Importance of School Sanitation Programs

Introduction

In many countries there exists a high prevalence of water and sanitation related diseases, causing many people, children in particular, to fall ill or even die. Improved hygiene practices are essential if transmission routes of water and sanitation related diseases are to be cut. Whereas appropriate hygiene education can bring about the intention to change hygiene behaviour, for most hygiene behaviours appropriate water and sanitation facilities are needed to allow people to transform intention to change into real change.

Why is it important to focus on schools?

After the family, schools are most important places of learning for children; they have a central place in the community. Schools are a stimulating learning environment for children and stimulate or initiate change. If sanitary facilities in schools are available, they can act as a model, and teachers can function as role models. Schools can also influence communities through outreach activities, since through their students, schools are in touch with a large proportion of the households in a community.

Links to Full-Text Reports

Bringing Together Health and Education for Schools – USAID, 1998

Manual on School Sanitation and Hygiene. IRC/UNICEF, 1998.

Nigeria: Water and Environmental Sanitation in Schools M. Kamfut. UNICEF, 1998.

School Sanitation in Primary Schools in Vietnam – UNICEF WATERfront, 1996.

PUBMED Bibliography

1 : S Afr Med J 1999 Mar;89(3):273-9Helminth control as an entry point for health-promoting schools in KwaZulu-Natal.

Taylor M, Coovadia HM, Kvalsvig JD, Jinabhai CC, Reddy P

Department of Community Health, University of Natal.

OBJECTIVES: To use a health promotion model to investigate the risk factors (predisposing, enabling and reinforcing) for geohelminth and schistosomiasis infections, in order to develop and implement effective intervention strategies. DESIGN: Phase 1: Qualitative study using focus group discussions (FGDs) with parents, pupils and teachers; and interviews with health workers. Phase 2: Quantitative study using a semi-structured questionnaire to investigate whether the determinants identified in phase 1 were generalisable. SETTING: Rural primary schools in Vulamehlo magisterial district, southern KwaZulu-Natal. STUDY POPULATION: Qualitative study: 9 schools with 179 pupils, 93 parents and 82 teachers; and local clinics (4 fixed, 1 mobile), with 7 professional nurses. Quantitative study: 2 other schools, with 730 pupils. RESULTS: Predisposing factors: Respondents were familiar with symptoms, but did not know the cause or mode of transmission of helminth infections. Many respondents perceived food to be the cause of geohelminth infection and swimming in the river to be the cause of schistosomiasis. Although 649 (88.9%) pupils had toilets at home and at school, only 218 (29.9%) were motivated to ‘always’ use the toilet for faecal disposal (rural communities previously did not have toilets). Six hundred and seventy-eight pupils (92.9%) understood that it was necessary to wash their hands after using the toilet, but many schools lacked water. Personal cleanliness was a problem despite the emphasis on hygiene by health workers and teachers. Few pupils admitted to eating soil, but it was agreed that geophagia affected young children between the ages of 8 months and 6 years. Enabling factors (positive/negative): Barriers to health promotion frequently included inadequate toilet facilities at school and home, and river-water contact resulting from a lack of clean water. A dearth of recreational facilities resulted in children swimming and playing in the river. Positive factors were the health-seeking behaviour of the majority of the target group, who identified helminth infections as a health problem and sought treatment. Parents and pupils in the FGDs unanimously supported health education and 655 (89.8%) questionnaire respondents indicated that they wished to learn how to avoid helminth infections. CONCLUSIONS: Although the Government strategy is to provide clean water and adequate sanitation, provision of services does not necessarily ensure usage. A comprehensive approach to health promotion is required and the complementary development of the ‘health-promoting school’ would support, reinforce and sustain a helminth control programme.

2 : Health Policy Plan 1998 Sep;13(3):263-76Enhancing health programme efficiency: a Cambodian case study.

Stuer F

Cambodian Urban Health Care Association, Phnom Penh, Cambodia.

In 1995, the Cambodian Urban Health Care Association (CUHCA) was set up as facilitator between private health care providers and patients, guaranteeing good quality health care and fair pricing to patients and providing training and logistic support to providers. Providers were engaged on a fee-for-service basis and competition encouraged. CUHCA’s objectives followed the same line of thought as the 1993 World Development Report, aiming at influencing the unregulated private health care market through competition mechanisms. But soon after the start of the project the basic problem was recognized to be not the absence of effective government regulation but rather that consumers lack the requisite knowledge to make good choices in the market for health services. CUHCA had not adequately addressed the demand for health services. The original supply-side strategy of improving health services by increasing competition was a failure. In order to improve CUHCA’s health programme efficiency the association’s objectives were subsequently redefined and its functioning reorganized. CUHCA now tries to educate consumers and provides good quality services so that consumers will be able to act on the basis of their newly acquired knowledge. CUHCA’s health centres serve as model clinics for first-line health care. Community educators organize information, education and communication (IEC) activities. Staff help school teachers to improve formal health education in schools and CUHCA assists local leaders in sanitation development. Only full-time personnel are employed, encouraging team spirit and communication with the target population. Salaries are based on team performance. The CUHCA programme demonstrates that, depending on the market situation, health programme models need to address both the supply and the demand for services in order to be efficient. Where consumers lack essential knowledge to make appropriate choices in the health service market, interventions should focus on health education and social marketing and provide models of quality care catering to informed consumer choice.

PUBMED Bibliography
(continued)

3 : Rev Inst Med Trop Sao Paulo 1993 Nov-Dec;35(6):573-9[Health education in 1st grade public schools at the periphery of Belo Horizonte, MG, Brazil. II. Knowledge, opinion and prevalence of helminthiasis among students and teachers].

