When drinking water, sanitation, and hygiene conditions are improved at primary schools in rural Western Kenya, more girls say 'HERE' at roll call. School conditions in Kenya are particularly dire. Although the recent policy to let all children attend primary school for free has increased the number of children in schools, the infrastructure has not been able to keep up. The latrine conditions are particularly bad, and safe water for drinking and washing hands is not always available.
A study involving 135 schools was carried out between 2007 and 2009. Ninety of those schools received improvements in the form of water treatment, hygiene promotion (lessons about hand-washing), and new latrines. Forty-five schools did not receive the improvements, and the researchers compared the schools over time to see if there were any differences. The researchers of this study expected that improving conditions would result in decreased absenteeism for all students.
But that was not the case. There was no reduction in absenteeism for boys. However, great reductions in absenteeism were seen among the girls students.
So what does this all mean? Well that is hard to answer. In an interview with one of the lead authors, Dr. Matthew Freeman, even he asks "Why did this intervention, these improvements, really impact girls but not boys?" He answers that "this raises question for further studies and further exploration of what components really made a difference for girls."
The results of this study, Dr. Freeman noted, can be used to advocate for and justify increased spending on water, sanitation and hygiene in schools. Further, he notes that quality matters. In order for these improvements to have a lasting effect, they need to be maintained over time.
So what about the schools that did not get the improvements at the start of the study? Is it ethically ok to not give them anything? Dr. Freeman added that the schools that did not initially get the improvements received them at the end of the study.
Footage from the interview is posted here.
To Learn more:
Freeman, M. C., L. E. Greene, et al. (In Press). "Assessing the impact of a school-based water treatment, hygiene and sanitation programme on a pupil absence in Nyanza Province, Kenya: a cluster-randomized trial." Tropical Medicine and International Health.
Interesting finding but I feel that there is no conclusion and that is what interested me enough to read the blog. Maybe the study isn't finished? I feel like I'm missing a couple of paragraphs explaining HOW the students were taught about this upgrades in their school and their importance. Maybe they weren't taught and that's the problem.
ReplyDelete(Posted for a friend who couldn't sign in)
ReplyDeleteImproving drinking water and hygeine - especially for children - is so important; thank you for the interesting synopsis! I am curious about what the author thinks about why there was an improvement in absenteeism among boys but not girls? Perhaps consider that boys have a better understanding about how to use these new facilities (e.g., they were provided different/more education about these resources, either formally or informally) or the facilities themselves were more male-oriented? Were the facilities for the boys better maintained over time?
- Ashli Owen-Smith, PhD (friend of Dr. Freedman's from graduate school)
Thanks for the feedback. I would like to answer issues raised.
ReplyDeleteTo Doda:
Great points. As part of the trial, school health patrons and head teachers (like a principal of a school in the US) were trained in the importance of these interventions. They were also taught to start school health clubs. In these clubs, students become members and learn about water, sanitation and hygiene issues, as well as other relevant health issues, and are then peer educators. The study itself goes into this a bit more.
In addition, this was an 'effectiveness' trial. This means that the study conditions were tested in real-life conditions with real-life limitations. The researchers implemented a relatively hands-off intervention (one that taught teachers and had teachers teach students) because that would be the most likely way it would be repeated in the future by local public health and education ministry officials.
Finally, yes there are more questions. The point of this trial simply was to see if there was an impact, specifically a change in absenteeism as a result of having the intervention. Later studies carried out by the research team attempted to get at these 'How' questions. Getting answers to the 'how' questions could potentially improve the intervention.
To Ashli:
Just to clarify, the reduction in absenteeism was for girls, not boys. So, the improvement was for girls.
The reasons for the improvement for girls remain unclear. One follow-on study, simply a qualitative study, investigated how girl students handle menstruation in school. Menstrual hygiene management in a school may be difficult, and these improvements may help (latrines for privacy, hand-washing stations for cleaning after changing). A paper investigating menstruation challenges for girls in the study schools can be found here: http://www.biomedcentral.com/1472-698X/11/7.
Another speculation is that the improvements may have decreased the spread of pathogens, or germs, from schools to the home. And, behaviors in the home, like hand washing, may also have improved. Reductions in germs at home may lead to reductions in illness.Traditionally, if a young child is in the home and gets sick, it may be the girls who would take care of them. If there was reduced sickness at home, girls may miss less school. The question of whether or not there was improved health at the homes is currently being investigated currently.
Finally, your question about the facilities themselves is also important. Maintenance of the facilities is difficult in low-resource settings since soap and brooms and such are not provided or even funded. I do not expect a different impact on absenteeism due to conditions because there are not enough resources to clean any thoroughly. In addition, girls traditionally have the job of cleaning, so if they were to clean, if even with sticks, I do not expect they would do a hasty job on their own latrines and a better job on the boy's latrines. A later trial investigating conditions followed and results are still emerging. Additionally, qualitative papers investigating latrine use and cleaning papers should be finished shortly. Please be in touch if you would like me to forward them along when complete.
If questions remain, please feel free to ask.
I think the comments above cover my own questions - I was attracted to this article, honestly, b/c of the title. It's catchy, but informative. While I like that it's succinct, I was also left wanting more. I almost think 1-2 more sentences on the possible links on girls vs boys would have been enough. The comments you provided were really helpful - figuring out a way to summarize 2-3 of the possible 'causes' in the actual blog would be great. In my experience, readers want to know WHY, but they want it in short soundbytes.
ReplyDeleteGreat read!
~Kiran/Ariela's former student and perpetual mentee
This was really interesting to read – but left me curious about the differences seen with boys and girls. I wonder if there are other reasons (unrelated to water quality, sanitation, and hygiene) that keep the boys from school. I wanted to know more about these communities in rural western Kenya. Do you have any thoughts about further research that might be done to tease out the differences seen?
ReplyDeleteI was also interested in Dr. Freeman’s conclusion that “the results of this study… can be used to advocate for and justify increased spending on water, sanitation and hygiene in schools” because this followed a sentence that said there was no absenteeism reduction for the boys.
I’m glad you touched on the ethics of the study – and let us know that everyone get improvements in the end!
Nice job conveying this information.
- Moose Alperin
(CMPH Chair; BSHE Faculty)
I loved watching the actual interview (and seeing Dr. Freeman work to couch this in real-people language)! : )
ReplyDeleteLike Doda, I'd like to hear more about how this actually worked/what it looked like. If you were going to go back and do more in-depth qualitative work on this, what might you look at? What would you ask the girls and the boys if you could sit down and talk with them? Also, is observational research ethical in this situation? : )
Catchy picture as well!
I like this post, it is very clear and very interesting. The study was very well stated and very easy to understand. I think a lay person can understand it.
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