209355 Contribution of household and school water, sanitation, and hygiene (WASH) to primary school absenteeism in Kenya

Monday, November 9, 2009: 11:24 AM

Rick Rheingans, PhD , Hubert Global Health, Emory University, Atlanta, GA
Robert Dreibelbis, MPH , Hubert Global Health, Emory University, Atlanta, GA
Matthew Freeman, MPH , Hubert Department of Global Health, Emory University, Atlanta, GA
Shadi Saboori, BA , Hubert Department of Global Health, Emory University, Atlanta, GA
Leslie Greene, MPH , Hubert Global Health, Emory University, Atlanta, GA
April Davies, MPH , Hubert Global Health, Emory University, Atlanta, GA
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.

Learning Objectives:
- Describe the relationships between school and community water, sanitation, and hygiene (WASH) and recent absenteeism among primary school-aged children. - Discuss the implications for policy and programs related to school WASH.

Keywords: Water, Adolescent Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Primary analyst and contributing author.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.