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Design, Intervention Fidelity, and Behavioral Outcomes of a School-Based Water, Sanitation, and Hygiene Cluster-Randomized Trial in Laos

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  • Anna N. Chard

    (Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

  • Matthew C. Freeman

    (Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

Abstract

Evidence of the impact of water, sanitation, and hygiene (WASH) in schools (WinS) interventions on pupil absence and health is mixed. Few WinS evaluations rigorously report on output and outcome measures that allow for comparisons of effectiveness between interventions to be made, or for an understanding of why programs succeed. The Water, Sanitation, and Hygiene for Health and Education in Laotian Primary Schools (WASH HELPS) study was a randomized controlled trial designed to measure the impact of the United Nations Children’s Fund (UNICEF) Laos WinS project on child health and education. We also measured the sustainability of intervention outputs and outcomes, and analyzed the effectiveness of group hygiene activities on behavior change and habit formation. Here, we present the design and intermediate results from this study. We found the WinS project improved the WASH environment in intervention schools; 87.8% of schools received the intervention per design. School-level adherence to outputs was lower; on average, schools met 61.4% of adherence-related criteria. The WinS project produced positive changes in pupils’ school WASH behaviors, specifically increasing toilet use and daily group handwashing. Daily group hygiene activities are effective strategies to improve school WASH behaviors, but a complementary strategy needs to be concurrently promoted for effective and sustained individual handwashing practice at critical times.

Suggested Citation

  • Anna N. Chard & Matthew C. Freeman, 2018. "Design, Intervention Fidelity, and Behavioral Outcomes of a School-Based Water, Sanitation, and Hygiene Cluster-Randomized Trial in Laos," IJERPH, MDPI, vol. 15(4), pages 1-17, March.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:4:p:570-:d:137487
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    References listed on IDEAS

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    1. Joshua V. Garn & Bethany A. Caruso & Carolyn D. Drews-Botsch & Michael R. Kramer & Babette A. Brumback & Richard D. Rheingans & Matthew C. Freeman, 2014. "Factors Associated With Pupil Toilet Use in Kenyan Primary Schools," IJERPH, MDPI, vol. 11(9), pages 1-18, September.
    2. Mitsuaki Hirai & Jay P. Graham & Kay D. Mattson & Andrea Kelsey & Supriya Mukherji & Aidan A. Cronin, 2016. "Exploring Determinants of Handwashing with Soap in Indonesia: A Quantitative Analysis," IJERPH, MDPI, vol. 13(9), pages 1-15, September.
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    Cited by:

    1. Celia McMichael, 2019. "Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact," IJERPH, MDPI, vol. 16(3), pages 1-21, January.
    2. Yuko Noguchi & Daisuke Nonaka & Sengchanh Kounnavong & Jun Kobayashi, 2021. "Effects of Hand-Washing Facilities with Water and Soap on Diarrhea Incidence among Children under Five Years in Lao People’s Democratic Republic: A Cross-Sectional Study," IJERPH, MDPI, vol. 18(2), pages 1-14, January.
    3. Denise Duijster & Bella Monse & Marvin Marquez & Ubo Pakes & Nicole Stauf & Habib Benzian, 2022. "Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention," IJERPH, MDPI, vol. 19(16), pages 1-11, August.

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