Impact of a school-based water, sanitation and hygiene programme on children's independent handwashing and toothbrushing habits: a cluster-randomised trial

Int J Public Health. 2020 Dec;65(9):1699-1709. doi: 10.1007/s00038-020-01514-z. Epub 2020 Nov 3.


Objectives: To explore whether a school-based water, sanitation and hygiene programme, which includes group hygiene activities, contributes to the formation of independent handwashing and toothbrushing habits among Filipino children.

Methods: In this cluster-randomised trial, twenty primary schools were randomly allocated to the intervention or control arm. Intervention schools received group handwashing facilities and implemented daily group handwashing and toothbrushing activities. A soap use to toilet event ratio was calculated to measure children's independent handwashing behaviour after toilet use, and dental plaque accumulation on Monday morning was measured as a proxy indicator for children's independent toothbrushing behaviour at home.

Results: Four months after implementation, handwashing and toothbrushing behaviours did not significantly differ between intervention and control schools. The mean soap use in intervention schools and control schools was 0.41 g and 0.30 g per toilet event, respectively (p = 0.637). Compared to baseline, mean plaque scores reduced by 4.2% and 3.5% in intervention and control schools, respectively (p = 0.857).

Conclusions: Although health benefits have been established, school-based group handwashing and toothbrushing may not be sufficient to increase children's uptake of independent hygiene behaviours.

Keywords: Children; Habit formation; Handwashing; School programme; Toothbrushing.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Child
  • Female
  • Habits
  • Hand Disinfection / methods*
  • Health Promotion / organization & administration*
  • Humans
  • Male
  • Sanitation / methods*
  • School Health Services
  • Toothbrushing / methods*
  • Water Supply / methods*