Trial reportEpidemiology (Cambridge, Mass.)2016
Estimating the Effect of School Water, Sanitation, and Hygiene Improvements on Pupil Health Outcomes.
Trial report in Epidemiology (Cambridge, Mass.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 4 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- Interventions to improve sanitation for preventing diarrhoea.The Cochrane database of systematic reviews · 2023Pooled it
- Interventions to improve water, sanitation, and hygiene for preventing soil-transmitted helminth infection.The Cochrane database of systematic reviews · 2022Pooled it
- Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection.The Cochrane database of systematic reviews · 2019Pooled it
- Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact.International journal of environmental research and public health · 2019Pooled it
- The impact of an operation and management intervention on toilet usability in schools in the Philippines: a cluster randomised controlled trial.BMC public health · 2019Trial
- 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.Journal of global health · 2019Trial
- The impact of school water, sanitation, and hygiene improvements on infectious disease using serum antibody detection.PLoS neglected tropical diseases · 2018Trial
- Design, Intervention Fidelity, and Behavioral Outcomes of a School-Based Water, Sanitation, and Hygiene Cluster-Randomized Trial in Laos.International journal of environmental research and public health · 2018Trial
- Evaluating the outcomes of a school-based intervention on water, sanitation, and hygiene practices in urban slums of Nigeria: a qualitative evaluation based on implementation research outcome frameworks.BMC public health · 2026Article
- Effectiveness of the newly designed WASH implementation strategy on WASH practices, diarrheal diseases, respiratory illness, and absenteeism among ashram school children.Journal of family medicine and primary care · 2025Article
- Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies.Campbell systematic reviews · 2021Article
- Article
- The associations between water and sanitation and hookworm infection using cross-sectional data from Togo's national deworming program.PLoS neglected tropical diseases · 2018Article
- Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d'Ivoire.Parasites & vectors · 2018Article
- Re: Estimating the Effect of School Water, Sanitation, and Hygiene Improvements on Pupil Health Outcomes.Epidemiology (Cambridge, Mass.) · 2017Article
- The Role of Adherence on the Impact of a School-Based Water, Sanitation, and Hygiene Intervention in Mali.The American journal of tropical medicine and hygiene · 2017Article
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundWe conducted a cluster-randomized water, sanitation, and hygiene trial in 185 schools in Nyanza province, Kenya. The trial, however, had imperfect school-level adherence at many schools. The primary goal of this study was to estimate the causal effects of school-level adherence to interventions on pupil diarrhea and soil-transmitted helminth infection.
methodsSchools were divided into water availability groups, which were then randomized separately into either water, sanitation, and hygiene intervention arms or a control arm. School-level adherence to the intervention was defined by the number of intervention components-water, latrines, soap-that had been adequately implemented. The outcomes of interest were pupil diarrhea and soil-transmitted helminth infection. We used a weighted generalized structural nested model to calculate prevalence ratio.
resultsIn the water-scarce group, there was evidence of a reduced prevalence of diarrhea among pupils attending schools that adhered to two or to three intervention components (prevalence ratio = 0.28, 95% confidence interval: 0.10, 0.75), compared with what the prevalence would have been had the same schools instead adhered to zero components or one. In the water-available group, there was no evidence of reduced diarrhea with better adherence. For the soil-transmitted helminth infection and intensity outcomes, we often observed point estimates in the preventive direction with increasing intervention adherence, but primarily among girls, and the confidence intervals were often very wide.
conclusionsOur instrumental variable point estimates sometimes suggested protective effects with increased water, sanitation, and hygiene intervention adherence, although many of the estimates were imprecise.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.