Impact of School-Led Total Sanitation Intervention on Hygiene and Sanitation Knowledge and Practices among Caregivers in Kenya: A Quasi-Experimental Study.

ABSTRACT Background Open defecation is a significant public health problem in Kenya, particularly in Baringo County, where 54% of households lack basic sanitation facilities. School-Led Total Sanitation (SLTS) leverages children as change agents to promote hygiene and sanitation behaviors at the household level. This study investigated the effect of SLTS intervention on hygiene and sanitation knowledge and practices among caregivers in this region. Methods A quasi-experimental design was carried out in Baringo county Kenya, comparing an intervention group receiving SLTS with a control group. The study recruited 220 participants per arm. Data on caregivers' hygiene and sanitation knowledge and practices were collected at baseline and endline. Results Caregivers in the intervention group showed significantly greater confidence in hygiene messages from children (80.5% vs. 56.8%; p < 0.001), improved knowledge of handwashing (49.1% vs. 37.3%; p=0.004) and safe fecal disposal (88.2% vs. 69.1%; p < 0.001). Handwashing practices improved significantly, including all recommended steps (21.8% vs. 5.0%; p < 0.001) and soap use (27.3% vs. 12.7%). Latrine use (88.2% vs. 74.1%; p < 0.001) and safe child feces disposal (79.5% vs. 67.3%; p=0.004) also increased. Conclusion The SLTS intervention significantly improved hygiene and sanitation knowledge and practices among caregivers in Baringo County. Leveraging schools and children as change agents, combined with community engagement, SLTS offers a promising approach to reducing open defecation and improving public health outcomes in resource-limited settings.