Development and Impact of a Primary School Handwashing Intervention in Western Kenya

Diarrhea, malaria, and infectious diseases cause half of morbidity and one-quarter of mortality in Kenyan children <5yo. Handwashing with soap significantly reduces morbidity due to diarrheal and respiratory infections. The Nyando Integrated Child Health and Education (NICHE) Project is a collaborative effort by the CDC and local partners to assess the effectiveness of multiple interventions for improving child survival in an impoverished rural district of western Kenya. To improve handwashing behavior in schoolchildren, NICHE trained teachers and installed handwashing stations with soap in 51 primary schools. We conducted a cluster-randomized trial of the impact of a handwashing poster contest on handwashing behavior in 23 NICHE primary schools (range 170 to 793 pupils per school). We randomly assigned 11 schools to participate in the contest and 12 schools as controls. We observed pupil handwashing behavior at baseline in June 2008, implemented the poster contest in October 2008, and conducted follow-up observations in March 2009. At baseline, approximately three-quarters of pupils observed in all schools washed hands after using the latrine, when water was available (no significant difference between intervention and comparison schools). Follow-up observations failed to show a significant effect; 67.4% of pupils in comparison schools and 76.6% of pupils in intervention schools washed hands after using the latrine, when water was available. Lack of water due to drought posed a substantial problem for the schools. This study illustrates the feasibility of adopting a handwashing promotion intervention in a resource poor setting, but provides no evidence for or against effectiveness.