{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:12:11Z","timestamp":1790745131723,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2014,7,24]],"date-time":"2014-07-24T00:00:00Z","timestamp":1406160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Improving school water, sanitation and hygiene (\n                      <jats:styled-content style=\"fixed-case\">WASH<\/jats:styled-content>\n                      ) conditions reduces pupil absence and illness. However, these benefits may depend on the conditions of the latrines and availability of consumables. We sought to determine whether a low\u2010cost, policy\u2010relevant, environmental\u2010level latrine cleaning intervention could improve latrine cleanliness, increase its use and reduce absenteeism.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a three\u2010arm, cluster\u2010randomized trial we assessed absence via periodical roll\u2010call among 17\u00a0564 pupils in 60 schools that had previously received\n                      <jats:styled-content style=\"fixed-case\">WASH<\/jats:styled-content>\n                      improvements as part of the\n                      <jats:styled-content style=\"fixed-case\">SWASH<\/jats:styled-content>\n                      + project. Latrine conditions and use were also assessed using structured observation. Latrine cleanliness increased significantly during the post\u2010intervention period among schools receiving the latrine cleaning package compared to controls, as did handwashing with soap. We found no difference in latrine use and absence across arms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The additive impact of cleaning may not have been strong enough to impact absence above and beyond reductions attributable to the original\n                      <jats:styled-content style=\"fixed-case\">WASH<\/jats:styled-content>\n                      infrastructure improvements and basic hygiene education the schools previously received. Improving latrine conditions is important for the dignity and well\u2010being of pupils, and investments and strategies are necessary to ensure that school toilets are clean and pupil\u2010friendly.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.12360","type":"journal-article","created":{"date-parts":[[2014,7,24]],"date-time":"2014-07-24T01:19:26Z","timestamp":1406164766000},"page":"1185-1197","source":"Crossref","is-referenced-by-count":55,"title":["Assessing the impact of a school\u2010based latrine cleaning and handwashing program on pupil absence in\n                    <scp>N<\/scp>\n                    yanza\n                    <scp>P<\/scp>\n                    rovince,\n                    <scp>K<\/scp>\n                    enya: a cluster\u2010randomized trial"],"prefix":"10.1111","volume":"19","author":[{"given":"Bethany A.","family":"Caruso","sequence":"first","affiliation":[{"name":"Department of Behavioral Sciences and Health 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