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A Survey of Water, Sanitation and Hygiene in Schools in the Caribbean Coast of Nicaragua: Findings, Lessons Learned, and Recommendations for Future Studies
Tania Jordanova1, Ryan Cronk1, Octavio Zeledon Medina2, Rinko Kinoshita2
1University of North Carolina-Chapel Hill, 2UNICEF Nicaragua
Background
Schools in rural areas of developing countries lack the resources to build, operate, and
maintain water, sanitation and hygiene (WaSH) infrastructure.
Lack of adequate WaSH facilities in schools can:
Increase health risks and spread of disease
Decrease a child’s ability to learn due to increased absence from class
Contribute to inequality in education of girls and boys
Nicaragua lacks basic, disaggregated data at the local level on WaSH in schools
To understand where investment is most needed to support WaSH in Schools, UNICEF
Nicaragua worked with government agencies to conduct a survey (Nov-Dec 2012)
Acknowledgments We would like to thank: Jessica Rocha and Connie Bushey (GRAAN), Nubia Ordóñez and Inés Hernádez (GRAAS), Oscar Aburto (Min.Education); Wanda Obando, Philippe Barragne-Bigot, Walter Gomez, and Jose Ramon Espinoza (UNICEF Nicaragua) ; Emma Chávez and Luciano Lucchesi (Consultants for UNICEF Nicaragua)
Methods and Data
Urban and Rural Discrepancies
Prioritize assistance to help schools meet the minimum national WaSH standards.
Address urban vs. rural inequalities in WaSH, through concentrated focus on aid and projects for rural areas.
Increase financial investment in maintenance and cleanliness of existing facilities. (gov. budget or school-level fundraising)
Require environmental health training for teachers and mobilize teachers with training to lead WaSH improvement projects.
Organize parents in areas which lack water infrastructure to fundraise, advocate for and participate in building a water system.
LOCATION: Northern and Southern Atlantic Autonomous Regions (RAAN and RAAS), Nicaragua
TOOL: A semi-structured survey with 102 questions was pretested and administered to the
directors of primary/secondary schools.
OBJECTIVE: (1) assess WaSH conditions in schools to identify areas of greatest need and (2)
analyze associations between variables to determine possible interventions and future studies.
RESPONSE RATE: 524 of 1,229 targeted schools (42.6%) responded to the questionnaire.
Individual questions had lower response rates.
SCHOOL CONTEXT AND TYPE: dispersed rural (53.4%), concentrated rural (29.2%), urban
(17.4% ). Primary and/or preschool (84.6%), secondary only (7.1%), all school levels (8.3%).
ANALYSIS: The majority of variables were categorical. Differences in proportions were analyzed
with Chi-sq. tests, using R Version 2.15.2.
Statistical Analysis Results
Water Sanitation
Hygiene
Sanitation Infrastructure at School
Student Per Toilet Ratio
Toilets Separated by Gender
Water Infrastructure at School
Water Transport Method to School
Water Treatment
Personal Hygiene Training
In Past 3 Years Frequency of Bathroom Cleaning
Drinking from a Shared Cup
Absence
No Absence Total
Proportion Absence*
No Water Infrastructure
74 26 100 74.0%
Water Infra. 95 64 159 59.7%
*Proportions significantly different at the p<0.01 level.
Teachers Involved
Not Involved Total
Proportion Involved*
Hygiene Training 67 67 134 50.0%
No Training 29 65 94 30.9%
*Proportions significantly different at the p<0.01 level.
Parents Involved
Not Involved Total
Proportion Involved*
None 16 7 23 69.5%
Carry 70 14 84 83.3%
Piped or Well
34 54 88 38.6%
*Proportions significantly different at the p<0.001 level.
