Kenya – Survey of school hygiene in Nairobi's informal settlements

Source: Africa Population and Health Research Working Paper 42, 2008: Determining Appropriate Entry Point for Health Promoting Schools Intervention in Nairobi’s Informal Settlements. Osnat Keidar, Elliot M. Berry, Alex C. Ezeh, Milka Donchin.

“89% of the students do not use soap when washing hands in school and about 40% do not wash hands when out of school, hence the need for an intervention focusing on personal hygiene and healthy nutrition in their schools.”Before enrolling their children to a particular school, parents usually have to consider a number of factors. Quality of education and a school environment that assure the health and safety of the children are normally top on the list.

However, parents in Nairobi slums do not have the luxury of choosing schools based on such considerations. Instead they have to scramble for the little space available in the few schools that serve these communities, regardless of the environment. Out of a desperate need, many children from the slum communities are enrolled in schools where infrastructure is wanting and where poor sanitary and hygiene conditions pose a major health threat. A recent study by Osnat Keidar, Elliot M. Berry, Alex Ezeh and Milka Donchin ttled, “Determining appropriate entry point for health promoting schools intervention in Nairobi’s informal settlements” identified characteristics of school environment that could affect children’s health and academic performance in Korogocho and Viwandani slums of Nairobi, Kenya where APHRC conducts a continuous survey.

Twenty-two primary schools, in these two communities participated in the study. Only three schools reported that they occasionally provide soap for washing hands, a fact that could not be verified because the soap was not available in the three schools during the research visits. When assessing the toilet facilities, the study found that while the recommended ratio of the number of students per toilet is 1:25 for girls and 1:30 for boys, in these schools the ratio was 1:84 for both boys and girls. The situation is aggravated by limited access to water, with about 270 children relying on one tap, against the recommended standard set by Kenya’s Ministry of Education (MoE) of 50 students per tap.

The aim of the study was to assess school health needs and identify an entry point for the implementation of a Health Promoting Schools (HPS) initiative. This is an initiative of the World Health Organization (WHO) that aims to improve the health of school communities and academic performance of students through a comprehensive program that uses a major health need as an entry point for intervention.During the assessment, headteachers as well as school teachers and over one thousand students from classes 5 and 6 were interviewed. Among the schools studied, 16 were informal schools (not run by the government), which were either private (individual owned) or community (community owned). The other six were formal (government) schools. Government schools were observed to have a healthier school profile than private and community informal schools. School health profile comprises of ‘school’s health policies, structure, environment, community involvement, health related programs and topics integrated into the curriculum and extra-curriculum activities.’This finding speaks to the poor infrastructure found in these informal schools, which because of their informal nature are not accountable to government and do not comply with the regulations and standards of operation set by the MoE. However, the existence of these schools is significant as they serve a crucial need in these communities. The teacher student ratio shows that the government schools are overwhelmed. The public schools register a high rate of 53.6 while non-formal schools register 33.9 (community-owned) and 26.5 (private-owned).

Looking at the students’ health behaviors, the researchers found that 89% of the students do not use soap when washing hands in school and about 40% do not wash hands when out of school. There is also a high percentage of students who do not eat breakfast before coming to school (35%) and an almost equally high percentage of students who hardly eat fruits and vegetables. As a result, all those interviewed, head-teachers, students and teachers, unanimously identified a need for an intervention focusing on personal hygiene and healthy nutrition in their schools. Given that children from the slums tend to suffer from common infections such as pneumonia and diarrhea, the study recommends that the Ministry of Education in Kenya and other development partners allocate resources for ‘upgrading infrastructure in informal and formal schools that serve the informal settlements (slums) to enable them meet the national water and sanitation standards.

’Diarrhea cases among students could drastically reduce by ensuring personal hygiene in schools through the provision of soap and training them on hand-washing. Healthy nutrition in such deprived settings can also be promoted through regular and sustainable school feeding programs. Training of teachers on health issues is an important way of promoting health in schools, as it builds the teachers’ capacity to implement programs and to pass the skills they have acquired to the students and community at large. However, teachers from all schools in the study generally reported insufficient level of training on health related issues.Following the study, a “health promoting schools” pilot intervention, informed by the study’s findings and using personal hygiene as an entry point, has been initiated in 11 schools in Korogocho.

“This pilot intervention will hopefully scale up at a later stage, and will not only turn all schools into a safe and healthy environment for our children to grow and learn, but will go a long way in ensuring higher academic achievements,” concludes Osnat Keidar, the lead researcher on the study. Osnat is a visiting scholar at APHRC and the study is part of her PhD dissertation program.