Global Health, Department of Global Public Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
Department of Pediatrics, R. D. Gardi Medical College, Ujjain, 456006, India.
BMC Public Health. 2021 Dec 11;21(1):2258. doi: 10.1186/s12889-021-12279-2.
Globally, diarrhea is one of the major causes of under-5 mortality. India accounts for the highest number of childhood deaths from diarrhea globally. Therefore, facilitating the implementation of water, sanitation, and hygiene (WASH)-related interventions in schools and communities is crucial. In the present study, we investigated the effectiveness of a school-based educational WASH intervention in improving students' knowledge on prevention and management of diarrhea in Ujjain district, India.
The present pre-post intervention study with a two-stage (schools and classrooms) cluster sampling was conducted on 1,781 students studying in grades: 8-12 age: 14-19 years) in schools located in Ujjain, Madhya Pradesh, India. The intervention comprised an educational training session using a WASH training module. The means of pre- and post-intervention scores were compared using repeated measure analysis of variance. A multivariate quantile regression model was used to test the correlation between the change in score after intervention and the independent variables. A P value of <0.05 was considered statistically significant.
The proportions of students possessing knowledge on the treatment of diarrhea, use of zinc tablets during an episode of diarrhea, and the symptoms and signs of severe pediatric diarrhea were 28%, 27%, and 27%, respectively, before intervention. These proportions increased (P<0.001) after the educational intervention to 72%, 73%, and 74%, respectively. The mean post-intervention knowledge score (34.13) was higher than the mean pre-intervention score (15.17) (F = 16513.36, P< 0.001). Age was associated with the knowledge score at the 25 and higher quantile (q). Gender exhibited a greater effect at q10. School location was positively associated at q25 and higher. School type was strongly associated at low quantiles (q10 and q25). School medium exhibited a greater association at low quantiles (≤q25).
WASH- and diarrhea-related knowledge among higher secondary school students increased after the educational intervention. Further research is required to evaluate the sociodemographic characteristics associated with change in the knowledge score to better evaluate school-based educational WASH interventions and improve the management and prevention of diarrhea.
在全球范围内，腹泻是导致 5 岁以下儿童死亡的主要原因之一。印度是全球儿童因腹泻导致死亡人数最多的国家。因此，促进学校和社区开展水、环境卫生和个人卫生（WASH）相关干预措施至关重要。本研究旨在调查在印度乌贾因地区开展以学校为基础的教育 WASH 干预措施对改善学生预防和管理腹泻知识的效果。
本研究为一项在印度中央邦乌贾因开展的、基于预-后干预的两阶段（学校和教室）聚类抽样研究，共纳入了 1781 名 8-12 年级（年龄 14-19 岁）的学生。干预措施包括使用 WASH 培训模块进行教育培训。采用重复测量方差分析比较干预前后的得分均值。采用多元分位数回归模型检验干预后得分变化与自变量之间的相关性。P 值＜0.05 为统计学显著差异。
干预前，学生中对腹泻治疗、腹泻发作时使用锌片、小儿严重腹泻症状和体征的知晓率分别为 28%、27%和 27%。经教育干预后，这些比例分别增加至 72%、73%和 74%（P＜0.001）。干预后知识得分的均值（34.13）高于干预前的均值（15.17）（F=16513.36，P＜0.001）。年龄与第 25 和更高分位数（q）的知识得分相关。性别在 q10 处的影响更大。学校位置与 q25 及更高分位呈正相关。学校类型与低分位（q10 和 q25）强相关。学校中等与低分位（≤q25）相关性更强。
在开展教育干预后，中学生的 WASH 和腹泻相关知识有所增加。需要进一步研究以评估与知识得分变化相关的社会人口学特征，以便更好地评估以学校为基础的教育 WASH 干预措施，并改善腹泻的管理和预防。
