Effect of school-led total sanitation intervention on school attendance among pupils in primary schools within Baringo County, Kenya

Phanice K. Omari; Simon M. Karanja; Susan N. Mambo

doi:10.18203/2394-6040.ijcmph20254417

Authors

Phanice K. Omari School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi Kenya; School of Health Sciences, University of Kabianga, Kericho, Kenya https://orcid.org/0000-0003-0039-3433
Simon M. Karanja School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi Kenya; Digital Health Applied Research Centre (DHARC), Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
Susan N. Mambo School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi Kenya; Digital Health Applied Research Centre (DHARC), Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20254417

Keywords:

Absenteeism, School attendance, School-led total sanitation

Abstract

Background: School attendance critically determines educational outcomes, especially in resource-constrained settings. Poor sanitation and hygiene cause illness-related absenteeism in primary schools. This study evaluated the impact of school-led total sanitation (SLTS) intervention on pupil attendance in Baringo County, Kenya.

Methods: A pre-post quasi-experimental design with non-equivalent control groups was conducted in six primary schools across two sub-counties in Baringo County. Three Mogotio Sub-County schools received SLTS intervention; three Baringo South Sub-County schools served as controls. Using multistage sampling, 440 pupils from grades 4-7 were enrolled. SLTS intervention included health club establishment, triggering, and health education. Data were collected at baseline and post-intervention using questionnaires and headteacher key informant interviews. School attendance was measured as absence in the previous two weeks, with chi-square analysis at p<0.05.

Results: At baseline, absence rates were similar between intervention (22.6%) and control (26.1%) schools (χ²=0.739, p=0.390). At the endline, intervention schools improved to 20.6% absence rates while control schools declined to 28.7%. However, this difference was not statistically significant (χ²=3.823, p=0.051). Illness remained the primary cause of absenteeism across groups (>70%), with no significant differences in illness-related absences or specific conditions, such as diarrhoea and respiratory diseases, between groups. School feeding programs strongly motivated attendance, while cultural practices, gender roles, and environmental factors acted as barriers.

Conclusions: School-led total sanitation intervention did not significantly improve attendance in the study. School absenteeism is multifaceted with multiple contributing factors. While SLTS may create enabling environments, comprehensive approaches addressing multiple absenteeism determinants are needed for meaningful attendance improvements.

Metrics

Metrics Loading ...

References

UNICEF. Primary education. 2022. Available from: https://data.unicef.org/topic/education/primary-education/#. Accessed on 04 September 2025.

UNESCO. Kenya Primary school enrollment, percent of all eligible children. The Global economy. 2019. Available from: https://www.theglobaleconomy.com/Kenya/Primary_school_enrollment/. Accessed on 13 August 2025.

MoE. Basic Education Statistical Booklet 2020. Nairobi, Kenya; 2020. Available from: https://www.education.go.ke/sites/default/files/Docs/The%20Basic%20Education%20Statistical%20Booklet%202020%20(1).pdf. Accessed on 13 August 2025.

Frost B. Water and Sanitation: The Silent Emergency. UN Chronicle. 2007. Available from: https://www.un.org/en/chronicle/article/water-and-sanitation-silent-emergency. Accessed on 4 September 2025.

Sharma MK, Adhikari R, Khanal SP, Acharya D, van Teijlingen E. Do school water, sanitation, and hygiene facilities affect students’ health status, attendance, and educational achievements? A qualitative study in Nepal. Health Sci Rep. 2024;7(8):e2293. DOI: https://doi.org/10.1002/hsr2.2293

Vally H, McMichael C, Doherty C, Li X, Guevarra G, Tobias P. The impact of a school-based water, sanitation and hygiene intervention on knowledge, practices, and diarrhoea rates in the Philippines. Int J Environ Res Public Health. 2019;16(21). DOI: https://doi.org/10.3390/ijerph16214056

Trinies V, Garn JV, Chang HH, Freeman MC. The impact of a school-based water, sanitation, and hygiene program on absenteeism, diarrhea, and respiratory infection: a matched-control trial in Mali. Am J Trop Med Hyg. 2016;94(6):1418-25. DOI: https://doi.org/10.4269/ajtmh.15-0757

Bick S, Ezezew A, Opondo C, Leurent B, Argaw W, Hunter EC, et al. Impact of a school-based water and hygiene intervention on child health and school attendance in Addis Ababa, Ethiopia: a cluster-randomised controlled trial. BMC Med. 2024;22(1):348. DOI: https://doi.org/10.1186/s12916-024-03558-x

UNICEF. School-Led Total Sanitation: School Facilitator Training Guide. 2014. Available from: https://archive.ids.ac.uk/clts/sites/communityledtotalsanitation.org/files/SLTS_Handbook_Malawi.pdf. Accessed on 04 September 2025.

Baringo County. Baringo County Integrated Development plan (2023-2027). 2023. Available from: https://www.baringo.go.ke/resource/cidp-2023-2027-full/?tk=OTYxNQ==. Accessed on 4 September 2025.

Sontakki B, Venkatesan P, Rao VKJ. Participatory rural appraisal (PRA): tools and techniques. A training manual for the IFS probationers published by ICAR and ICAR-NAARM, Hyderabad; 2019.

Chard AN, Garn JV, Chang HH, Clasen T, Freeman MC. Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: Results from the WASH HELPS cluster-randomized trial. J Glob Health. 2019;9(2). DOI: https://doi.org/10.7189/jogh.09.020402

Garn JV, Trinies V, Toubkiss J, Freeman MC. The role of adherence on the impact of a school-based water, sanitation, and hygiene intervention in Mali. Am J Trop Med Hyg. 2017;96(4):984-93. DOI: https://doi.org/10.4269/ajtmh.16-0558

Munn Z, Tufanaru C, Lockwood C, Stern C, McAneney H, Barker TH. Rinse‐free hand wash for reducing absenteeism among preschool and school children. Cochrane Database Syst Rev. 2020(4). DOI: https://doi.org/10.1002/14651858.CD012566.pub2

Bowen A, Ma H, Ou J, Billhimer W, Long T, Mintz E, et al. A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools. Am J Trop Med Hyg. 2007;76(6):1166-73. DOI: https://doi.org/10.4269/ajtmh.2007.76.1166

Pijl EK, Vanneste YTM, de Rijk AE, Feron FJM, Mathijssen J. The prevalence of sickness absence among primary school pupils- reason to be worried? BMC Public Health. 2021;21(1):1-8. DOI: https://doi.org/10.1186/s12889-021-10193-1