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FN1Financial support: Funding for this impact evaluation was provided by Dubai Cares Foundation.
FN2Authors' addresses: Joshua V. Garn, Victoria Trinies, and Matthew C. Freeman, Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, E-mails: email@example.com, firstname.lastname@example.org, and email@example.com. Jérémie Toubkiss, Evaluation Office, The United Nations Children's Fund Headquarter, New York City, NY, E-mail: firstname.lastname@example.org.Notes
Disclaimer: The funder had no involvement in its design, in collection, analysis, or interpretation of the data, or in the preparation of this manuscript.
- The American Society of Tropical Medicine and Hygiene
- Source: The American Journal of Tropical Medicine and Hygiene, Volume 96, Issue 4, Apr 2017, p. 984 - 993
The Role of Adherence on the Impact of a School-Based Water, Sanitation, and Hygiene Intervention in Mali
Studies assessing the impacts of school-based water, sanitation, and hygiene (WASH) interventions have revealed inconsistent improvements in pupils' health and educational outcomes. This may be in part due to suboptimal project fidelity or adherence. As part of a matched-control trial of a comprehensive school-based WASH project in Mali, we measured the degree to which schools met four prespecified WASH targets, comprised of 15 criteria, 0–3 years after program implementation. We compared achievement of the targets and criteria between beneficiary and matched control schools, and compared achievement within beneficiary schools at baseline and at follow-up visits. We assessed the “as-treated” associations between WASH target achievement and pupil diarrhea, respiratory symptoms, and absence. Between 44% and 81% of beneficiary schools achieved each target. Although adherence was inconsistent across schools, beneficiary schools, on average, met more WASH targets than matched control schools, and beneficiary schools also met more WASH targets at follow-up than at baseline. Very few of the targets were individually associated with health and absenteeism outcomes. Increasing achievement of multiple WASH targets together was associated with a lower odds of pupils having diarrhea (P trend < 0.01) and having respiratory symptoms (P trend < 0.01), but was not associated with roll-call absence (P trend = 0.14) or pupil-reported absence (P trend = 0.41). These results indicate that a comprehensive WASH intervention and a focus on increasing adherence may help maximize the health effects of school WASH programs, but that WASH alone might not be sufficient to decrease pupils' absenteeism.