Improved water, Sanitation and Hygiene Facilities at School and their effect on educational achievement in basic level students in Nepal

Schools with Water, Sanitation, and Hygiene (WASH) facilities can contribute to the well-being and educational achievements of pupils. The study aims to assess whether introducing WASH facilities in schools influences the educational achievements of pupils in Nepal. This research utilized a controlled before-and-after study with a quantitative, causal-comparative design. The research was conducted among 768 respondents, split between 384 in the schools with improved WASH facilities and 384 in the schools without improved school group. This study applied a stratified random sampling design, and the data were collected using a face-to-face method and administered through the structured survey tool. School WASH facilities have a significant association with educational achievements. Similarly, gender, ethnicity, grade, score, subjective norms, and intention have also significant association with educational achievements as do religion, attitudes, and self-efficacy. Students from improved school WASH facilities are more likely to obtain higher educational achievement (crude Odds Ratio (cOR) = 2.77; 95% confidence intervals (CI): 2.06 to 3.72, p < 0.001), even after adjusting for attitude, subjective norms, self-efficacy, and intention (adjusted OR (aOR) = 2.70; 95% CI: 1.99 to 3.67, p < 0.001), than those who are from the unimproved schools, keeping all socio-demographic characteristics constant. The effect is approximately four times larger (aOR = 8.31; 95% CI: 5.08 to 13.59, p < 0.001) than that exhibited by the above model, after adjusting for all socio-covariates and theory-based variables. In conclusion, improving school WASH facilities may need additional school interventions to overcome low educational achievements among students.