Water, sanitation, and hygiene (WASH) coverage and practices of children from five public primary schools in Guinea

The water, sanitation, and hygiene (WASH) coverage and practices in and out of primary schools play a vital role in affecting the health, education, and welfare of children, particularly in low-income nations. Inadequate WASH coverage and practices have significantly contributed to increasing disease burdens among the populations of less developed countries (Pruss et al. 2002; Fewtrell et al. 2005). Significant efforts and progress have been made in combating the diseases derived from inadequate access to safe WASH conditions (Gine-Garriga et al. 2017). However, diarrhea and other diseases such as cholera and typhus are still responsible for 10% of all childhood deaths on a global scale in 2010 (Liu et al. 2012). Particularly, school-age children are among the most vulnerable to such diseases in developing countries, with an estimated 2−3 million deaths annually from diarrhea-related diseases, many of which could be prevented by improving WASH coverage and practices (Thakadu et al. 2018). Water- and sanitation-related diseases kill approximately 10,000 Africans each day, with thousands more suffering from incapacitating illnesses (Armah et al. 2018). The improvement of WASH coverage and practices in primary schools can significantly improve the living standards of pupils and lead to better hygiene behavior throughout their lifetimes (Delea et al. 2019). Enhanced hygiene and personal sanitation practices are of great importance for minimizing the risks of increasing communicable diseases and improving public health (Thakadu et al. 2018). Nevertheless, millions of Africans still lack access to soap and clean water for handwashing, which otherwise would help prevent the spread of diseases (WHO & UN-Water 2014).

Guinea is ranked 32nd out of 56 African nations with respect to the Sustainable Development Goal (SDG) 6 targets for ensuring the global accessibility and sustainable management of water and sanitation (Nhamo et al. 2019). The country has often suffered from acute public health events associated with the lack of accessible public toilets (Collins et al. 2020). Consequently, fecal wastes were discharged directly to the water bodies. Notably, the disposal of children's feces is more likely to be a source of pollution than the household environment (WHO 2006).

This study presents an exploratory analysis of WASH coverage, including water supply and quality, waste management, sanitation, hygiene practices, and health education within five public primary schools in N'Zerekore, Guinea. The main objective of this practical paper is to correlate the WASH coverage and practices with the high incidence and prevalence of diseases in children and to inform the local governments on the need for school-level WASH interventions and continuous improvement in WASH coverage and practices to reduce the incidence of common illnesses among children.

A questionnaire (in French) was designed to cover the following sections: (i) general information about the institutions (6 questions), (ii) drinking water supply (10 questions), (iii) waste management (4 questions), (iv) sanitary conditions of toilets (9 questions), (v) personal health protection (18 questions), (vi) handwashing practice, and (vii) total sanitation situation of the school.

A mixed research approach (Pfadenhauer & Rehfuess 2015) was adopted in this study. The primary data were collected by a face-to-face questionnaire survey of 1,048 random students from grades 3 to 6 in these schools (Table 1). It is worth specifying that all students were capable of answering the questions on the questionnaire in the official language, i.e., French. Individual interviews with the headmasters and the teachers were also performed to verify the authenticity of the data from the pupils. Data collection was based on students' knowledge of hygiene practices, and handwashing situations at school and after school. Data were analyzed by using OriginLab Origin v9.0 software and Microsoft Excel 2010.

Ethical and scientific approval was obtained from the NUIST and the University of N'Zerekore Ethics and the Scientific Review Committee.

The sample numbers (n) are 179, 257, 142, 142, and 328 for MK, Mh, Gh, TL, and N'ZT, respectively. A total of 1,048 pupils (∼20% of the total enrollment) were sampled and interviewed. The detailed sampling information is listed in Table 1.

The most common drinking water sources in the selected schools originated from the on-campus boreholes by hand-pumping. Three primary schools (i.e., Mh, Gh, and N'ZT) used boreholes as their only drinking water source. The main problem associated with the boreholes, according to the school headmasters, was the frequent breakdown of the hand pumps. One of the five primary schools, i.e., MK, obtained drinking water from a local water company (i.e., SEG), who distributed the water to MK by water transporting vehicles once or twice a week. TL usually drew water from an unprotected dug well within the school and used it as drinking water.

Water quality surveys were also carried out in the five schools, and the results are given in Table 2. The percentages of the surveyed pupils who have no doubts about the water quality of the borehole or well water account for 88.8, 80.9, 62.7, and 62.5% for MK, Gh, TL, and N'ZT, respectively. Our survey indicates that the majority of these students who appreciated the water quality made their choices mainly in terms of the clarity of the water, i.e., if the water is clear, it was considered drinkable. However, most pupils (73.9%) in Mh claimed that they have no opinion because they used to bring their drinking water with portable bottles from a borehole near the school rather than the on-campus boreholes.

Waste management and sanitation situations in these schools were investigated by surveying and on-site inspection. In all five schools, there were many trash bins (TBs) sponsored by some local Non-Governmental Organizations (NGOs). Unfortunately, many pupils are used to depositing their trash anywhere (AW) in schools rather than discarding them into the provided bins (Table 2). Some pupils complained that there were no TBs in their classrooms, so they are used to discarding their trash everywhere.

