Abstract
The United Nation’s Sustainable Development Goals include the target of ensuring access to water and sanitation and hygiene (WASH) for all; however, very few studies have assessed comprehensive school WASH service in Pakistan. The purpose of this study was to identify WASH services in primary schools of Pakistan, and to assess how recent WASH interventions and policies are associated with the school’s academic performance. A representative cross-sectional study was conducted in primary schools in the Sindh province of Pakistan. Structured observations and interviews were done to ascertain the schools’ WASH conditions. The primary exposures of interest were the implementation of previous WASH interventions and National WASH policy in the school and the WASH coverage. Outcomes of interest included WASH conditions and school performance. The structural equation modeling (SEM) using a bootstrap resampling procedure was employed to characterize how WASH exposures were associated with WASH conditions and school performance. Data were collected from 425 schools. The Basic WASH facilities coverage in the primary schools of Sindh remains overall low according to WHO WASH service ladder criteria. Also, inconsistency in all three inclusive domains of WASH (availability, accessibility, and functionality) facilities were found. The school performance was significantly associated (P<0.001) with the presence of WASH interventions and/or WASH policy, while WASH policy and/or recent WASH intervention at the school were not associated with overall water quality. Our assessment unveiled several WASH gaps that exist, including high heavy metal and fecal contamination. Adoption of national WASH policy and financing of evidence-based WASH interventions are recommended in primary schools to improve educational outcomes.
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Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Funding
The researchers want to acknowledge USAID for providing financial support through USPCASW Seed Grant Phase-II; Division of Public Health, University of Utah and Department of Community Health Sciences, University of Nevada, Reno, for providing technical support. Lastly, US-Pakistan Center for Advance Studies in Water, Mehran University of Engineering and Technology for providing platform to accomplish this research project.
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JA: conceptualization, investigation, original draft preparation, and funding acquisition. WLP: conceptualization, supervision, original draft preparation, and editing. YPC: contributed in result analysis and original draft preparation. MZIH: contributed in original draft preparation and editing NC: Data collection and original draft preparation.
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Ethical approval from the Institutional Review Board of Muhammad Medical College, Pakistan and University of Malaya, Malaysia, was obtained (approval number MMC/3236 and UM.TNC.2/UMREC respectively) prior to the commencement of the study. A permission letter from the provincial secretary education department was also obtained before data collection. Informed consent was taken from all the participants after explaining the purpose, nature, and procedures used in the study. The respondents were told that their participation in the study was voluntary and that their names or their school address will not be recorded. Moreover, participants were free to withdraw from the study at any time without explaining the reason for it. The respondents were also informed that compensation of any form would not be provided for taking part in the study. Confidentiality was ensured throughout the study period such as; during data collection, data analysis, and result dissemination. While recording the findings during data collection, a serial number was assigned, and no identifying information was collected.
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Appendix
Appendix
Algorithm (ALG) of water sanitation and hygiene indicators
Average concentration of heavy metals by source of water ith reference to WHO’s permissible limits
Average Concentration of total coliform bacteria in water samples
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Ahmed, ., Wong, L.P., Chua, Y.P. et al. Drinking water, sanitation, and hygiene (WASH) situation in primary schools of Pakistan: the impact of WASH-related interventions and policy on children school performance. Environ Sci Pollut Res 29, 1259–1277 (2022). https://doi.org/10.1007/s11356-021-15681-w
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DOI: https://doi.org/10.1007/s11356-021-15681-w