The status of water access, sanitation, and hygiene in schools: a cross sectional survey to identify capacities and assess coverage in Garoua, North Cameroon

Abstract
There has been an increasing global interest in understanding, documenting, and monitoring water, sanitation, and hygiene (WASH) services in schools. This study is the first to identify existing WASH-in-school capacities and understand the magnitude of the gaps in WASH coverage in schools in the Northern Cameroon. Using a cross-sectional design, relevant authorities of 176 schools in Garoua, were interviewed. The survey guide included core questions for monitoring WASH in schools from recommended guidelines. Eleven indicators-related variables were extracted from data to calculate the WASH-in-school indicators composite score. Eighteen schools (10.2%) didn’t have any existing drinking water supply infrastructure. Latrine facilities were existing in most of the included schools, the boy students-to-latrine ratio=77:1 and girl students-to-latrine ratio=76:1 remained very high compared to the WHO norms. Two-thirds of schools accessed all the three most basic WASH services. The WASH-in-schools indicators composite score ranged from 3-11, with a mean of 10.08±1.61 and private schools were more likely to have a high total score (p=0.014). The WASH-in-school composite score provides an assessment of the spatial dimensions of reduced access to water in schools, improper hygiene practices, and inadequate sanitation facilities. Such a score could be used to identify hotspots lacking WASH infrastructural facilities and strategize optimal interventions to reduce the incidence of WASH related diseases in schools.