Evaluation of the School Sanitation and Hygiene Education (SSHE) Program in Ghana, West-Africa

Introduction: Poor hygiene and sanitation practices among school youth in Ghana lead to infectious diseases, diarrheal ailments and worm infestations. In 2004, the School Health Education Program (SHEP) unit partnered with local and international agencies to initiate the School Sanitation and Hygiene Education (SSHE) program in 4 of 10 regions. In 2007, SHEP employed WHO's Global School-based Student Health Survey (GSHS) to monitor and evaluate the SSHE program.

Methods: We compared data between the 3 geographic study zones (South, Central and North) on hygiene/sanitation of 6236 junior secondary school students from 75 sample schools. Five questions on hygiene behaviors and sanitation were selected for analysis.

Results: Students in the South were significantly more likely than students in the Central or Northern zones to: 1) report tap water as the source of drinking water at school (64.2% [±1.9], 39.2% [±8.5], and 32.7% [±9.9], respectively); 2) brush teeth 1 or more times per day (92.2% [±1.9], 85.2% [±3.5], and 79.8% [±4.5], respectively); 3) wash hands before eating (95.6% [±1.7], 88.7% [±2.4], and 88.9% [±2.2], respectively); 4) wash hands after using the toilet or latrine (92.7% [±2.3], 85.1% [±3.0], and 85.3% [±2.8], respectively); 5) use soap when washing hands (90.6% [±2.0], 82.7% [±2.9], and 82.2% [±4.0], respectively).

Conclusion: Overall, students in the Southern zone which included 3 of the 4 SSHE regions reported better hygiene behaviors and sanitation than those in the Central and Northern zones. Since positive changes in hygiene/sanitation leads to lower morbidity and mortality, the SSHE should be implemented nationwide.