Water, Sanitation and Hygiene in Schools in Low- and Middle-Income Countries: A Systematic Review and Implications for the COVID-19 Pandemic

Abstract

The global COVID-19 pandemic has revealed the extent to which schools are struggling with the provision of safe drinking water, sanitation and hygiene (WASH). To describe the WASH conditions in schools and discuss the implications for the safe reopening of schools during the ongoing COVID-19 pandemic, a systematic review of peer-reviewed literature on WASH in schools in low- and middle-income countries was performed. In April 2021, five databases, including MEDLINE (via PubMed), Web of Science, Scopus, AJOL, and LILACS, were used to identify studies. Sixty-five papers met the inclusion criteria. We extracted and analyzed data considering the Joint Monitoring Programme (JMP) definitions and the normative contents of Human Rights to safe drinking water and sanitation. Publications included in this systematic review considered 18,465 schools, across 30 different countries. Results indicate a lack of adequate WASH conditions and menstrual hygiene management requirements in all countries. The largely insufficient and inadequate school infrastructure hampers students to practice healthy hygiene habits and handwashing in particular. In the context of the COVID-19 pandemic, being hindered to implement such a key strategy to contain the spread of SARS-CoV-2 in the school environment is of major concern.

Water, sanitation and hygiene (WASH) in schools in Brazil pre-and peri-COVID-19 pandemic: Are schools making any progress?

“…While the JMP estimates that 5% of schools in Brazil have no sanitation service, which represents 2 million students without this resource in the school environment, our findings indicated that 22% of the Brazilian schools could be classified as with no sanitation service, ultimately impacting over 9 million of students. Nonetheless, the percentage of schools with improved sanitation facilities found in this study is higher than what was reported by Poague et al (2022) in LMICS (31%) and in Central America (64%, though this estimate was based on data from 412 schools included in only three studies).…”

“…As with WASH in schools monitoring, indicators vary between sources and countries, which hampers the comparison of WASH in schools across locations ( Chatterley et al, 2018 ). According to the systematic review on WASH in schools in LMICs conducted by Poague et al (2022) considering 18,465 schools described in 65 studies across 30 different countries, the water source in 6% of schools (n = 1118) was classified as “unknown” because the terms and indicators used in the studies did not fit the JMP classification. In Brazil, for instance, the standard when working with WASH is to use the definitions and indicators of the Plano Nacional de Saneamento Básico ( Brazil, 2014 ).…”

“…The current state of water services in 85% and sanitation services in 95% of the Brazilian institutions could not be evaluated due to insufficient data (WHO and WHO UNICEF, 2020 ). A recent systematic review performed by Poague et al (2022) on WASH in schools in low- and middle-income (LMICs) countries also indicated limited data and research on WASH in schools in Brazil and Latin America as well. Out of 65 studies included in the review, only three were conducted in Central America, one in South America and none in Brazil ( Poague et al, 2022 ).…”

“…A recent systematic review performed by Poague et al (2022) on WASH in schools in low- and middle-income (LMICs) countries also indicated limited data and research on WASH in schools in Brazil and Latin America as well. Out of 65 studies included in the review, only three were conducted in Central America, one in South America and none in Brazil ( Poague et al, 2022 ). According to the WHO/UNICEF report on WASH in schools from 2020, Latin America and the Caribbean were the only regions to record a decrease in data availability on WASH in schools from 2000 to 2019 (WHO and WHO UNICEF, 2020 ).…”

Menstrual health and management during the COVID-19 syndemic in the Barcelona area (Spain): A qualitative study

“… 11 Evidence in other countries 21 , 20 also supports these findings, especially in contexts where access to WASH has also been burdened during the syndemic. 48 For this reason, reusable products such as the menstrual cup may have facilitated menstrual management during lockdown. 49 Further research is needed to explore accessibility of menstrual products and menstrual poverty (including price regulations) among vulnerable populations, and particularly those who were highly burdened the economic impact of the syndemic or that were already in socioeconomic vulnerable contexts prior to the syndemic.…”