The Impact of a School-based WASH Intervention on Child Health and School Attendance in Addis Ababa, Ethiopia
Condition: Diarrhea; Respiratory Tract Infections; Absenteeism
MeSH terms: Respiratory Tract Infections; Diarrhea
Study type: Interventional

Summary: 
      This study aims to assess the effects of school-based, comprehensive water, sanitation, and
      hygiene improvements on child health and educational outcomes in schools in Addis Ababa,
      Ethiopia. Eligible schools will be randomly allocated to intervention or control groups. Data
      on pupil absence and illness will be collected longitudinally from students in selected
      classrooms in each school over the course of one academic year (2021/2022). This study will
      also assess the effects of the intervention on kindergarten students through parent
      interviews.
    

Detailed description: 
      This study uses a cluster-randomised controlled trial design to evaluate the impact of the
      WASH in Schools for Everyone (WISE) programme. Project WISE, implemented by Splash, aims to
      improve child health and attendance by 1) improving WASH infrastructure, 2) promoting WASH
      behaviour change and 3) strengthening menstrual hygiene management (MHM) services targeting
      girls aged 10 and above, in public schools across Addis Ababa.

      60 public schools from planned implementation groups that will receive the WISE intervention
      will be randomised: 30 schools will be allocated to the intervention group (to receive the
      WISE intervention during the 2021/2022 academic year) and 30 schools will be allocated to the
      control group (on a waitlist to receive the WISE intervention after study completion).
      Randomisation will be stratified by school size (number of students) and presence of a
      kindergarten. In each selected school, between two and four classes will be randomly selected
      from grades 2-8 - to obtain a sample size of approximately 100 students in total per school.
      Students in the selected classes will be enrolled at the start of the academic year
      (September 2021) and followed up with unannounced visits every 4-6 weeks until the end of the
      academic year (May 2022). Primary outcomes of pupil-reported illness and absence will be
      assessed during enrolment and at each follow-up visit. Secondary outcomes are restricted to
      subsets of students by age and gender, and will be assessed during the final follow-up visit.
      Students joining the class mid-way through the year will be enrolled in the study, and
      students who leave the class will be recorded.

      Key outcomes of interest are longitudinal prevalence of absence and illness (diarrhoea and
      respiratory infection) over the course of the academic year, measured as cumulative number of
      days absent/with illness per 100 school days after adjustment for child- and school-specific
      covariates. Data collected in intervention schools prior to and/or during the active Splash
      intervention will not be included in the primary impact evaluation analysis. Sub-population
      analysis of evaluation outcomes in girls post-menarche will allow assessment of the gendered
      effects of the intervention. We will also monitor intervention fidelity and compliance, as
      well as cost-effectiveness of the intervention, through routine data collection with students
      and school staff.

      40 public schools with a kindergarten will be enrolled to assess the impacts of the
      intervention among kindergarten students (20 intervention, 20 control). Schools enrolled in
      the intervention and control arms of the main study among older children that have a
      kindergarten will be also enrolled in the kindergarten evaluation. If there are fewer than 20
      such schools in each arm, additional kindergarten schools will be randomised (estimated 10
      additional schools per arm). In each selected school, 20 kindergarten students will be
      randomly selected for participation. Parents of selected students will be invited to
      participate in weekly telephone surveys over a four-week period in February/March 2022 in
      order to assess the longitudinal prevalence of illness and absence among kindergarteners.
    

Intervention name(s): Splash WASH in Schools programme (Project WISE)
Intervention type(s): Other
Intervention description(s): The Project WISE intervention includes:
WASH infrastructure
Water storage tanks and water filtration systems
Durable plastic drinking water and handwashing stations
New/rehabilitated toilet facilities (gender-segregated, wheelchair-accessible, well-lit, ventilated, durable door and lock)
Behaviour change promotion
Training of focal teachers to organise student 'hygiene club'
Annual soap drive and soap restocking
Behavioural 'nudges' (posters and mirrors at handwashing stations, colourful vests for hygiene clubs)
MHM services
Toilets have water tap, bucket and waste bin
Emergency menstrual hygiene products available at school
Training of focal teachers to organise student 'gender club'
Education on puberty and menstruation for all pupils above 10 and parent resource guide
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: water; sanitation; hygiene; schoolchildren; WASH in schools