School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines

Sangalang, Stephanie O.; Lemence, Allen Lemuel G.; Ottong, Zheina J.; Valencia, John Cedrick; Olaguera, Mikaela; Canja, Rovin James F.; Mariano, Shyrill Mae F.; Prado, Nelissa O.; Ocaña, Roezel Mari Z.; Singson, Patricia Andrea A.; Cumagun, Ma. Lourdes; Liao, Janine; Anglo, Maria Vianca Jasmin C.; Borgemeister, Christian; Kistemann, Thomas

doi:10.1186/s12889-022-14398-w

Table 2 Effect of intervention on children’s hygiene-related health literacy and observed handwashing

From: School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines

Outcome	Study arm	Baseline		Endline		Effect of intervention (95% CI)	p-value
Binary outcomes*		n	%	n	%
Overall health literacy, passing score**	Control	73	93.6	80	98.8
	Low-intensity education	106	93.8	99	100	1.00 (0.97, 1.03)	0.97
	Medium-intensity education	307	88.7	287	95.4	1.05 (1.02, 1.08)	p < 0.01
	High-intensity education	189	92.2	173	96.1	1.03 (1.00, 1.06)	0.02
Overall knowledge about germs, passing score	Control	74	94.9	77	95.1
	Low-intensity education	105	92.9	98	99	1.04 (1.01, 1.07)	0.02
	Medium-intensity education	301	87	288	95.7	1.11 (1.08, 1.13)	p < 0.01
	High-intensity education	184	89.8	174	96.7	1.05 (1.03, 1.08)	p < 0.01
Overall knowledge about handwashing, passing score	Control	63	80.8	74	91.4
	Low-intensity education	98	86.7	97	98	0.98 (0.81, 1.20)	0.88
	Medium-intensity education	281	81.2	266	88.4	1.02 (0.87, 1.19)	0.81
	High-intensity education	171	83.4	160	88.9	0.98 (0.80, 1.20)	0.88
Washed hands after using toilet/urinal***	Control			18	23.7
	Low-intensity education			15	25.4	1.02 (0.80, 1.31)	0.84
	Medium-intensity education			15	14.2	3.18 (1.34, 7.55)	p < 0.01
	High-intensity education			40	37.8	3.89 (3.74, 4.05)	p < 0.01
Continuous outcomes****		Mean	±SD	Mean	±SD
Mean (± SD) overall health literacy score	Control	80.3	13.9	89.1	12.4
	Low-intensity education	86.6	13.3	95.7	7.6	-0.01 (-0.10, 0.08)	0.77
	Medium-intensity education	79.1	19	87	15.5	0.01 (-0.06, 0.08)	0.79
	High-intensity education	81.8	14.2	90.3	13.2	0.01 (-0.10, 0.11)	0.89
Mean (± SD) overall knowledge about germs score	Control	84.3	13.7	92.7	13.3
	Low-intensity education	90.5	15.1	97.4	7.2	-0.02 (-0.09, 0.04)	0.49
	Medium-intensity education	83.5	19.8	91.2	14.7	0.02 (-0.04, 0.07)	0.53
	High-intensity education	85	15.8	93.1	12.6	0.01 (-0.04, 0.06)	0.66
Mean (± SD) overall knowledge about handwashing score	Control	73.7	20.1	83.6	16.8
	Low-intensity education	79.9	17	92.9	15.6	0.02 (-0.14, 0.17)	0.84
	Medium-intensity education	72.3	22.6	80.6	20.8	-0.01 (-0.13, 0.11)	0.86
	High-intensity education	76.7	17.2	86	19.6	-0.005 (-0.30, 0.29)	0.98
Mean (± SD) handwashing practice score*****	Control			71.1	19.7
	Low-intensity education			49.3	10.3	-0.22 (-0.31, -0.13)	p < 0.01
	Medium-intensity education			50.7	12.8	-0.17 (-0.21, -0.13)	p < 0.01
	High-intensity education			36.5	16.3	-0.51 (-0.58, -0.44)	p < 0.01

CI = confidence interval. SD = standard deviation. The p-value refers to the difference in intervention effect between the respective intervention group (IG) and the control group (CG)
*We used a multilevel mixed-effects Poisson regression model to estimate intervention effects, which can be interpreted as the incidence-rate ratio (IRR) of a desired follow-up outcome between the respective IG and the CG. The model included the respective IG, random intercept for the city, and robust standard errors. We adjusted for the child’s sex, age, and desired outcome at baseline, and the parent/caregiver’s education level and socioeconomic status (SES)
**Passing score ≥ 60%
***We used a multilevel mixed-effects logistic regression model to estimate intervention effects expressed as the odds ratio (OR) of the prevalence at endline of the desired outcome between the respective IG and CG. The model included the respective IG, random intercept for the city, and robust standard errors. We adjusted for the child’s sex, attendance in primary school, the school’s maintenance and other operating expenses (MOOE) budget and handwashing basin-to-student ratio, and the availability of water in the school restroom
****We used a multilevel mixed-effects linear regression model to estimate intervention effects, which can be interpreted as the adjusted differences in the mean changes of the desired follow-up outcome between the respective IG and the CG. The model included the respective IG, random intercept for the city, and robust standard errors. We adjusted for the child’s sex, age, and desired outcome at baseline, and the parent/caregiver’s education level and SES
*****We used a multilevel mixed-effects linear regression model to estimate intervention effects, which can be interpreted as the adjusted differences at endline of the desired outcome between the respective IG and the CG. The model included the respective IG, random intercept for the city, and robust standard errors. We adjusted for the child’s sex, attendance in primary school, the school’s MOOE budget and handwashing basin-to-student ratio, and the availability of water in the school restroom

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