The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC 27599, United States; ICF, 2635 Meridian Pkwy Suite 200, Durham, NC 27713, United States.
The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC 27599, United States.
Sci Total Environ. 2021 Mar 20;761:144226. doi: 10.1016/j.scitotenv.2020.144226. Epub 2020 Dec 4.
Improving access to water, sanitation, and hygiene (WaSH) and menstrual hygiene management (MHM) in schools is important to achieve Sustainable Development Goals (SDGs) 3 and 6. Inadequate WaSH and MHM in schools adversely affect student health and educational performance, as well as teacher satisfaction. However, there is little evidence describing factors associated with WaSH services and MHM in schools. We conducted 2690 surveys and collected 1946 water samples at randomly selected schools in rural areas of 14 low- and middle-income countries (LMICs). We developed multilevel mixed-effects logistic regression models to identify factors associated with basic water services, water quality, basic sanitation facilities, basic handwashing facilities, and availability of MHM materials. We found that 51% of schools had at least a basic, on-premises water service. Twenty-eight percent of schools had at least basic sanitation services, 12% had at least a basic handwashing facility, and 26% had MHM materials available. Four percent of schools had all basic WaSH services. Half (52%) of schools had drinking water compliant with the WHO guideline value for E. coli. In regression models, we found that schools that did not share their water point with a community, had a parent-teacher association that supported WaSH, or had support from an external WaSH program were more likely to have access to basic, continuous, on-premises water service versus worse access. Schools with an on-premises water point, water available on the day of survey, a health club, or handwashing stations near toilets were more likely to have a basic sanitation service versus a lower service. Schools with limited or basic sanitation, health clubs, an MHM curriculum, a designated MHM focal person, or school funds for WaSH were more likely to have MHM materials. We conclude that improved institutional management and external support, accountability mechanisms, and enhanced training and hygiene curriculum will support sustained WaSH service delivery in schools in LMICs.
改善学校供水、环境卫生和个人卫生（WASH）以及经期卫生管理（MHM）服务对于实现可持续发展目标 3 和 6 至关重要。学校内 WASH 服务和 MHM 服务不足会对学生的健康和学习成绩以及教师的满意度产生不利影响。然而，目前几乎没有证据描述与学校 WASH 服务和 MHM 相关的因素。我们在 14 个中低收入国家（LMICs）的农村地区随机选择学校进行了 2690 项调查并采集了 1946 个水样。我们开发了多水平混合效应逻辑回归模型，以确定与基本供水服务、水质、基本卫生设施、基本洗手设施以及 MHM 材料供应相关的因素。我们发现，51%的学校至少有一项基本的、校内供水服务。28%的学校至少有基本的卫生服务，12%的学校至少有基本的洗手设施，26%的学校有 MHM 材料供应。有 4%的学校拥有所有基本的 WASH 服务。有一半（52%）的学校饮用水符合世界卫生组织（WHO）对大肠杆菌的指导值。在回归模型中，我们发现那些没有与社区共享供水点、有支持 WASH 的家长教师协会或得到外部 WASH 项目支持的学校，更有可能获得基本的、持续的、校内供水服务，而不是较差的服务。有校内供水点、调查当天有水供应、有健康俱乐部或厕所附近有洗手站的学校更有可能提供基本的卫生服务，而不是较差的服务。有基本或有限的卫生设施、健康俱乐部、MHM 课程、指定的 MHM 协调人或学校用于 WASH 的资金的学校更有可能提供 MHM 材料。我们的结论是，加强机构管理和外部支持、问责机制以及加强培训和卫生课程，将有助于在 LMIC 中持续提供学校 WASH 服务。
