Update by William Oswald. William recently completed his PhD in Epidemiology at Emory University, Atlanta, USA. He visited the TUMIKIA project in June to support the study’s activities. In this entry, he shares some preliminary observations made on primary school water, sanitation, and hygiene conditions in Kwale County.
Coverage with improved sanitation in Kenya is currently estimated to be 30% (WHO/UNICEF 2014). Among the counties of Kenya, Kwale County on the southern coast has one of the lowest levels of coverage with improved household sanitation based on the most recent census (Government of Kenya 2009). This situation likely contributes to the high rates of soil-transmitted helminth (STH) infections, particularly hookworm, observed in this area. Beyond the household, school is another area of disease transmission for children. In addition to estimating the effect of community versus school-based deworming on STH transmission, the TUMIKIA project aims to measure the relationships between water, sanitation, and hygiene (WASH) conditions in schools and homes with the occurrence of these parasitic infections.
To assess the WASH conditions within primary schools and early child development (ECD) centres, a survey of schools across the county was conducted. The survey activities included detailed observations of schools’ water sources and sanitation and hygiene infrastructure. I accompanied survey teams to several schools and ECD centres around the county. My previous work has focused primarily on household WASH conditions, so I was very interested to see conditions in schools firsthand.
The schools visited ranged from small schools located several kilometres away from main roads to large schools located closer to towns with several hundred pupils. In almost all of the schools I visited there was an inadequate number of latrines available or usable to meet the needs of boys and girls. The lack of sufficient latrines to meet the needs of students was often immediately apparent. One head teacher explained, that “when pressed” and unable to enter a latrine, children may defecate around the latrine. The conditions within some of the latrines - dark, smelly, or fly-ridden - may also dissuade young children from using them. In schools with very low latrine access, evidence of regular open defecation behind nearby walls and bushes was observable.
Facilities for washing hands near latrines were rarely available among the schools visited. Where schools had access to water from a piped or rainwater tank, children were observed to wash using these sources and may have been able to wash their hands after using the toilet. These taps were often not located near the latrines, however, and this proximity is an important cue for prompting handwashing at critical times, such as after defecation. Soap was not observed to be available for handwashing at any of the schools visited. School water points that could have been used for handwashing, when available, were not necessarily made accessible to children out of concern that the children would break the hardware.
Materials, like toilet paper or water, were not always available for children to clean themselves after defecation, leading to hand contamination, and in some latrines it was clear that soiled hands had been wiped on latrine walls. Hand contamination with feces in conjunction with inadequate or nonexistent facilities for handwashing could contribute to transmission of STH infections and other diseases among these children.
Past efforts to improve latrine access and hygiene facilities were apparent, particularly at the larger schools, but these had often not matched the need or were hampered by other factors. Schools often had multiple latrine blocks of different ages and conditions. Because latrines filled or deteriorated over time, they may have been replaced, but such replacements did not increase the number of latrines per pupil. Provision of sanitation infrastructure was further challenged by theft. At one school an array of new plastic, mobile latrines had their doors ripped off, so they were only usable as urinals by boys. Locking hardware and wooden doors, both key to privacy and girls’ usage of latrines, appeared to be prime targets for theft. Environmental conditions were another threat to sustained latrine access. Many of the soils found in this area were reportedly prone to collapse, and collapse of pit walls was observed to be a threat to both old and new latrines. At one school, where the only available latrine’s pit was thought to be unstable, teachers discouraged children from entering the latrine, which further limited their access to a sanitation facility.
Further insight on school WASH conditions will be made through analyses of the full survey results. Although based on a limited number of schools, these preliminary observations concur with those of a study on school WASH conditions from another area of Kenya (Alexander et al. 2014). Additional efforts are needed to improve WASH conditions in primary schools in Kwale County to ensure that children there have a clean and disease-free place in which to learn.
Example of a primary school latrine block from Kwale County, Kenya:
Evidence of open defecation by children “pressed” and unable or unwilling to enter a latrine in Kwale County, Kenya:
Evidence of open defecation behind a low wall at a primary school with limited access to latrines in Kwale County, Kenya:
Rainwater collection tank at a primary school with the tap covered with large stones reportedly to prevent breakage by children in Kwale County, Kenya:
Interior walls of a primary school latrine with streaks from the cleaning of hands by children after defecation in Kwale County, Kenya:
Newly constructed latrine block at a primary school in Kwale County collapsed two days after completion due to poor soil stability of the latrine’s pit:
Alexander KT et al. 2014. Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls? Water, 6: 1453-1466.
WHO/UNICEF. 2014. Progress on drinking water and sanitation - 2014 update. World Health Organization: Geneva, Switzerland.