of a School-Based Water, Sanitation, and Hygiene Program on Absenteeism, Diarrhea, and Respiratory Infection: A Matched–Control Trial in Mali

Trinies¹,

Garn²,

Chang³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…For example, a handwashing intervention among pre-school students in Israel recorded observed rates of handwashing with soap after toilet use in the range of 43-47% (although pre-school children might be expected to have lower compliance). 8 Observational data from other school-based studies are not available; however, these rates are also high compared with observed hand hygiene by caregivers in similar settings. A review of data from 11 lowincome countries found that just 17% of caregivers were observed to wash their hands with soap after using the toilet.…”

Section: Discussionmentioning

confidence: 98%

Access to Waterless Hand Sanitizer Improves Student Hand Hygiene Behavior in Primary Schools in Nairobi, Kenya

Pickering¹,

Davis²,

Blum³

et al. 2013

The American Society of Tropical Medicine and Hygiene

111

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Abstract. 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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“…[3][4][5][6][7][8] Improvements to WASH at schools have sometimes been shown to reduce diarrheal disease, 6,9 acute respiratory infections, 10 soil-transmitted helminth reinfections, 11 and absence among pupils. 3,12 However, these effects are often not consistent between studies and within studies they are dependent on study context and/or the subgroup of pupils under study.…”

Section: Introductionmentioning

confidence: 99%

The Role of Adherence on the Impact of a School-Based Water, Sanitation, and Hygiene Intervention in Mali

Garn

Trinies

Toubkiss

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. Studies assessing the impacts of school-based water, sanitation, and hygiene (WASH) interventions have revealed inconsistent improvements in pupils' health and educational outcomes. This may be in part due to suboptimal project fidelity or adherence. As part of a matched-control trial of a comprehensive school-based WASH project in Mali, we measured the degree to which schools met four prespecified WASH targets, comprised of 15 criteria, 0-3 years after program implementation. We compared achievement of the targets and criteria between beneficiary and matched control schools, and compared achievement within beneficiary schools at baseline and at follow-up visits. We assessed the "as-treated" associations between WASH target achievement and pupil diarrhea, respiratory symptoms, and absence. Between 44% and 81% of beneficiary schools achieved each target. Although adherence was inconsistent across schools, beneficiary schools, on average, met more WASH targets than matched control schools, and beneficiary schools also met more WASH targets at follow-up than at baseline. Very few of the targets were individually associated with health and absenteeism outcomes. Increasing achievement of multiple WASH targets together was associated with a lower odds of pupils having diarrhea (P trend < 0.01) and having respiratory symptoms (P trend < 0.01), but was not associated with roll-call absence (P trend = 0.14) or pupil-reported absence (P trend = 0.41). These results indicate that a comprehensive WASH intervention and a focus on increasing adherence may help maximize the health effects of school WASH programs, but that WASH alone might not be sufficient to decrease pupils' absenteeism.

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Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools

Cited by 76 publications

References 11 publications

The Impact of a School-Based Water, Sanitation, and Hygiene Program on Absenteeism, Diarrhea, and Respiratory Infection: A Matched–Control Trial in Mali

The Impact of a School-Based Water, Sanitation, and Hygiene Program on Absenteeism, Diarrhea, and Respiratory Infection: A Matched–Control Trial in Mali

Access to Waterless Hand Sanitizer Improves Student Hand Hygiene Behavior in Primary Schools in Nairobi, Kenya

The Role of Adherence on the Impact of a School-Based Water, Sanitation, and Hygiene Intervention in Mali

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