Enhancing a safe water intervention with student-created visual aids to promote handwashing behavior in Kenyan...

The Nyando Integrated Child Health Education (NICHE) project was a collaborative effort by the U.S. Centers for Disease Control and local partners to assess the effectiveness of multiple interventions for improving child survival in western Kenya. To increase handwashing in schools, NICHE trained teachers and installed handwashing stations with treated water and soap in 51 primary schools. This cluster-randomized trial evaluated an additional educational strategy (a poster contest themed, "Handwashing with Soap") to improve handwashing behavior in 23 NICHE primary schools. Pupils were engaged in the poster development. Pupil handwashing behavior was observed unobtrusively at baseline and after four months. Intervention schools displayed a significant increase in the number of handwashing stations and proportion of teacher-supervised stations over the study period. No significant between-group differences of intervention in handwashing frequency, soap availability, or visibility of handwashing stations was observed. Despite finding a limited effect beyond the NICHE intervention, the trial appeared to promote sustainability across some measures.