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Evaluación del impacto de un programa sanitario, de higiene y de tratamiento del agua en las escuelas sobre el ausentismo escolar en la Provincia de Nyanza, Kenia: ensayo aleatorizado por conglomerados
Author(s) -
Freeman Matthew C.,
Greene Leslie E.,
Dreibelbis Robert,
Saboori Shadi,
Muga Richard,
Brumback Babette,
Rheingans Richard
Publication year - 2012
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2011.02927.x
Subject(s) - sanitation , hygiene , medicine , environmental health , randomized controlled trial , cluster randomised controlled trial , public health , psychological intervention , attendance , population , odds , cluster (spacecraft) , socioeconomics , logistic regression , nursing , surgery , economic growth , computer science , programming language , pathology , sociology , economics
Objectives There has been increased attention to access to water, sanitation and hygiene (WASH) at schools in developing countries, but a dearth of empirical studies on the impact. We conducted a cluster‐randomized trial of school‐based WASH on pupil absence in Nyanza Province, Kenya, from 2007 to 2008. Methods Public primary schools nested in three geographical strata were randomly assigned and allocated to one of three study arms [water treatment and hygiene promotion (WT & HP), additional sanitation improvement, or control] to assess the effects on pupil absence at 2‐year follow‐up. Results We found no overall effect of the intervention on absence. However, among schools in two of the geographical areas not affected by post‐election violence, those that received WT and HP showed a 58% reduction in the odds of absence for girls (OR 0.42, CI 0.21–0.85). In the same strata, sanitation improvement in combination with WT and HP resulted in a comparable drop in absence, although results were marginally significant (OR 0.47, 0.21–1.05). Boys were not impacted by the intervention. Conclusion School WASH improvements can improve school attendance for girls, and mechanisms for gendered impacts should be explored. Incomplete intervention compliance highlights the challenges of achieving consistent results across all settings.