The impact of regular soap provision to primary schools on hand washing with soap and E. coli hand contamination among pupils in Nyanza Province, Kenya: A cluster-randomized trial 公开
Saboori, Shadi (2012)
Published
Abstract
Objectives: This cluster-randomized trial, conducted in
Nyanza Province, Kenya from
May to November 2010, assessed whether supplying soap to primary
schools on a
regular basis increased pupil hand washing and decreased E.
coli contamination on
pupils' hands.
Methods: Sixty public schools, in two
geographic strata, were randomly assigned to one
of three study arms-a hand washing intervention including soap
provision and teacher
training on hygiene promotion (HW), the same HW intervention plus a
latrine cleaning
component (LC+HW), or control. Multiple rounds of structured
observations of pupil
hand washing after latrine use were conducted over a 6-month
period. A subset of 457
children from 24 schools (8 schools per study arm) was randomly
selected for one
round of hand rinse collection to measure E. coli
contamination on hands.
Results: The odds of observing at least 50%
and 75% of pupils practicing hand washing
with soap (HWWS) after latrine use was significantly greater in
both intervention arms
compared to controls. The overall proportion of pupils observed
practicing HWWS was
31.5% and 38.2% in the HW and LC+HW arms, respectively, compared to
2.9% in the
controls. Girls and boys had similar hand washing rates. There were
no significant
differences in E. coli contamination of hands between
intervention schools and controls.
Conclusion: Removing the barrier of soap
procurement can significantly increase
availability of soap and hand washing among pupils, but other
limitations in the
enabling policy and institutional environment may still prevent
reaching desired levels
of HWWS. A single measurement of E. coli contamination on
hands may not be sufficient
to indicate differences in hand washing behavior between
intervention and control
schools. Instead of relying on biased self-reported behavior,
future hand washing
studies should consider using multiple observations in order to
more accurately capture
variability in hand washing behavior.
Table of Contents
INTRODUCTION_____________________________________________________1
METHODS__________________________________________________________7
RESULTS__________________________________________________________15
DISCUSSION_______________________________________________________20
LIMITATIONS_______________________________________________________24
CONCLUSIONS, PUBLIC HEALTH IMPLICATIONS, & FUTURE
DIRECTIONS_________25
TABLES AND
FIGURES________________________________________________27
REFERENCES_______________________________________________________32
APPENDICES_______________________________________________________37
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