Association Between: Parent Council Involvement in Water System Planning
and Maintenance and Type of Water Transport to
School [In Non-Urban Areas]
Association Between: Prolonged Student Absence from School Due to Sickness
(as estimated by directors) and Water Infrastructure at
School
Percentage of Children in Extreme Poverty
in Study Area Image of Latrines at a Nicaraguan School
Source: INIDE and UNICEF Nicaragua 2013 (measured by multi-dimentional
poverty indices)
Implement Personal Hygiene Program 57% of schools don’t have water infrastructure (n= 455)
26% of water infrastructure is broken (n= 196)
30% of schools require water to be carried from a distance (n= 455)
63% of school directors know the school water is treated (n= 202)
37% of schools don’t have sanitation infrastructure (n= 411)
28% of toilets are not used due to poor conditions or habits (n=261)
35% of schools had separate bathrooms for boys and girls (n= 368)
81% of schools don’t have sinks for hand washing (n= 463)
74% of schools don’t have soap for hand washing (n= 362)
41% of schools do not implement any type hygiene program (n= 413)
Percent of Schools with a Dedicated Budget
for Supplies, Maintenance
and Operations:
Water (n= 142): 6%
Sanitation (n= 270): 8%
Hygiene (n= 362): 1%
Association Between: Teacher Involvement in Water System Planning and
Maintenance and At Least One Type of Hygiene
Program at School
© UNICEF / NICARAGUA – 2012 / W. Obando
Cost and logistical constraints in remote rural areas.
Based on convenience sample (not random).
Missing values can mislead interpretation of proportions.
Lack of buy-in from some communities.
Use of self-reporting instead of trained interviewers.
Potential bias from school principals due to:
lack of knowledge and forgetfulness
misunderstanding of the question
desire to give a good impression
other unconscious personal biases
Recommendations for Interventions
Recommendations for Future Studies
To avoid response or reporting bias, future studies can take the following approaches:
Carefully define the questions and responses to eliminate as much subjectivity as possible
Verify responses through third-party observation (such as observation of hand washing practices)
Have trained and objective employees or volunteers collect data based on specific guidelines
Collect quantitative data (such as water quality samples)
Standardize Data Reporting: Require schools to track and regularly report standardized data. E.g.: each school should keep
accurate records of student absences and report numbers to the ministry of education monthly.
Deploy Rapid Surveys: Surveys with fewer questions and a smaller sample size are an alternative to long-format surveys and
can be used to study a specific research question in a smaller geographic area. Use innovative data collection techniques for geographically remote areas such as SMS/text messaging.
Recommendations
The percentage of schools with water infrastructure increases from 28%
to 68% when moving from dispersed rural to urban areas. This difference
is statistically significant (p-value: <0.001).
Association Between: Existence of Teachers’ Association and Teacher
Involvement in Water System Planning and
Maintenance [In Non-Urban Areas]
Teachers Involved
Not Involved Total
Proportion Involved*
Teacher Assoc.
39 23 62 62.9%
No Assoc. 36 84 120 30.0%
*Proportions significantly different at the p<0.001 level.
Association Between: Frequency of Latrine Cleaning and Personal Hygiene
Training at School in Past 3 Years
Hygiene Training No Training Total
Proportion w/ Training*
Daily 36 42 78 46.2%
Weekly 28 91 119 23.5%
Over a Week
10 36 46 21.7%
*Proportions significantly different at the p<0.01 level.
Limitations
Urban schools have a higher proportion of functioning water systems,
while rural schools have a higher proportion of carrying water from
outside of school. The differences are statistically significant (p-value:
<0.001).
The percentage of schools with water treatment increases from 50% to
83% when moving from dispersed rural to urban areas. This difference is
statistically significant (p-value: <0.001).
The percentage of schools with sanitation infrastructure increases from
56% to 79% when moving from dispersed rural to urban areas. This
difference is statistically significant (p-value: <0.001).
The percentage of schools with toilets separated by gender increases
from 24% to 49% when moving from dispersed rural to urban areas. This
difference is statistically significant (p-value: <0.001).
While not statistically significant, there is a strong pattern of higher
student per toilet ratios in more urbanized areas. [Median ratio is 55, 33,
and 24 for urban, concentrated, and dispersed rural respectively].
The percentage of schools with personal hygiene training increases from
22% to 54% when moving from dispersed rural to urban areas. This
difference is statistically significant (p-value: <0.001).
The percentage of schools with a personal hygiene program increases
from 35% to 65% when moving from dispersed rural to urban areas. This
difference is statistically significant (p-value: <0.001).
The percentage of schools where students drink from a shared cup
decreases from 48% to 34% when moving from dispersed rural to urban
areas. This difference is not statistically significant (p-value: 0.1648).
Urban schools have a higher proportion of daily latrine cleaning, while
rural schools have a higher proportion of weekly or less frequent cleaning.
The differences are statistically significant (p-value: <0.001).
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