Kenya (2013): Evaluation study measuring handwashing with soap among primary school children in Coast Province.

Each year, an estimated 2.5 billion cases of diarrhea occur among children under five years of age, and estimates suggest that overall incidence has remained relatively stable over the past two decades In Kenya, awareness about the importance of hand washing with soap is high, while awareness about the relationship between hand washing with soap and disease is weak. School going children have often been used as agents of change based on the premise that they are able to use new learnt knowledge to adopt habits. Unilever Foundation selected Population Services International (PSI) to implement a global partnership around water, sanitation and hygiene. The aim of this study was to generate credible evidence that would help assess the impact of hand washing and hygiene interventions carried out by PSI-Kenya and partners in five districts in Coast province. Study design: This report combines two different surveys, an Endline survey among a select 9 schools and a Baseline survey among an expanded sample of 70 schools in 4 more districts in Mombasa and Kilifi counties. The two counties have a total of 559 schools. The study adopted a descriptive cross-sectional design using 5 different tools to collect data from different target groups. Results: There was a signific ant improvement in hand washing with soap and water between Baseline and Endline surveys in all school types among the initial sample of 9 schools in Likoni district. Between the two survey periods, there was a notable fall in number of children bringing soap from home and an increase in the number of children who reported availability of soap at the hand washing area/ toilet. There was no major shift in hand washing behavior among pupils at home. However, there was a 51% increase in the number of pupils reporting washing hands at all five main occasions. There was a slight increase in pupils' membership to health/hygiene clubs, mainly contributed by a 135% rise among special school pupils. There was a shift from parents to teacher with respect to influences to hand washing between the two survey periods, while awareness of school of five grew by about 65 percentage points. Most of the Baseline indicators in the expanded program resembled those of the initially sampled 9 schools at baseline. Reported hand washing remained high but observed hand washing was very low, with observed hand washing with soap and water remaining as low as 4% of all sampled pupils. Hand washing on all five occasions remained below 10% in all school types. Membership to health/hygiene clubs was low at 5% of all sampled pupils. Mothers formed a greater influence on pupils' hand washing behavior, just like in Likoni Baseline, while awareness of the school of five programme was at 4%. Conclusions and policy recommendations: There is a very clear improvement in hand washing behavior in all schools where interventions were carried out in the Coast province. This gives hope that the expanded program will improve hand washing as a major step towards reduction of mortality due to diarrheal diseases. A major contributing factor of this low hand washing practice could be the minimal presence of soap in the toilets in all the sampled schools. The findings of this study support the need for strengthened school health clubs in all schools, expansion of school values and life skills training, increases focus on both quality and quantity toilet facilities in schools, availing soap at hand washing areas, and the need for household involvement in creating long-lasting influence on hand washing behavior among pupils.