Dos Santos MG, Moreira MM, Malaquias ML, Schall VT

Laboratorio de Esquistossomose, Centro de Pesquisas Rene Rachou, Fundacao Oswaldo Cruz, Belo Horizonte-MG, Brasil.

As part of a wide ranging project concerning education and health, aiming both to update and develop new materials and methods for 1st Grade schools, the present study investigated the state of knowledge and prevalence of helminthic diseases in school populations. Interviews and parasitological exams undertaken in four schools (two experimental and two controls) on the outskirts of Belo Horizonte showed: a. that both teachers and pupils have little information concerning helminthic diseases as well as incorrect notions and ignorance of the mechanisms of transmission; b. high prevalence in the school: 69.0% and 76.0% (Bairro Gorduras) and 46.0% and 24.0% (Vale do Jatoba and Barreiro de Cima) in the first year of study (1988).

Comparing the four schools, there is a direct relationship between the living conditions of the pupils and the indices of prevalence. Considering the fact that such helminthic diseases are known to have been present for a long time, it is a striking how removed the school is from the problems and realities of its pupils.

4 : Rev Inst Med Trop Sao Paulo 1993 Nov-Dec;35(6):563-72[Health education in 1st grade public schools at the periphery of Belo Horizonte, MG, Brazil. I. Evaluation of the program relative to schistosomiasis].

Schall VT, Dias AG, Malaquias ML, Dos Santos MG

Departamento de Biologia, IOC, FIOCRUZ, Rio de Janeiro, Brasil.

A project has been developed with the objective of implanting and testing new materials and methodologies related to health education in first level schools. The present study is being performed in 4 public schools of a periferic area of Belo Horizonte, in two regions, one of high and another of low prevalence of schistosomiasis. The experimental design includes 2 experimental schools and 2 of control. The procedure involves interviews with teachers and students before and after the experimental test of the new materials; stool surveys and treatment of the sample of students. The results of the first interviews demonstrated that the knowledge of schistosomiasis is almost absent among teachers and students, although the prevalence of this disease has been maintained for a long time (70 years) in one of the regions studied (Gorduras). Out of 3131 students of the 4 schools, 67.5% were examined and 235 (11.0%) were tested positively. When the new students of 1989 were not included the prevalence decrease to 9.0% demonstrating a significative difference (X2 – 5%) in relation to 1988, showing the consequence of the treatment performed. Comparing the 2 schools of high prevalence, the decrease of prevalence of the experimental one is higher than the control. Therefore, in relation to the schools of low prevalence, the same has not happened. Thus, it is only possible to suggest an initial effect of the educative strategy and the decreases of the prevalence in the schools of high prevalence. In relation to the knowledge about the disease transmission, the students from the experimental schools presented a significative increase of correct answers in 1989 than the control ones.

5 : Cent Afr J Med 1991 Mar;37(3):69-77

Community control of schistosomiasis in Zimbabwe.

Chandiwana SK, Taylor P, Matanhire D

Blair Research Laboratory, Causeway, Harare, Zimbabwe.

The community-based primary health care approach to control schistosomiasis morbidity is the strategy adopted in Zimbabwe. The paper outlines the results of such a control strategy in a rural community with over 30,000 people in the Madziwa area of Zimbabwe from 1985 to 1989. The community-based control strategy involved diagnosis of infection in school children (seven-15 years of age) using reagent strips followed by treatment with praziquantel. The treatment was linked to programmes aimed at improved sanitation, better water supplies and health education. Following chemotherapy, there was a marked reduction in schistosomiasis prevalence (urinary and intestinal forms combined) (from 60 to 20pc) in the affected groups. Of even greater importance was the significant reduction of 90pc in heavy infections (greater than 50 S. haematobium eggs per 10 ml of urine of greater than 100 S. mansoni eggs per gram of faeces). Progress made through chemotherapy was consolidated by the implementation of intervention measures aimed at reducing human water contact with cercariae infested water. In the last three years of the community-based programme, 2,152 improved ventilated pit latrines were constructed and 104 hand pumps installed at new or existing water points. Drama competitions at schools showed great potential in communicating health education messages. However, technical and organisational difficulties limited the impact of the health education to the general population. A single application of the synthetic molluscicide Bayluscide was carried out in the main streams at the beginning of the programme in support of the initial chemotherapy.

6 : Mem Inst Oswaldo Cruz 1987;82 Suppl 4:285-92Health education for children in the control of schistosomiasis.

Schall VT

Instituto Oswaldo Cruz, Departamento de Biologia, Rio de Janeiro, Brasil.

Health education for children is an important measure in the control of schistosomiasis especially considering the characteristics of the disease during childhood, such as high prevalence, high percent of treatment resistance, high rates of egg elimination and high level of reinfection, as reported in studies conducted in endemic areas. All of these facts indicate that children play a role in the maintenance and transmission of schistosomiasis. Historically in Brazil, Health Education concerning the major Brazilian endemies consists of a kind of vertical, interventionist and temporary action. An alternative would be to create a permanent health education process by assigning health education teachers to elementary schools. This would require expansion and improvement of teacher training and the development of programs taking into account: 1) the cognitive aspects of the child, the child’s perception of reality and of the health/illness process; 2) the adaptation of instruction means and materials to the age group; 3) a “pedagogy of liberation” approach emphasizing the possibility of transforming life conditions since schistosomiasis is related to the lack of public services such as basic sanitation and clean domestic water supply.