ArticleBMC public health2021
The potential of school-based WASH programming to support children as agents of change in rural Zambian households.
Article in BMC public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 19 citations in OpenAlex.
- A cluster-randomised controlled equivalence trial of the Surprise Soap handwashing intervention among older children living in a refugee settlement in Sudan.BMJ global health · 2023Trial
- Evaluating the acceptability of a portable handwashing intervention (the Spatap) in three Fijian communities, a mixed-methods study.BMC public health · 2026Article
- Household Water and Handwashing Facilities and Early Childhood Education Participation in Nepal: Evidence From a Nationally Representative Cross-Sectional Survey.Health science reports · 2026Article
- Train-the-trainer model in public health practice: Feasibility of senior nursing students as catalysts for hand hygiene education in school-aged children.Journal of family medicine and primary care · 2026Article
- Intimate partner violence and the dual burden of anxiety and depression among women in Zambia: Spatial inequalities and implications for the sustainable development goals.Global mental health (Cambridge, England) · 2026Article
- Hand Hygiene Knowledge, Attitudes, Practices, and Hand Dirtiness of Primary School Students Before and After a Behavioral Change Intervention During the COVID-19 Pandemic, Belize 2022-2023.The American journal of tropical medicine and hygiene · 2025Article
- Hand Hygiene Roles, Challenges, and Intervention Feedback from School Staff: A Qualitative Analysis, Belize, 2022-2023.International journal of environmental research and public health · 2025Article
- Coproduced, arts interventions for nurturing care (0-5 years) in low-income and middle-income countries (LMICs): a realist review.BMJ open · 2024Review
- Nongovernmental Organization Practitioners' Perspectives on the Challenges and Solutions to Changing Handwashing Behavior in Older Children: A Qualitative Study.Global health, science and practice · 2023Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWater, sanitation, and hygiene (WASH) interventions frequently assume that students who learn positive WASH behaviors will disseminate this information to their families. This is most prominent in school-based programs, which rely on students to act as "agents of change" to translate impact from school to home. However, there is little evidence to support or contradict this assumption.
methodsWe conducted a quasi-experimental, prospective cohort study in 12 schools in rural, southern Zambia to measure the impact of WASH UP!, a school-based WASH program designed by the creators of Sesame Street. WASH UP! is an educational program that uses stories and interactive games to teach students in grades 1-4 about healthy behaviors, such as washing hands and using the latrine. We completed in-person interviews with grade 1 and 4 students (N = 392 and 369, respectively), their teachers (N = 24) and caregivers (N = 729) using structured surveys containing both open- and closed-ended questions. We measured changes in knowledge and whether students reported sharing WASH-related messages learned in school with their caregivers at home.
resultsStudent knowledge increased significantly, but primarily among students in grade 1. Overall rates of students reporting that they shared messages from the curriculum with their caregivers rose from 7 to 23% (p < 0.001). Students in grade 4 were 5.2 times as likely as those in grade 1 to report sharing a WASH-related message with their caregivers (ARR = 5.2, 95% C.I. = (2.3, 8.9); p < 0.001).
conclusionsAlthough we measured only modest levels of student dissemination of WASH UP! messages from the school to the home, students in grade 4 showed significantly more promise as agents of change than those in grade 1. Future work should prioritize developing curricula that reflect the variability in needs, capabilities and support in the home and community among primary school students rather than a single approach for a wide range of ages and contexts.
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