Contribution of household and school water, sanitation, and hygiene (WASH) to primary school absenteeism in Kenya

Background: Improvements in school water, sanitation, and hygiene (WASH) are often proposed as key interventions to improve school attendance and educational attainment in the developing world, yet large-scale, representative surveys examining the contribution of household and school WASH to reported absenteeism are rare.

Methods: Data on absenteeism in the previous two weeks for over 8,000 primary school-aged children in 183 communities in Nyanza Province, Kenya, included in a community-randomized trial of school-based WASH interventions. Adjusted odds ratios for recent absenteeism were calculated using multilevel logistic regression models with random effects included at both the community and household level.

Results: At the household level, presence of a latrine and the use of soap during handwashing demonstrations were associated with reduced absenteeism (ORs 0.72 and 0.63, respectively, p<0.05). Increased odds of recent absenteeism were associated with children's involvement in water collection (OR 1.77, p<0.05) and for increased distance to the household's primary water source. At the school level, only the cleanliness and structural integrity of school latrines were associated with reduced odds of recent absenteeism (ORs 0.54 and 0.62, respectively). Household wealth quintile and pupil's gender significantly modified the effect of school and household WASH characteristics on recent absenteeism.

Conclusion: Improvements in the quality of school sanitation may have a greater effect on absenteeism and educational attainment than improvements in sanitation quantity. Improvements in school WASH may also require commensurate improvements in household WASH in order to result in significant reductions in absenteeism.