The status of water access, sanitation, and hygiene in schools: a cross sectional survey to identify capacities and assess coverage in Garoua, North Cameroon
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Abstract There has been an increasing global interest in understanding, documenting, and monitoring water, sanitation, and hygiene (WASH) services in schools. This study is the first to identify existing WASH-in-school capacities and understand the magnitude of the gaps in WASH coverage in schools in the Northern Cameroon. Using a cross-sectional design, relevant authorities of 176 schools in Garoua, were interviewed. The survey guide included core questions for monitoring WASH in schools from recommended guidelines. Eleven indicators-related variables were extracted from data to calculate the WASH-in-school indicators composite score. Eighteen schools (10.2%) didn’t have any existing drinking water supply infrastructure. Latrine facilities were existing in most of the included schools, the boy students-to-latrine ratio=77:1 and girl students-to-latrine ratio=76:1 remained very high compared to the WHO norms. Two-thirds of schools accessed all the three most basic WASH services. The WASH-in-schools indicators composite score ranged from 3-11, with a mean of 10.08±1.61 and private schools were more likely to have a high total score (p=0.014). The WASH-in-school composite score provides an assessment of the spatial dimensions of reduced access to water in schools, improper hygiene practices, and inadequate sanitation facilities. Such a score could be used to identify hotspots lacking WASH infrastructural facilities and strategize optimal interventions to reduce the incidence of WASH related diseases in schools.
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Methods Following the JMP guidelines, all schools with preprimary-level, primary-level, and secondary-level students were counted as preprimary, primary, and secondary schools respectively; meaning some schools could have been double-counted and the total number of schools might not necessarily correspond to the sum of the preprimary, primary and secondary schools in the study area. As a first step, an exhaustive list of schools obtained from local adminstrative authorities and using a cross-sectional design, invitations to participate in the study were sent to all the schools identified in the study area i.e., Garoua 1, Garoua 2, and Garoua 3 cities. The authorities of a total of 183 out of 270 schools, who gave consent to participate in the survey were consecutively included in the study. Survey instrument A semi-structured questionnaire was used and one-on-one face-to-face interviews were conducted in a private setting. The questionnaire included a first section providing basic school-related information: location of school, type of school ownership, education level of the school, number of students, and number of teachers. In the second section, indicators following international standards. The eleven indicators respectively addressed drinking water access (water source, improved water source, improved water source with water available), sanitation (toilets facilities, improved toilets, sex-separated improved toilets, usable improved toilets, sex-separate usable improved toilets), and hygiene practices (handwashing facilities, handwashing facilities with water available, handwashing facilities with water and soap available). Then, a set of questions was developed from those indicators and assembled into a survey guide for schools.