213315 Development and Impact of a Primary School Handwashing Intervention in Western Kenya

Tuesday, November 10, 2009: 10:30 AM

Janessa M. Graves, MPH , Department of Health Services, School of Public Health, University of Washington, Seattle, WA
William E. Daniell, MD, MPH , Environmental & Occupational Health Sciences, University of Washington, Seattle, WA
Alfredo F. Obure, MPhil , Nyando Integrated Child Health Education (NICHE) project, Kenya Medical Research Institute (KEMRI) / Center for Disease Control (CDC), Kisumu, Kenya
Julie Harris, PhD, MPH , Enteric Diseases Epidemiology Branch, Center for Disease Control and Prevention, Atlanta, GA
Rob Quick, MD, MPH , Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA
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.

Learning Objectives:
1) List the pros and cons of school-based hygiene curriculum.

Keywords: Health Behavior, International

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have spent the past two years researching hand hygiene intervention. I am currently a doctoral student at the University of Washington.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Colgate-Palmolive Research Grant, Hygiene Funded research

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.