Overview of baseline data collection
As part of the hands4health project, a baseline data collection took place in primary schools in Nigeria between May 8th and June 20th, 2023. The exercise was carried out by the Terre des hommes (Tdh) and Swiss TPH teams.
The primary objective of the baseline data collection was to evaluate current handwashing practices and investigate the underlying factors that influence students’ handwashing behaviours. Furthermore, it aimed provide an essential benchmark to measure the impact of the hands4health intervention, by tracking the anticipated changes attributable to the project.
The baseline data collection covered the handwashing observation, hand rinse sample collection and interviews of targeted school children aged 10-12 years.
School selection
Prior to the beginning of the baseline data collection, Tdh Nigeria conducted a FACET survey in 50 public primary schools within Jere and MMC Borno state. These schools had been recommended by the Nigerian Ministry of Education for being in significant need of WASH services.
Of the 50 schools, 26 were selected to integrate the hands4health project. This selection was based on the FACET survey results, the security conditions in the study regions, and consultations with the ministry. The selection criteria included: (i) the school’s accessibility by the project teams; (ii) the absence of a functioning water source; and (iii) a student population of no more than 7’000. In the selected schools, 50 students aged between 10 and 12 years were randomly selected from one or two classes to participate in the baseline data collection.
The selected schools showcased diverse characteristics. Fourteen combined primary and secondary schools, while 12 were primary schools only. Regarding their geographic locations, 20 were situated in towns or cities, and the remaining 6 were village-based. When it came to water sources, only 7 schools were connected to the public water network. In contrast, 17 relied on solar boreholes or hand pumps, and 2 lacked a water source altogether. Water availability varied as well, with 11 schools having consistent water access, 11 having water access 3-5 days a week, and 4 experiencing water availability less than 2 days a week.
The project team will revisit the same 50 students for data collection at follow-up (one to two months post-intervention) and endline stages (12 months post-baseline).
Data collection tools
The tools used for the baseline data collection included: questionnaires, handwashing observations, hand rinse sampling, and a longitudinal approach for abseenteism and health outcomes, all targeting students in the selected schools.
RANAS questionnaire
Pupils were interviewed by Tdh staff and enumerators on RANAS (The Risks, Attitudes, Norms, Abilities and Self-regulation) questionnaire, to understand the individual behaviour of children towards handwashing, especially before eating and after visiting the toilet.
Handwashing observations
Three-hour structured handwashing observations were implemented by Tdh staff and trained data collectors (enumerators). The method comprised 15–20 minute drawing sessions with the targeted children, to ensure that the children’s hands became dirty with chalk. As a reward for the drawing activity, participants received snacks at the end. The task of the observers was to observe the children (without them noticing), identifying if and how well they washed their hands before eating.
Hand rinse sampling
Hand rinse samples were collected from childrens’ hands following the modified glove juice method, and analysed for the number of colony-forming units (CFUs) of E.coli and total coliforms.
Main results
Main results of the baseline data collection include:
- 640 RANAS behaviour change and well-being surveys;
- Structured observations on a total of 1300 students;
- 369 hand rinse samples.
Feedback from the school administration on the data collection activities was very positive. School administrations welcomed the hands4health project, emphasising the need for initiatives that can enhance WASH infrastructure and improve water access in schools.
Challenges
- Security concerns: certain schools were located in areas with greater security risks.
- Student attendance: the lack of water and food at schools negatively impacted student attendance.
- Water scarcity: observer allocation was sometimes challenging due to the total absence of water in some schools.
- Implementation difficulty: in certain schools, the large distances between toilets and water points complicated the observation process.
- Overcrowded schools: the high student density made it challenging to recognise all students during the three-hour observation period.
- Lack of adequate facilities: most schools lacked water points near toilets, and none had soap available. No designated handwashing stations were present, with students using scattered water points around the school yard for drinking or handwashing.
- Sanitation issues: toilets, typically in the form of holes in the ground, were often avoided by the students due to blockages or unsanitary conditions, leading to open defecation practices. This made observing handwashing after toilet use difficult.
Next steps
The Tdh Nigeria team has been installing the Gravit’eau handwashing stations and implementing the RANAS behaviour change activities with the target pupils in the 13 intervention schools.
Next steps include the kick-off of the follow-up and qualitative data collection process in October 2023, followed by the endline data collection, which is scheduled to be conducted between May and June 2024. The project team is currently analysing the baseline data, with the goal of publishing the results within the year 2024.