Furthermore, our surveys of 1,048 pupils (Table 3) show that 100% of pupils were not used to washing their hands with soap after using the toilet, 87.9% were not accustomed to washing before eating, 90.8% were not conditioned to washing after eating, and 94.4% were not habituated to washing after playing. Most of the pupils were not likely to wash their hands at the critical moments for hand hygiene in schools mainly due to the scarcity of water and soap and the ignorance of the importance of hand hygiene in personal and health care. Thakadu et al. (2018) have conducted a similar study and found that poor water supply hindered washing hands, with 65.7% of students ‘always’ cleaning their hands if tap water is accessible, which is consistent with our findings. Furthermore, they also noted that even when sanitary facilities are always available there is no guarantee that students will use them for a variety of reasons, e.g., lack of awareness of hygiene, concerns about privacy, etc.

As shown in Table 3, it appears that the hand hygiene of the surveyed pupils at home (or after school) has significantly improved from that observed in school. Our data indicate that 99.7% of the participants washed their hands before eating, 81.7% after eating, 55.2% after playing, and 69.5% after defecating (Table 3). This improvement in hand hygiene at home is likely due to the fact that the accessibility to water is often better in most students' families than in schools, and that students tend to maintain good personal hygiene when water is available at home.

Due to overpopulation, lack of teachers, and probably inadequate primary schools in the region surveyed, all five primary schools were overcrowded with a total overloading rate of 143.6% (Table 1). As expected, overpopulation has led to extra intake in schools. (e.g., there was an excess of 940 students in N'ZT school), and also put undue pressure on the school WASH facilities. This situation appears to facilitate the transmission of diseases, particularly the spreading of infectious diseases as confirmed long ago by Garnett & Lewis (2007). The water access and quality varied from school to school, and only three schools, i.e., Mh, Gh, and N'ZT, can meet the SDG-6 standards to some degree for the safe management of the drinking water from the on-campus boreholes. However, they often experience severe water shortages in dry seasons when the wells dried up. Either the water accessibility or the water quality cannot meet the SDG-6 requirements in the cases of MK and TL. Besides, our data indicate that the waste management (e.g., access to the trash can, garbage collection, and disposal on campus), sanitation access (e.g., access to handwashing kits with soap and water, access to latrines with water, latrine maintenance, and fecal sludge management), and hygiene practices (e.g., handwashing before eating and after defecation, soap use) in schools were insufficiently implemented by the school administrators and/or operators (Tables 2 and 3), resulting in a higher incidence and prevalence of disease in children in all primary schools (Figure 2).

Many reports demonstrated that WASH interventions can reduce illness through improvements in drinking water, sanitation facilities, and hygiene practices in less developed countries (Stocks et al. 2014; Wolfe et al. 2018). Our data indicate that the illnesses found in the children from all five primary schools include cholera, diarrhea, eye diseases, fever, headache, malaria, skin diseases, and typhoid (Figure 2). All of these illnesses can be reduced or eliminated by appropriate WASH interventions. According to Jones et al. (2020), the five general WASH interventions e.g., water treatment, water source/supply, sanitation, hand hygiene, and water storage, can reduce the risk of cholera transmission.

Different interventions may play different or similar roles to reduce the odds of some diseases, and multiple interventions would likely be more efficient than a single one. However, for a specific condition, e.g., diarrhea, it has been demonstrated that water quality interventions such as point-of-use water treatment would be more efficient than multiple WASH interventions (Fewtrell et al. 2005). Therefore, it is essential and urgent to conduct a WASH intervention trial in these primary schools focusing on which intervention would be the most efficient for lowering the odds of the most common illnesses in children. A detailed WASH strategy should be developed for each primary school based on their specific survey results. In terms of our survey, improving the water source and quality and providing the essential excreta disposal facilities are likely to be among the most efficient interventions for controlling waterborne diseases among children. Nevertheless, maintaining the WASH facilities, raising awareness, and sustaining practices of children remain challenges, which must also be properly addressed in the long run.

Basic sanitary services, such as running tap water and handwashing soaps, are required in a learning institution to protect students and staff from disease. Students have the right to learn in safe places with appropriate WASH facilities. However, the WASH coverage in five Guinean primary public schools was deplorable, significantly contributing to their high incidence and prevalence of diseases in children. Consequently, school-level WASH intervention trials are needed to elucidate what package of specific interventions will maximize the health benefits to each school and to ensure the most efficient use of limited resources. Constructive policies must be initiated and enacted at all levels, from the national to the district, and from the community to the school, to encourage and facilitate efficient WASH coverage and practices in schools. Besides, the local WASH sector and the global WASH professionals should work together to find long-term solutions that leave behind the challenge of WASH facilities maintenance and sustainable practices.

Data cannot be made publicly available; readers should contact the corresponding author for details.

The authors declare there is no conflict.