Garn Joshua V, Trinies Victoria, Toubkiss Jérémie, Freeman Matthew C
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Evaluation Office, The United Nations Children's Fund, New York, New York.
Am J Trop Med Hyg. 2017 Apr;96(4):984-993. doi: 10.4269/ajtmh.16-0558. Epub 2017 Jan 16.
AbstractStudies assessing the impacts of school-based water, sanitation, and hygiene (WASH) interventions have revealed inconsistent improvements in pupils' health and educational outcomes. This may be in part due to suboptimal project fidelity or adherence. As part of a matched-control trial of a comprehensive school-based WASH project in Mali, we measured the degree to which schools met four prespecified WASH targets, comprised of 15 criteria, 0-3 years after program implementation. We compared achievement of the targets and criteria between beneficiary and matched control schools, and compared achievement within beneficiary schools at baseline and at follow-up visits. We assessed the "as-treated" associations between WASH target achievement and pupil diarrhea, respiratory symptoms, and absence. Between 44% and 81% of beneficiary schools achieved each target. Although adherence was inconsistent across schools, beneficiary schools, on average, met more WASH targets than matched control schools, and beneficiary schools also met more WASH targets at follow-up than at baseline. Very few of the targets were individually associated with health and absenteeism outcomes. Increasing achievement of multiple WASH targets together was associated with a lower odds of pupils having diarrhea ( trend < 0.01) and having respiratory symptoms ( trend < 0.01), but was not associated with roll-call absence ( trend = 0.14) or pupil-reported absence ( trend = 0.41). These results indicate that a comprehensive WASH intervention and a focus on increasing adherence may help maximize the health effects of school WASH programs, but that WASH alone might not be sufficient to decrease pupils' absenteeism.
评估以学校为基础的水、环境卫生和个人卫生（WASH）干预措施影响的研究表明，学生的健康和教育成果改善情况并不一致。这可能部分归因于项目保真度或依从性欠佳。作为马里一项全面的以学校为基础的WASH项目配对对照试验的一部分，我们在项目实施后的0至3年，衡量了学校达到四个预先设定的WASH目标的程度，这些目标由15项标准组成。我们比较了受益学校和配对对照学校在目标和标准达成情况上的差异，并比较了受益学校在基线期和随访期的目标达成情况。我们评估了WASH目标达成情况与学生腹泻、呼吸道症状及缺勤之间的“实际治疗”关联。44%至81%的受益学校实现了每个目标。尽管各学校的依从情况不一致，但受益学校平均而言比配对对照学校达成了更多的WASH目标，且受益学校在随访期比在基线期也达成了更多的WASH目标。很少有目标单独与健康和缺勤结果相关。多个WASH目标达成情况的增加与学生腹泻几率降低（趋势<0.01）和呼吸道症状几率降低（趋势<0.01）相关，但与点名缺勤（趋势=0.14）或学生报告的缺勤（趋势=0.41）无关。这些结果表明，全面的WASH干预以及对提高依从性的关注可能有助于使学校WASH项目的健康效果最大化，但仅靠WASH可能不足以减少学生的缺勤情况。
