Understandings of the impacts of infrastructure placement like dams and weirs, and channelization, on flow and sediment regimes in rivers, have produced…
Gracie Hornsby is a PhD candidate and Knight-Hennessy Scholar in Civil & Environmental Engineering at Stanford University, U.S., and is working with local stakeholders in Uttar Pradesh, India, to enable children to practice good hand hygiene at school
As I walk through my day at Stanford University, I might encounter a table with morning pastries or a lunch event with excess food for students. While I can’t say my “hand washing before eating” record is perfect, I can certainly say my surrounding infrastructure never prevents me from washing my hands. Bathrooms with clean, running water and plenty of soap directly adjacent to clean, functional toilets abound on campus. I generally don’t pay much attention to the toilets or sinks I use because I simply expect that everything I need to practice good hand hygiene will be available to me at my school. The reality for government primary school students in Uttar Pradesh (UP), India couldn’t be more different. Toilets often become unusably dirty after installation and handwashing stations often lack running water or soap — basic necessities for good hand hygiene. I’ve spent much of 2022 in UP with teachers, headmasters, cleaners, government officials, and local implementers to co-create strategies to transform resource constrained schools into enabling environments for good hand hygiene.
The importance of children regularly washing their hands with soap can’t be overstated. Handwashing with soap is associated with reduced diarrheal disease in children under 5 years old, better child development outcomes, and reduced absenteeism from school. Despite this known importance, 818 million children (43 percent) still lacked a basic hygiene service at their school in 2019 (WHO/UNICEF JMP, 2021). The good news is that soap has been shown to be widely available. A 2017 review identified that availability of soap was almost universal across the 51 countries surveyed, but they also identified children from poorer or rural households as the most at-risk for preventable mortality.
So what might enable children practicing good hand hygiene?
To solve an intersectional problem, we should be testing intersectional solutions. In particular, we’re interested in testing how infrastructure and education may interact to enact and sustain behavior change in children. “Doing” is a critical part of learning. While describing good hand hygiene behaviors to students is an important component of cultivating these behaviors, students need to experience it for themselves. Students need to be able to put what they’re learning about hand hygiene into practice not just once, but repeatedly, to achieve lasting behavior change. This means students need functional hand hygiene facilities in their school, which can be challenging in resource constrained settings. Interviews with key stakeholders have informed a new preventative maintenance intervention for school water, sanitation, and hygiene (WASH) facilities involving a local 3rd party cleaning agency. This new intervention will be implemented alongside a play-based educational hand hygiene curriculum designed especially for primary school-aged children. Through this 4-armed cluster randomized controlled trial, we’ll test the hypothesis that an enabling environment is necessary for children to not just learn the importance of handwashing, but to begin and continue practicing good hand hygiene even after the end of the hand hygiene curriculum.
On this Global Handwashing Day, I’m more aware than ever of the importance and urgency of increasing and maintaining hygiene services in schools. Today I’m also encouraged by the array of people working to dismantle these barriers and ensure that the known benefits of handwashing are enjoyed by every student.