The impact of an operation and management intervention on toilet usability in schools in the Philippines: a cluster randomised controlled trial
Abstract Background Access to usable water, sanitation and hygiene provision in schools is included within indicators in the Sustainable Development Goals. Progress towards these indicators is dependent on developing an understanding of which intervention components are most effective to operate and...
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doaj-d0c87ff90cb740378fc735a8eff1c15b2020-12-20T12:02:55ZengBMCBMC Public Health1471-24582019-12-0119111110.1186/s12889-019-7833-7The impact of an operation and management intervention on toilet usability in schools in the Philippines: a cluster randomised controlled trialHelen Buxton0Jed Dimaisip-Nabuab1Denise Duijster2Bella Monse3Habib Benzian4Robert Dreibelbis5Disease Control Department, London School of Hygiene and Tropical MedicineDepartment of Epidemiology and Biostatistics, College of Public Health, University of the PhilippinesDepartment of Social Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU UniversityRegional Fit for School Programme, Gesellschaft für Internationale Zusammenarbeit (GIZ)Department of Epidemiology and Health Promotion, WHO Collaborating Center for Quality Improvement and Evidence-based Dentistry, College of Dentistry & College of Global Public Health, New York UniversityDisease Control Department, London School of Hygiene and Tropical MedicineAbstract Background Access to usable water, sanitation and hygiene provision in schools is included within indicators in the Sustainable Development Goals. Progress towards these indicators is dependent on developing an understanding of which intervention components are most effective to operate and maintain usable services. This study aimed to determine the impact of a school toilet operation and management intervention in the Philippines on toilet usability and student and teacher satisfaction, adjusted for clustering at school level. Methods In a non-blinded cluster randomised controlled trial, we compared improvements in usability and cleanliness of school toilets among those schools receiving a low-cost, replicable intervention. Toilet usability was measured based on Sustainable Development Goal indicators related to school sanitation defined by the UNICEF/WHO Joint Monitoring Programme for Water, Sanitation and Hygiene. Intervention schools received consumables, support kits, and structured tools designed to facilitate operation and maintenance of sanitation facilities. The primary outcome, toilet usability and cleanliness, was compared through a difference-in-difference analysis of toilet usability. Secondary outcomes of student and teacher satisfaction were measured through a survey at endline. All outcomes were adjusted for clustering at school level. Results 20 eligible schools in the Batangas region of the Philippines were randomly selected and allocated to either control or intervention group. We found that non-classroom toilets were 48% more likely to meet quality benchmarks in intervention schools, but this was not statistically significant. When including in-classroom toilets in the analysis, there were no significant differences in toilet usability - defined as accessible, functional, private and of high quality – between intervention and control schools. When stratified by toilet location, children in the intervention group clusters expressed a minor, but statistically significant increase in overall satisfaction with sanitation facilities (p = 0.035). Conclusion Water, sanitation and hygiene interventions in schools focusing on operation and maintenance showed potential to improve toilet usability, but universal achievement of SDG targets may require additional efforts addressing toilet infrastructure. Trial registration ClinicalTrials.gov NCT03204175, June 2017 prior to participant enrolment.https://doi.org/10.1186/s12889-019-7833-7School sanitationOperation and managementJoint monitoring programme |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Helen Buxton Jed Dimaisip-Nabuab Denise Duijster Bella Monse Habib Benzian Robert Dreibelbis |
spellingShingle |
Helen Buxton Jed Dimaisip-Nabuab Denise Duijster Bella Monse Habib Benzian Robert Dreibelbis The impact of an operation and management intervention on toilet usability in schools in the Philippines: a cluster randomised controlled trial BMC Public Health School sanitation Operation and management Joint monitoring programme |
author_facet |
Helen Buxton Jed Dimaisip-Nabuab Denise Duijster Bella Monse Habib Benzian Robert Dreibelbis |
author_sort |
Helen Buxton |
title |
The impact of an operation and management intervention on toilet usability in schools in the Philippines: a cluster randomised controlled trial |
title_short |
The impact of an operation and management intervention on toilet usability in schools in the Philippines: a cluster randomised controlled trial |
title_full |
The impact of an operation and management intervention on toilet usability in schools in the Philippines: a cluster randomised controlled trial |
title_fullStr |
The impact of an operation and management intervention on toilet usability in schools in the Philippines: a cluster randomised controlled trial |
title_full_unstemmed |
The impact of an operation and management intervention on toilet usability in schools in the Philippines: a cluster randomised controlled trial |
title_sort |
impact of an operation and management intervention on toilet usability in schools in the philippines: a cluster randomised controlled trial |
publisher |
BMC |
series |
BMC Public Health |
issn |
1471-2458 |
publishDate |
2019-12-01 |
description |
Abstract Background Access to usable water, sanitation and hygiene provision in schools is included within indicators in the Sustainable Development Goals. Progress towards these indicators is dependent on developing an understanding of which intervention components are most effective to operate and maintain usable services. This study aimed to determine the impact of a school toilet operation and management intervention in the Philippines on toilet usability and student and teacher satisfaction, adjusted for clustering at school level. Methods In a non-blinded cluster randomised controlled trial, we compared improvements in usability and cleanliness of school toilets among those schools receiving a low-cost, replicable intervention. Toilet usability was measured based on Sustainable Development Goal indicators related to school sanitation defined by the UNICEF/WHO Joint Monitoring Programme for Water, Sanitation and Hygiene. Intervention schools received consumables, support kits, and structured tools designed to facilitate operation and maintenance of sanitation facilities. The primary outcome, toilet usability and cleanliness, was compared through a difference-in-difference analysis of toilet usability. Secondary outcomes of student and teacher satisfaction were measured through a survey at endline. All outcomes were adjusted for clustering at school level. Results 20 eligible schools in the Batangas region of the Philippines were randomly selected and allocated to either control or intervention group. We found that non-classroom toilets were 48% more likely to meet quality benchmarks in intervention schools, but this was not statistically significant. When including in-classroom toilets in the analysis, there were no significant differences in toilet usability - defined as accessible, functional, private and of high quality – between intervention and control schools. When stratified by toilet location, children in the intervention group clusters expressed a minor, but statistically significant increase in overall satisfaction with sanitation facilities (p = 0.035). Conclusion Water, sanitation and hygiene interventions in schools focusing on operation and maintenance showed potential to improve toilet usability, but universal achievement of SDG targets may require additional efforts addressing toilet infrastructure. Trial registration ClinicalTrials.gov NCT03204175, June 2017 prior to participant enrolment. |
topic |
School sanitation Operation and management Joint monitoring programme |
url |
https://doi.org/10.1186/s12889-019-7833-7 |
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